Current Status of Neuromodulatory Therapies for Disorders of Consciousness

Xia, Xiaoyu; Yang, Yi; Guo, Yingshu; Bai, Yang; Dang, Yuanyuan; Xu, Ran; He, Jianghong

doi:10.1007/s12264-018-0244-4

Cited by 34 publications

(26 citation statements)

References 112 publications

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“…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. Few studies have addressed the application of NIBS, with conflicting results [3]. Thibaut et al in 2014 observed transiently improved signs of consciousness in 13 of 30 MCS patients following severe brain damage as measured by changes in the CRS-R total scores after a single session of tDCS over the left dorsolateral prefrontal cortex (DLPFC), while no effect was seen in VS/UWS subjects [4].…”

Section: Introductionmentioning

confidence: 99%

Stimulation of the Angular Gyrus Improves the Level of Consciousness

et al. 2019

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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.

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Section: Introductionmentioning

confidence: 99%

Stimulation of the Angular Gyrus Improves the Level of Consciousness

et al. 2019

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“…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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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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“…La ETD puede inducir neuroplasticidad y modular la función cortical a través de una débil corriente continua en el cuero cabelludo y la EMC es una técnica segura, no invasiva e indolora que también ha demostrado efecto neuromodulador, cuando se administra en forma repetitiva. Ambas pueden actuar como un excitador o un inhibidor de la actividad cerebral en regiones de interés 58 , pero tienen la limitación de estimular superficialmente, perdiendo efecto en núcleos grises profundos. Otras terapias neuromoduladoras, como la estimulación eléctrica del nervio vago y del nervio mediano, igualmente modulan la actividad cerebral funcional 59 .…”

Section: Nuevas Terapias Neuromoduladorasunclassified

“…A pesar de su amplio uso, los defectos en los diseños de estudios, el tamaño de muestral y la falta de un grupo control, han limitado la potencia de las investigaciones. Además, algunos investigadores han señalado preocupación que la potencial sobreestimulación en pacientes no respondedores (específicamente estimulación del nervio mediano) pudiera llevar a una reducción de la percepción de algunos estímulos 58 .…”

Section: Nuevas Terapias Neuromoduladorasunclassified

Trastornos prolongados de conciencia en pediatría, una mirada actual

et al. 2021

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Los niños que permanecen con un Trastorno Prolongado de Conciencia (TPC) presentan un complejo desafío clínico, ético y legal para médicos y cuidadores. Se define TPC cualquier trastorno de la conciencia que continúa durante al menos 4 semanas después de una lesión cerebral de aparición repentina. El TPC incluye las subcategorías de estado vegetativo/estado de vigilia sin respuesta (EV/ SVSR) y el estado de mínima conciencia (ECM). Los niños con TPC carecen de capacidad para tomar decisiones respecto a su cuidado y tratamiento, las que deben tomarse sobre la base de sus mejores beneficios. Estos beneficios pueden variar de paciente a paciente, entre médicos, familia y público general llevando a conflictos, en sus esfuerzos respectivos para hacer lo que creen correcto para el paciente. El diagnóstico se basa en evaluaciones clínicas que por sí solas, tienen hasta un 45% de errores, por lo que deben complementarse con guías clínicas estandarizadas y en ocasiones estudios paraclínicos. Otro aspecto que dificulta la evaluación son las redenominaciones, definiciones y subcategorizaciones cambiantes de los TPC, que en algunos casos varían entre diferentes estudios a nivel internacional. El objetivo de esta revisión es presentar una puesta al día de los diferentes TPC, su definición, subcategorización, etiología, pronóstico, evaluación integral y manejo en Pediatría y contribuir a la mejor práctica clínica en base a la evidencia actual disponible.

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Current Status of Neuromodulatory Therapies for Disorders of Consciousness

Cited by 34 publications

References 112 publications

Stimulation of the Angular Gyrus Improves the Level of Consciousness

Stimulation of the Angular Gyrus Improves the Level of Consciousness

Neuromodulatory therapies for patients with prolonged disorders of consciousness

Trastornos prolongados de conciencia en pediatría, una mirada actual

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