Poster 1 Safety and Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) for Two Persons in Vegetative State

Abstract

Demonstrate safety and efficacy of repetitive transcranial magnetic stimulation (rTMS) for severe traumatic brain injury (TBI). Baseline-Control Pilot. Medical research unit. Two men in vegetative state for 287 and 188 days. Poor recovery likelihood indicated by low odds (27% ; 45%) for regaining consciousness and unresponsiveness to somatosensory evoked potentials (SSEP). rTMS subjects are compared with controls (n = 22) admitted to rehabilitation an average of 54 days after TBI. 30 rTMS sessions without neurostimulants. For both groups, neurobehavioral functioning measured for six weeks with the Disorders of Consciousness Scale (DOCS). For rTMS, functional imaging, diffusion tensor imaging (DTI), functional connectivity, brainstem auditory evoked potentials, SSEP and safety data collected at least weekly. No adverse events. rTMS # 1 progressed from non-responsive to inconsistent command following and answering yes/no questions (DOCS gain = 15.2). rTMS # 2 progressed from non-responsive to consistent communication in sentences (DOCS gain= 9.7). rTMS subjects achieved greater DOCS gains than average control gains (9.2). Region of interest, functional connectivity and DTI findings indicate that rTMS neurobeahvioral gains related to increasing number and strength of significantly (p = 0.001) correlated regions and between the Brainstem, Thalamus, Wernicke's and Heschl's. Patterns corresponding with more function (#2), relative to less (#1), include increasing strength of some correlations simultaneous with decreasing strength of others s (e. g. midbrain to thalamus) and bilateral rather than only ipsilateral changes. DOCS gains during rTMS exceed controls' gains and correspond with changes in brainstem-thalamo-cortical connections.