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

Liu, Ping; Gao, Jian; Pan, Siwei; Fang, Meng; Pan, Gang; Li, Jingqi; Luo, Benyan

doi:10.1159/000447325

Cited by 37 publications

(40 citation statements)

References 24 publications

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“…Neuroimaging data also showed changes of the blood-oxygenlevel-dependent signal [65] and cerebral blood flow [66] after rTMS of the premotor or motor cortex. MCS patients showed significant increases in cerebral blood flow, which were temporally related to high-frequency rTMS [67]. Our recent studies also added evidence to the case for rTMS as an effective neuromodulation tool by quantitative EEG [68] and TMS-EEG analysis [69].…”

Section: Repetitive Transcranial Magnetic Stimulationsupporting

confidence: 57%

Current Status of Neuromodulatory Therapies for Disorders of Consciousness

et al. 2018

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Treatment for disorders of consciousness (DOCs) is still a Gordian knot. Evidence-based guidelines on the treatment of DOC patients are not currently available, while neuromodulation techniques are seen as a potential treatment. Multiple neuromodulation therapies have been applied. This article reviews the most relevant studies in the literature in order to describe a clear picture of the current state of neuromodulation therapies that could be used to treat DOC patients. Both invasive and noninvasive brain stimulation is discussed. Significant behavioral improvements in prolonged DOCs under neuromodulation therapies are rare. The efficacy of various such therapies remains a matter of debate. Further clinical investigations of existing techniques in larger samples properly controlling for spontaneous recovery are needed, and new approaches are awaited.

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Section: Repetitive Transcranial Magnetic Stimulationsupporting

confidence: 57%

Current Status of Neuromodulatory Therapies for Disorders of Consciousness

et al. 2018

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“…However, at the group level, no behavioral enhancements were noticed in any of the RCTs when applied over M1. 45,46,48 Future RCTs should target the DLPFC, similarly to tDCS, as two uncontrolled observational rTMS studies show some positive effects. 50,51 Demographic and clinical characteristics of responders should also be investigated in larger RCTs or meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

“…45 The second RCT trial reported no behavioral improvement after one session of M1 20Hz rTMS for ~10 minutes in 10 patients with DOC (1-26 months post-onset) but improved hemodynamic functions (i.e., cerebral blood flow velocity) in the MCS as compared to the UWS group. 46 5-Hz rTMS was applied on M1 for ~7 minutes in a third RCT in 5 UWS and 5 MCS patients (5-23 months post-injury) evaluating its effects on sleep-wake cycles. 47 Even if there was no behavioral effect reported, significant rTMS after-effects regarding the slow wave activity power were detected in the MCS but not in the UWS group.…”

Section: Repeated Transcranial Magnetic Stimulationmentioning

confidence: 99%

Therapeutic interventions in patients with prolonged disorders of consciousness

Thibaut

Schiff

Giacino

et al. 2019

The Lancet Neurology

265

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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“…Sham stimulation was delivered using the same protocol except that the angled coil was positioned away from the head. Thus, the magnetic field could not penetrate the brain, although the acoustic artefact of real stimulation was reproduced in the sham rTMS [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Effects of 20 Hz Repetitive Transcranial Magnetic Stimulation on Disorders of Consciousness: A Resting-State Electroencephalography Study

Luo

Fang

et al. 2018

Neural Plasticity

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Repetitive transcranial magnetic stimulation (rTMS) has been proposed as an experimental approach for the treatment of disorders of consciousness (DOC). To date, there has been little research into the use of rTMS in DOC and the therapeutic effects have been variously documented. This study aimed to examine the effects of 20 Hz rTMS on the electroencephalography (EEG) reactivity and clinical response in patients with DOC and to explore the neuromodulatory effects of high-frequency rTMS. In this randomized, sham-controlled, crossover study, real or sham 20 Hz rTMS was applied to the left primary motor cortex (M1) of patients with DOC for 5 consecutive days. Evaluations were blindly performed at the baseline (T0), immediately after the end of the 5 days of treatment (T1) and 1 week after the treatment (T2) using the JFK coma recovery scale-revised (CRS-R) and resting-state EEG. Only one patient, with a history of 2 months of traumatic brain injury, showed long-lasting (T1, T2) behavioral and neurophysiological modifications after the real rTMS stimulation. The 5 remaining patients presented brain reactivity localized at several electrodes, and the EEG modification was not significant. rTMS stimulation may improve awareness and arousal of DOC. Additionally, EEG represents a potential biomarker for the therapeutic efficacy of rTMS. This trial is registered with (NCT03385278).

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

Cited by 37 publications

References 24 publications

Current Status of Neuromodulatory Therapies for Disorders of Consciousness

Current Status of Neuromodulatory Therapies for Disorders of Consciousness

Therapeutic interventions in patients with prolonged disorders of consciousness

Effects of 20 Hz Repetitive Transcranial Magnetic Stimulation on Disorders of Consciousness: A Resting-State Electroencephalography Study

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