Repeated transcranial direct current stimulation in prolonged disorders of consciousness: A double-blind cross-over study

Estraneo, Anna; Pascarella, Angelo; Moretta, Pasquale; Masotta, Orsola; Fiorenza, Salvatore; Chirico, Grazia; Crispino, Emanuela; Loreto, V.; Trojano, Luigi

doi:10.1016/j.jns.2017.02.036

Cited by 78 publications

(97 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Regarding our first outcome, we can conclude that applying 20 sessions of tDCS in patients with DOC appears to be safe, which is in line with previous observations [8,21,22]. However, one patient, who was under anti-epileptic medication (controlled epilepsy for 2 years), experienced a seizure.…”

Section: Discussionsupporting

confidence: 89%

“…Later, our group showed that applying tDCS using the same montage for five days could increase the number of responders and prolonged the duration of the effects up to one week after the end of the tDCS sessions [7]. Under a similar protocol (i.e., 5 days of tDCS with the anode positioned over the left DFLPC), Estraneo and colleagues revealed moderate improvements in consciousness in 3 patients in UWS and 3 patients in MCS (out of 13 patients with DOC) [8]. Angelakis and colleagues also identified an improvement in the CRS-R total scores following 10 days of tDCS, applied with the anode over the left DLPFC or the motor cortex, and at 12-month follow-up as well, in patients in MCS [9].…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state

Martens¹,

et al. 2018

View full text Add to dashboard Cite

a b s t r a c tBackground: Patients with chronic disorders of consciousness face a significant lack of treatment options. Objective: We aimed at investigating the feasibility and the behavioral effects of home-based transcranial direct current stimulation (tDCS), applied by relatives or caregivers, in chronic patients in minimally conscious state (MCS). Methods: Each participant received, in a randomized order, 20 sessions of active and 20 sessions of sham tDCS applied over the prefrontal cortex for 4 weeks; separated by 8 weeks of washout. Level of consciousness was assessed using the Coma Recovery Scale-Revised before the first stimulation (baseline), at the end of the 20 tDCS sessions (direct effects) and 8 weeks after the end of each stimulation period (long-term effects). Reported adverse events and data relative to the adherence (i.e., amount of sessions effectively received) were collected as well. Results: Twenty-seven patients completed the study and 22 patients received at least 80% of the stimulation sessions. All patients tolerated tDCS well, no severe adverse events were noticed after real stimulation and the overall adherence (i.e., total duration of stimulation) was good. A moderate effect size (0.47 and 0.53, for modified intention to treat and per protocol analysis, respectively) was observed at the end of the 4 weeks of tDCS in favor of the active treatment. Conclusions: We demonstrated that home-based tDCS can be used adequately outside a research facility or hospital by patients' relatives or caregivers. In addition, 4 weeks of tDCS moderately improved the recovery of signs of consciousness in chronic MCS patients.© 2018 Elsevier Inc. All rights reserved. IntroductionPatients who suffered from a severe brain injury and stay with a disorder of consciousness (DOC) represent a challenging population to treat since, by definition, these patients are unable to communicate, and therefore to participate in active rehabilitation programs. Currently, their treatment options are limited, especially in the chronic setting. Several drugs to improve the level of consciousness have been studied (e.g., zolpidem, levodopa or baclofen) [1]. However, so far, only amantadine showed significant clinical effects [2]. Recently, transcranial direct current stimulation (tDCS) showed promising results in patients in a minimally conscious state (MCS e i.e., showing fluctuating but reproducible signs of consciousness, such as response to command or visual pursuit for instance, while being unable to functionally communicate) while patients in unresponsive wakefulness syndrome (UWS e i.e., only showing cyclic eye-opening and reflexive behaviors) seem to be less responsive to that treatment. We demonstrated that a single session of tDCS, applied with the anode over the left dorsolateral prefrontal cortex (DLPFC) and the cathode over the contralateral supraorbital area, induced transient clinical improvement [4], as

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 98%

Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state

Martens¹,

et al. 2018

View full text Add to dashboard Cite

show abstract

“…They further revealed that the changes in excitability in temporal anspatial domains are different between patients with MCS and those with VS (Bai et al, 2017). However, Estraneo et al (2017) found that repeated tDCS did not exert remarkable short-term clinical and EEG effects in patients with prolonged DOC. In conclusion, some beneficial results of tDCS protocols have been demonstrated in DOC patients, especially targeting the left DLPFC in MCS.…”

