Behavioral and Neurophysiological Effects of Repetitive Transcranial Magnetic Stimulation on the Minimally Conscious State

Abstract

These results suggest that rTMS may improve awareness and arousal in MCS. If these results are reproducible, rTMS may identify subgroups of MCS patients who might benefit from DBS.

Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation on Cerebral Hemodynamics in Patients with Disorders of Consciousness: A Sham-Controlled Study

“…However, few case reports have addressed the application of rTMS in patients with DOC. A single session of 20-Hz rTMS to the M1 of a patient with MCS led to transient increases in meaningful behaviors [6] , and Louise-Bender Pape et al [24] reported a non-significant trend toward behavioral improvements in a patient with post-traumatic VS who underwent patterned high-frequency rTMS to the right dorsolateral prefrontal cortex. On the other hand, a combination of rTMS and electroencephalography did not produce any evidence of the therapeutic effects of 20-Hz rTMS to the M1 of a patient with chronic VS [8] .…”

“…High-frequency rTMS enhances the excitability of the stimulated hemisphere, while low-frequency rTMS can suppress it [4,5] . Recently, Piccione et al [6] reported that rTMS may improve awareness and arousal in patients in an MCS following the application of 20-Hz stimulation to the primary motor cortex (M1). However, using the same rTMS paradigm, Manganotti et al [7] did not observe any significant clinical or electroencephalographic modifications in 3 patients in a VS or 2 patients in an MCS in an uncontrolled study.…”

Electrical modulation of neuronal networks in brain-injured patients with disorders of consciousness: A systematic review

“…RSM and/or hyperbaric oxygen was also performed in a series of 41 brain-injured patients (25 trauma, 11 stroke and 5 hypoxia) after discharge from the intensive care unit [59]: combined rMNS plus hyperbaric oxygen was more likely to increase cerebral perfusion and improve Glasgow coma score in stroke and hypoxia patients whereas trauma patients were more likely to benefit from rMNS only. A case study testing repetitive transcranial magnetic stimulation (rTMS) against rMNS found that rTMS could be more efficient [60].…”

Assessment and Intervention with Patients with Severe Disorders of Consciousness

“…While general support is available for this approach, the studies assessing its impact with patients with disorders of consciousness seem to suggest some caution. For example, Pape et al (2009), Piccione et al (2011), and Manganotti et al (2013 reported differing results as to the effectiveness of repeated TMS in fostering the patients' arousal and awareness. Angelakis et al (2014), Naro et al (2015Naro et al ( , 2016, and Thibaut et al (2014Thibaut et al ( , 2017 reported promising effects of tDCS, but these effects were not necessarily robust or consistent across patients and were related to different types of measures (Lefaucheur et al 2017).…”

“…Main intervention procedures for persons with disorders of consciousness include various forms of environmental stimulation, transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS), deep brain stimulation, and learning-based intervention programs (i.e., programs constituting practical adaptations of the aforementioned learning test strategies) (Daveson 2010;Lancioni et al 2014a;Magee et al 2016;Pape et al 2009Pape et al , 2012Piccione et al 2011;Schnakers et al 2016). …”