rTMS Safety for Two Subjects With Disordered Consciousness After Traumatic Brain Injury

Pape, Theresa; Rosenow, Joshua M.; Patil, Vijaya; Steiner, M; Harton, Brett; Guernon, Ann; Herrold, Amy A.; Pacheco, Marilyn; Crisan, Elena; Ashley, William W.; Odle, Cheryl; Park, Youngsook; Chawla, Jasavinder; Sarkar, Korak

doi:10.1016/j.brs.2014.03.007

Cited by 25 publications

(22 citation statements)

References 5 publications

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“…Finally, the safety of repeated DLPFC rTMS was reported in two patients with DOC, months and 9 years post-onset, who received 30 sessions of rTMS and who showed no serious adverse-event related to rTMS. 52 The absence of severe adverse-events linked to prolonged use of rTMS is encouraging, but no conclusion can be drawn based on these two case-reports only.…”

Section: Repeated Transcranial Magnetic Stimulationmentioning

confidence: 93%

Therapeutic interventions in patients with prolonged disorders of consciousness

Thibaut

Schiff

Giacino

et al. 2019

The Lancet Neurology

262

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: Repeated Transcranial Magnetic Stimulationmentioning

confidence: 93%

Therapeutic interventions in patients with prolonged disorders of consciousness

Thibaut

Schiff

Giacino

et al. 2019

The Lancet Neurology

262

229

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“…Louise-Bender Pape et al report an electrographic seizure with no clinical accompaniment in a patient in a vegetative state following 21 sessions of rTMS ( 57 ). The patient was a 32-year-old male who had suffered a TBI 9 years prior and had a GCS score of 6 at injury.…”

Section: Rtmsmentioning

confidence: 99%

Non-Invasive Brain Stimulation for the Treatment of Symptoms Following Traumatic Brain Injury

2015

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BackgroundTraumatic brain injury (TBI) is a common cause of physical, psychological, and cognitive impairment, but many current treatments for TBI are ineffective or produce adverse side effects. Non-invasive methods of brain stimulation could help ameliorate some common trauma-induced symptoms.ObjectiveThis review summarizes instances in which repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS) have been used to treat symptoms following a TBI. A subsequent discussion attempts to determine the value of these methods in light of their potential risks.MethodsThe research databases of PubMed/MEDLINE and PsycINFO were electronically searched using terms relevant to the use of rTMS and tDCS as a tool to decrease symptoms in the context of rehabilitation post-TBI.ResultsEight case-studies and four multi-subject reports using rTMS and six multi-subject studies using tDCS were found. Two instances of seizure are discussed.ConclusionThere is evidence that rTMS can be an effective treatment option for some post-TBI symptoms, such as depression, tinnitus, and neglect. Although the safety of this method remains uncertain, the use of rTMS in cases of mild TBI without obvious structural damage may be justified. Evidence on the effectiveness of tDCS is mixed, highlighting the need for additional investigations.

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“…A non-significant trend toward behavioural improvement associated with an improvement of auditory pathways conduction has been reported (Louise-Bender Pape et al, 2009). The same research group applied such protocol in two additional VS/UWS patients in order to evaluate safety indicators of the treatment without reporting clinical data (Pape et al, 2014). Afterwards, Piccione et al (2011) described an arousal with transient increase of meaningful behaviours and EEG changes in a MCS patient who underwent a single session of 20-Hz rTMS applied on the scalp overlaying M1.…”

Section: Non-invasive Brain Stimulation (Nibs) As a Neuromodulatory Toolmentioning

confidence: 99%

Clinical neurophysiology of prolonged disorders of consciousness: From diagnostic stimulation to therapeutic neuromodulation

Ragazzoni¹,

Cincotta

Giovannelli

et al. 2017

Clinical Neurophysiology

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The identification of signs of awareness in patients with prolonged disorders of consciousness (DoC) after severe brain injury is a challenging task for clinicians. Differentiating on behavioural examination the vegetative state (VS) from the minimally conscious state (MCS) can lead to a high misdiagnosis rate. Advanced neuroimaging and neurophysiological techniques can supplement clinical evaluation by providing physiological evidence of brain activity. However, an open issue remains whether these empirical results are directly or indirectly associated with covert consciousness and limitations emerge for their diagnostic application at the single-patient level. On the therapeutic side, the efficacy of both non-invasive and invasive brain stimulation/modulation trials is matter of debate. The present review provides an updated analysis of the diagnostic and prognostic impact that the different neurophysiological techniques of stimulation [including short-latency evoked potentials, long-latency event related potentials (ERPs), transcranial magnetic stimulation (TMS), TMS-EEG co-registration] offer in prolonged DoC. The results of the therapeutic stimulation techniques are also evaluated. It is concluded that TMS-EEG emerges as the most promising tool for differentiating VS from MCS whereas ERPs allow neurophysiologists to probe covert cognitive capacities of each patient. Significant behavioural improvements in prolonged DoC with brain stimulation techniques are still anecdotical and further treatment options are awaited.

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rTMS Safety for Two Subjects With Disordered Consciousness After Traumatic Brain Injury

Cited by 25 publications

References 5 publications

Therapeutic interventions in patients with prolonged disorders of consciousness

Therapeutic interventions in patients with prolonged disorders of consciousness

Non-Invasive Brain Stimulation for the Treatment of Symptoms Following Traumatic Brain Injury

Clinical neurophysiology of prolonged disorders of consciousness: From diagnostic stimulation to therapeutic neuromodulation

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