Combined Behavioral and Mismatch Negativity Evidence for the Effects of Long-Lasting High-Definition tDCS in Disorders of Consciousness: A Pilot Study

Wang, Xiaoyu; Guo, Yingshu; Zhang, Yunge; Li, Jinju; Gao, Zhicheng; Li, Yingxin; Zhou, Tianlin; Zhang, Hui; He, Jianghong; Cong, Fengyu

doi:10.3389/fnins.2020.00381

Cited by 22 publications

(28 citation statements)

References 62 publications

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“…These studies have observed improvements both in the CRS-R scores and cortical functional connectivity of some patients. [ 84 – 86 ] Their preliminary results may provide insights into the basis for increasing the precision of therapeutic targets in relevant research; however, there is still little available information regarding the pathophysiological mechanisms of DOCs, there are numerous nuclei yet to be explored as potential targets. Therefore, at this stage, using conventional tDCS which stimulate a broader region is still the treatment of choice.…”

Section: Resultsmentioning

confidence: 99%

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Neuromodulatory therapies for patients with prolonged disorders of consciousness

Hong

et al. 2021

Chinese Medical Journal

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Background: Reviving patients with prolonged disorders of consciousness (DOCs) has always been focused and challenging in medical research. Owing to the limited effectiveness of available medicine, recent research has increasingly turned towards neuromodulatory therapies, involving the stimulation of neural circuits. We summarised the progression of research regarding neuromodulatory therapies in the field of DOCs, compared the differences among different studies, in an attempt to explore optimal stimulation patterns and parameters, and analyzed the major limitations of the relevant studies to facilitate future research. Methods: We performed a search in the PubMed database, using the concepts of DOCs and neuromodulation. Inclusion criteria were: articles in English, published after 2002, and reporting clinical trials of neuromodulatory therapies in human patients with DOCs. Results: Overall, 187 published articles met the search criteria, and 60 articles met the inclusion criteria. There are differences among these studies regarding the clinical efficacies of neurostimulation techniques for patients with DOCs, and large-sample studies are still lacking. Conclusions: Neuromodulatory techniques were used as trial therapies for DOCs wherein their curative effects were controversial. The difficulties in detecting residual consciousness, the confounding effect between the natural course of the disease and therapeutic effect, and the heterogeneity across patients are the major limitations. Large-sample, well-designed studies, and innovations for both treatment and assessment are anticipated in future research.

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Section: Resultsmentioning

confidence: 99%

“…Recently, a non-invasive DBS approach, θ burst TMS pattern, and novel forms of transcranial electrical stimulation, such as HD-tDCS, tACS, and tRNS, have either been described or practiced in this field. [ 49 , 84 – 86 , 97 , 100 , 102 ] More innovations are worth exploring.…”

Section: Discussionmentioning

confidence: 99%

Neuromodulatory therapies for patients with prolonged disorders of consciousness

Hong

et al. 2021

Chinese Medical Journal

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“…Angelakis et al reported the effects of 2-week tDCS over left DLPFC in patients with different degrees of consciousness disorders, in which all the patients with MCS showed increased CRS-R scores at the end of the treatment (29). Another study demonstrated that 10 tDCS sessions over precuneus could improve the signs of consciousness in patients with DoC represented by CRS-R total scores (22). In addition, the auditory and motor CRS-R subscales scores were significantly higher post-2-week real tDCS than both the baseline and sham tDCS (Table 2), from which we speculated that the potential of tDCS may be related to its effect on auditory and motor functions.…”

Section: Discussionmentioning

confidence: 99%

“…The CRS-R is a common scale for the assessment of consciousness, which was used to differentiate vegetative state (VS) from MCS and identify patients who have emerged from MCS (21). The CRS-R is comprised of six subscales, including auditory, visual, motor, oromotor, communication, and arousal function organized in 29 hierarchically items to reflect the level of consciousness and to track behavioral recovery, and each item has specific scoring criteria (22,23). In addition, adverse events related with the stimulation like allergies and redness of the skin were also recorded in the study.…”

