Behavioural improvement in a minimally conscious state after caloric vestibular stimulation: evidence from two single case studies

Vanzan, Serena; Wilkinson, David T.; Ferguson, Heather J.; Pullicino, Patrick; Sakel, Mohamed

doi:10.1177/0269215516646167

Cited by 14 publications

(12 citation statements)

References 19 publications

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“…Novel non-invasive brain stimulation techniques, including LIFUP, taVNS and spinal cord stimulation, have been tested in a few case-reports. [53][54][55] The only published report of a patient in MCS (19 days post-TBI) who received one session of LIFUP targeting the central thalamus ( figure 2E) showed a recovery of language comprehension and spatio-temporal orientation a few days later. 56 The effects of taVNS were presented in another case-report of UWS patient (50 days post-anoxia) (figure 2F 53 ).…”

Section: Other Novel Approachesmentioning

confidence: 99%

“…The caloric vestibular stimulation is another technique that has been tested in two patients in MCS (1 hemorrhagic stroke and 1 anoxia, about 6 months post-onset). 54 The protocol included two active and two sham daily sessions during 4 or 5 days per week. Both patients demonstrated clinical improvement with the CRS-R (i.e., arousal and auditory scales) and the Wessex Head Injury Matrix (i.e., gesture making and selective responses to relatives).…”

Section: Other Novel Approachesmentioning

confidence: 99%

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Therapeutic interventions in patients with prolonged disorders of consciousness

Thibaut

Schiff

Giacino

et al. 2019

The Lancet Neurology

268

229

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The management of patients with severe brain injuries and prolonged disorders of consciousness (DOC) raises important issues particularly with respect to their therapeutic options. The lack of treatment is challenged by new clinical and neuroimaging data indicating that some patients with prolonged DOC may benefit from therapeutic interventions, even years after the injury. The majority of the studies aiming at improving patients' level of consciousness and functional recovery includes behavioural and brain imaging open-label trials and case-reports, but several randomized clinical trials (RCT) have been conducted, especially using non-invasive brain stimulation. Only a couple of RCTs focused on the effects of drugs or sensory stimulation approaches, and only two Class II studies, on amantadine and transcranial direct current stimulation, have been published. While new therapeutic approaches seem to be valuable for patients with prolonged DOC, optimized stimulation parameters, alternative drugs or rehabilitation strategies still need to be tested and validated.

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Section: Other Novel Approachesmentioning

confidence: 99%

Section: Other Novel Approachesmentioning

confidence: 99%

Therapeutic interventions in patients with prolonged disorders of consciousness

Thibaut

Schiff

Giacino

et al. 2019

The Lancet Neurology

268

229

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“…Time-varying CVS has also been used in a case study with two subjects in a minimally conscious state (Vanzan et al, 2017) with the aim of increasing awareness. Spontaneous recovery for these subjects generally occurs within a time window after emergence from coma and both of the subjects were past the time when natural recovery was expected.…”

Section: Vnmmentioning

confidence: 99%

Sensory Neuromodulation

Black¹,

Rogers²

2018

Preprint

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We describe a model of neurological disease based on dysfunctional brain oscillators.  This is not a new model, but it is not one that is generally appreciated by clinicians.  The value of this model lies in the predictions it makes and the utility it provides in translational applications, in particular for neuromodulation devices.  We provide a perspective on the difference between neuromodulation devices that enforce an externally administered stimulus with devices that provide input to sensory receptors and thus stimulate endogenous sensory networks.  Current forms of clinically applied neuromodulation are of the former type, including devices such as (implanted) deep brain stimulators (DBS) and various, noninvasive methods such as transcranial magnetic stimulation (TMS) and transcranial current methods (tACS, tDCS).  The challenge with these methods is that they are not sensitive to underlying neuronal dynamics and work by applying an empirically derived electrical current waveform to affect dynamical patterns. Neuromodulation of a sensory organ accesses the same pathways that natural environmental stimuli do and, importantly, the modulatory signal will be transformed as it travels through the brain, allowing the modulation input to be consistent with regional dynamics.  We present specific examples of devices that rely on sensory neuromodulation and evaluate the translational potential of these approaches.  We argue that sensory neuromodulation is well suited to probe and, ideally, repair dysfunctional brain oscillators, thus providing a novel therapeutic approach for neurological diseases.

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“…The call for RCTs of rCVS (and rGVS) in psychiatry should ring particularly loudly, given issues with current therapeutic brain stimulation options, including: (i) complexity of administration variables, (ii) modest therapeutic effects with rTMS and controversial effects with tDCS, (iii) invasiveness and expense of DBS, with disappointing efficacy for depression, and (iv) inconvenience and potential side‐effects of anaesthesia‐requiring ECT. CVS, however, is noninvasive, safe (with guidelines regarding medical contraindications), inexpensive, easy to administer (outlined in Miller and Ngo3), and uncomplicated by administration variables (just left‐ vs right‐ear; although with emerging opportunities for CVS technological developments) . These features should make for relatively straightforward examination of CVS as a therapeutic option in clinical psychiatry and application of CVS as a research tool in cognitive neuroscience and biological psychiatry.…”

Section: Examining the Therapeutic Efficacy Of Vestibular Neuromodulamentioning

confidence: 99%

Vestibular neuromodulation: stimulating the neural crossroads of psychiatric illness

Miller

2016

Bipolar Disorders

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Behavioural improvement in a minimally conscious state after caloric vestibular stimulation: evidence from two single case studies

Abstract: The data provide the first evidence that vestibular stimulation may help improve outcome in a low awareness state, although further studies are needed to replicate effect and determine longer-term benefit.

Cited by 14 publications

References 19 publications

Therapeutic interventions in patients with prolonged disorders of consciousness

Therapeutic interventions in patients with prolonged disorders of consciousness

Sensory Neuromodulation

Vestibular neuromodulation: stimulating the neural crossroads of psychiatric illness

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