Abstract
ABSTRACTPrimary Objective: Patients with disorders of consciousness (DOC) face a lack of treatments and risk of misdiagnosis, potentially due to motor impairment. Transcranial direct current stimulation (tDCS) showed promising results over the prefrontal cortex in DOC and over the primary motor cortex (M1) in stroke. Tis pilot study aimed at evaluating the behavioral effects of M1 tDCS in patients with DOC.Research Design: In this randomized double-blind sham-controlled crossover trial, we included 10 patients (49 ± 22 years, 7 ± 13 months since injury, 4 unresponsive wakefulness syndrome, 6 minimally conscious state, 5 traumatic etiologies).Methods and Procedures: One session of tDCS (2 mA for 20 min) and one session of sham tDCS were applied over M1 in a randomized order with a washout period of minimum 24 h and behavioral effects were assessed using the CRS-R. At the group level, no treatment effect was identified on the total score (p = .55) and on the motor subscale (p = .75). Two patients responded to tDCS by showing a new sign of consciousness (visual pursuit and object localization).Conclusions: One session of M1 tDCS failed to improve behavioral responsiveness in patients with DOC. Other application strategies should be tested.
Highlights
Patients with disorders of consciousness (DOC) following severe brain damage represent a challenging population regarding diagnosis and treatment
During transcranial direct current stimulation (tDCS), the current was increased to 2 mA and applied for 20 minutes while for the sham condition, the same electrode placement was used but the current was applied for 5 seconds and ramped down
We looked at each Coma Recovery Scale – Revised (CRS-R) subscale separately using the method described above
Summary
Patients with disorders of consciousness (DOC) following severe brain damage represent a challenging population regarding diagnosis and treatment. The gold standard for assessing the level of consciousness is the Coma Recovery Scale – Revised (CRS-R), that relies on behaviors observed at bedside in response to external stimuli [1] It allows to disentangle an unresponsive wakefulness syndrome/vegetative state The high dependency on motor abilities represent an ee issue for a proportion of clinically unresponsive patients showing partial preservation of cortical activity on neuroimaging and/or neurophysiological assessments [4]. This specific situation, coined MCS*, cognitive-motor dissociation or covert consciousness characterizes ev patients unable to display responses at bedside despite being conscious [4,5,6]. Identification as a pilot or feasibility randomised trial in the title Structured summary of pilot trial design, methods, results, and conclusions (for specific guidance see CONSORT abstract extension for pilot trials) Title page
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