Section: Behavioral Assessmentsmentioning

confidence: 99%

Efficacy of Transcranial Direct Current Stimulation Over Dorsolateral Prefrontal Cortex in Patients With Minimally Conscious State

et al. 2022

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BackgroundThe treatment of patients in a minimally conscious state (MCS) remains challenging. Transcranial direct current stimulation (tDCS) is a non-invasive therapeutic method in treating neurologic diseases by regulating the cortical excitability. The aim is to investigate the effect of tDCS in patients with MCS in this study.MethodsEleven patients in MCS were enrolled in the study. All the patients received 5 daily sessions of 20-min sham tDCS, followed by 10 sessions of 20-min real tDCS. The anodal electrode and cathodal electrodes were placed over the left dorsolateral prefrontal cortex (DLPFC) and the right eyebrow, respectively. Assessment of Coma Recovery Scale-Revised (CRS-R) scores and resting-state functional MRI (rs-fMRI) scans was conducted three times in each patient: before tDCS (baseline, T0), post-sham tDCS at week 1 (T1), and post-real tDCS at week 2 (T2). The whole-brain functional connectivity (FC) was obtained by bilaterally computing FC from six seed regions: precuneus, middle frontal gyrus, supplemental motor area, angular gyrus, superior temporal gyrus, and occipital lobe. One-way repeated measure ANOVA was used to compare the differences of CRS-R scores and FC at T0, T1, and T2. The false discovery rate correction of p < 0.001 was adopted for controlling multiple comparisons in FC analysis.ResultsFive patients with MCS showed obvious clinical improvement represented by increased CRS-R scores post- 2-week real tDCS. The CRS-R scores did not change post- 1-week sham treatment. No side effects were reported during the study. The FC of the bilateral supplementary motor area, right angular gyrus, and right superior temporal gyrus were significantly enhanced after 2-week real tDCS compared with that after 1-week sham-tDCS. In addition, FC of bilateral occipital lobe and right precuneus were significantly enhanced post- 2-week real tDCS compared with the baseline.ConclusionOur findings indicated that tDCS over DLPFC could serve as a potentially effective therapy for improving the consciousness state in patients with MCS. The FC in rs-fMRI can be modulated by tDCS at both the stimulation site (left DLPFC) and the distant regions.

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“…Transcranial direct current stimulation [28][29][30][31][32][33][34][35][36]. DLPFC or posterior parietal cortex at 10-20 min/time (1-2 mA for 10-20 days) was chosen.…”

Section: Neurostimulation Therapymentioning

confidence: 99%

Clinical diagnosis guidelines and neurorestorative treatment for chronic disorders of consciousness (2021 China version)

Li¹,

He²,

Yang³

et al. 2021

Journal of Neurorestoratology

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Chronic disorders of consciousness (DOC) include the vegetative state and the minimally consciousness state. The DOC diagnosis mainly relies on the evaluation of clinical behavioral scales, electrophysiological testing, and neuroimaging examinations. No specifically effective neurorestorative methods for chronic DOC currently exist. Any valuable exploration therapies of being able to repair functions and/or structures in the consciousness loop (e.g., drugs, hyperbaric medicines, noninvasive neurostimulation, sensory and environmental stimulation, invasive neuromodulation therapy, and cell transplantation) may become effective neurorestorative strategies for chronic DOC. In the viewpoint of Neurorestoratology, this guideline proposes the diagnostic and neurorestorative therapeutic suggestions and future exploration direction for this disease following the review of the existing treatment exploration achievements for chronic DOC.

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Combined Behavioral and Mismatch Negativity Evidence for the Effects of Long-Lasting High-Definition tDCS in Disorders of Consciousness: A Pilot Study

Cited by 22 publications

References 62 publications

Neuromodulatory therapies for patients with prolonged disorders of consciousness

Neuromodulatory therapies for patients with prolonged disorders of consciousness

Efficacy of Transcranial Direct Current Stimulation Over Dorsolateral Prefrontal Cortex in Patients With Minimally Conscious State

Clinical diagnosis guidelines and neurorestorative treatment for chronic disorders of consciousness (2021 China version)

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