Abstract
Background: Transcranial low-level laser therapy (T-LLT) proved promising in acute stroke studies and in single traumatic brain injured subjects (TBI). It was assumed to increase cortical mitochondrial energy production and/or vasodilatation. Objective: Within this case series the potential of transcranial low-level laser therapy in improving the alertness and awareness in TBI subjects with severe disorders of consciousness will be investigated. Methods: Following a 21-day baseline, the forehead of five patients, four chronic in a state of unresponsive wakefulness or minimal consciousness, one subacute in the state of akinetic mutism, was stimulated with the T-LLT (785 nm, 10 mW/cm2, CW mode, 21 emitting diodes) for 10 min every workday for six weeks. Follow-up was four weeks after end of intervention. Primary variable was the revised version of the Coma Recovery Scale (r-CRS, 0-23), blindly assessed by an external reviewer with the help of videos. Results: The r-CRS, almost stable during baseline, improved in all patients during the intervention, from 3 to 12, 9 to 12, 8 to 12 and 5-12 in the chronic, and from 6 to 21 in the subacute patient. Follow-up revealed a sustained effect. The patient in the state of akinetic mutism improved her competence in the activities of daily living and mobility status. Single epileptic fits occurred in two patients during the intervention. Conclusion: T-LLT improved the patients’ alertness and awareness; epileptic fits were potential side effects. Sham-controlled studies including the quantitative assessment of awareness should follow the case series.
Highlights
Patients with severe disorders of consciousness (DOC) are a major challenge to the health care systems worldwide
DOCs can be clinically visualized on a functional continuum encompassing the level of vigilance and awareness
unresponsive wakefulness syndrome (UWS) patients show arousal signs objectified by sustained eye opening and the presence of reflex behavior only
Summary
Patients with severe disorders of consciousness (DOC) are a major challenge to the health care systems worldwide. The reported prevalence was 2-10 per 100,000 inhabitants, the major etiologies are traumatic and anoxic brain lesions [1]. DOCs can be clinically visualized on a functional continuum encompassing the level of vigilance and awareness. UWS patients show arousal signs objectified by sustained eye opening and the presence of reflex behavior only. The MCS patients show first signs of awareness recovery, for instance by the visual pursuit of moving stimuli in the front of the patients’ eyes or following simple verbal commands [3]. Transcranial low-level laser therapy (T-LLT) proved promising in acute stroke studies and in single traumatic brain injured subjects (TBI). It was assumed to increase cortical mitochondrial energy production and/or vasodilatation
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