Abstract
Background: Navigated repetitive transcranial magnetic stimulation (rTMS) is a promising tool for neuromodulation. In previous studies it has been shown that the activity of the default mode network (DMN) areas, particularly of its key region—the angular gyrus—is positively correlated with the level of consciousness. Our study aimed to explore the effect of rTMS of the angular gyrus as a new approach for disorders of consciousness (DOC) treatment; Methods: A 10-session 2-week high-frequency rTMS protocol was delivered over the left angular gyrus in 38 DOC patients with repeated neurobehavioral assessments obtained at baseline and in 2 days after the stimulation course was complete; Results: 20 Hz-rTMS over left angular gyrus improved the coma recovery scale revised (CRS-R) total score in minimally conscious state (MCS) patients. We observed no effects in vegetative state (VS) patients; and Conclusions: The left angular gyrus is likely to be effective target for rTMS in patients with present signs of consciousness.
Highlights
Some patients who have survived prolonged coma after severe brain damage and regained wakefulness develop disorders of consciousness (DOC)
We suggest left angular gyrus as a target for TMS due to its significant relations to other regions of the brain involved in a number of processes such as language, number processing and spatial cognition, memory retrieval and attention (Brodmann area 39)
To minimize the probability of confounding effect by spontaneous recovery, we excluded anoxic patients less than three months post-incident and traumatic brain injury (TBI) patients at less than 12 months since insult
Summary
Some patients who have survived prolonged coma after severe brain damage and regained wakefulness develop disorders of consciousness (DOC). Depending on the presence of observable signs of consciousness, these states can be divided into the vegetative state (VS, called the unresponsiveness wakefulness syndrome, UWS) and the minimally conscious state (MCS). Nowadays non-invasive brain stimulation methods (NIBS), such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), prove themselves as promising tools. Our study aimed to explore the effect of rTMS of the angular gyrus as a new approach for disorders of consciousness (DOC) treatment; Methods: A 10-session 2-week high-frequency rTMS protocol was delivered over the left angular gyrus in 38 DOC patients with repeated neurobehavioral assessments obtained at baseline and in 2 days after the stimulation course was complete; Results: 20 Hz-rTMS over left angular gyrus improved the coma recovery scale revised (CRS-R) total score in minimally conscious state (MCS) patients. We observed no effects in vegetative state (VS) patients; and Conclusions: The left angular gyrus is likely to be effective target for rTMS in patients with present signs of consciousness.
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