Section: Tdcs Applications In Clinical Samplesmentioning

confidence: 99%

Modulation of Brain Activity with Noninvasive Transcranial Direct Current Stimulation (tDCS): Clinical Applications and Safety Concerns

et al. 2017

View full text Add to dashboard Cite

Transcranial direct current stimulation (tDCS) is a widely-used tool to induce neuroplasticity and modulate cortical function by applying weak direct current over the scalp. In this review, we first introduce the underlying mechanism of action, the brief history from discovery to clinical scientific research, electrode positioning and montages, and parameter setup of tDCS. Then, we review tDCS application in clinical samples including people with drug addiction, major depression disorder, Alzheimer's disease, as well as in children. This review covers the typical characteristics and the underlying neural mechanisms of tDCS treatment in such studies. This is followed by a discussion of safety, especially when the current intensity is increased or the stimulation duration is prolonged. Given such concerns, we provide detailed suggestions regarding safety procedures for tDCS operation. Lastly, future research directions are discussed. They include foci on the development of multi-tech combination with tDCS such as with TMS and fMRI; long-term behavioral and morphological changes; possible applications in other research domains, and more animal research to deepen the understanding of the biological and physiological mechanisms of tDCS stimulation.

show abstract

“…Some studies focused on differentiating tDCS impact based on the patients' state of consciousness (50,51). Others used a qualitative analysis of the EEG background activity to characterize tDCS response (24). Our study is the first to link electrophysiological changes with behavioral response to tDCS, and the first to link this to electric fields magnitudes in the brain.…”

Section: Discussionmentioning

confidence: 92%

“…Encouraging results have been obtained on DoC patients with invasive electrical stimulation of the brain (16)(17)(18)(19) and recently, transcranial delivery of a low intensity electrical current over the scalp with tDCS (20)(21)(22). However, the efficacy of tDCS is debated (23)(24)(25), and its mechanisms have not been established yet.…”

Section: Main Text Introductionmentioning

confidence: 99%

Combined behavioral and electrophysiological evidence for a direct cortical effect of prefrontal tDCS on disorders of consciousness

Hermann¹,

Raimondo²,

Hirsch³

et al. 2019

Preprint

View full text Add to dashboard Cite

Severe brain injuries can lead to long-lasting disorders of consciousness (DoC) such as vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS). While behavioral assessment remains the gold standard to determine conscious state, EEG has proven to be a promising complementary tool to monitor the effect of new therapeutics. Encouraging results have been obtained with invasive electrical stimulation of the brain, and recent studies identified transcranial direct current stimulation (tDCS) as an effective approach in randomized controlled trials. This non-invasive and inexpensive tool may turn out to be the preferred treatment option. However, its mechanisms of action and physiological effects on brain activity remain unclear and debated. Here, we stimulated 60 DoC patients with the anode placed over left-dorsolateral prefrontal cortex in a prospective open-label study. Clinical behavioral assessment improved in twelve patients (20%) and none deteriorated. This behavioral response after tDCS coincided with an enhancement of putative EEG markers of consciousness: in comparison with non-responders, responders showed increases of power and long-range cortico-cortical functional connectivity in the theta-alpha band, and a larger and more sustained P300 suggesting improved conscious access to auditory novelty. The EEG changes correlated with electric fields strengths in prefrontal cortices, and no correlation was found on the scalp. Taken together, this prospective intervention in a large cohort of DoC patients strengthens the validity of the proposed EEG signatures of consciousness, and is suggestive of a direct causal effect of tDCS on consciousness.

show abstract

Repeated transcranial direct current stimulation in prolonged disorders of consciousness: A double-blind cross-over study

Cited by 78 publications

References 29 publications

Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state

Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state

Modulation of Brain Activity with Noninvasive Transcranial Direct Current Stimulation (tDCS): Clinical Applications and Safety Concerns

Combined behavioral and electrophysiological evidence for a direct cortical effect of prefrontal tDCS on disorders of consciousness

Contact Info

Product

Resources

About