Thanks to modern neuroimaging techniques it appears that 30% of clinically unresponsive
patients (i.e., unresponsive wakefulness syndrome – UWS [
[1]
]) retain cerebral functions that are similar to patients in a minimally conscious
state – MCS [
[1]
], as assessed by fluorodeoxyglucose positron emission tomography (FDG-PET), functional
magnetic resonance imaging (fMRI) and electroencephalography (EEG). These patients
are newly labeled as MCS* or with cognitive-motor dissociation [
[2]
,
[3]
]. Even if the majority of them will regain some signs of consciousness, techniques
to promote their recovery are still lacking. In this context, transcranial direct
current stimulation (tDCS) has been shown to improve the recovery of signs of consciousness
in a subset of patients in MCS [
[4]
]. This technique offers a safe, inexpensive and easy-to-use tool to stimulate patients'
brains in a non-invasive manner. Based on previous studies, the dorsolateral prefrontal
cortex (DFPLC) seems to be the most relevant area to target [
[5]
].To read this article in full you will need to make a payment
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References
- From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness.J Neurol. 2011; 258: 1373-1384https://doi.org/10.1007/s00415-011-6114-x
- Cognitive motor dissociation following severe brain injuries.JAMA Neurol. 2015; 72: 1413-1415https://doi.org/10.1001/jamaneurol.2015.2899
- Recent advances in disorders of consciousness: focus on the diagnosis.Brain Inj. 2014; 28: 1141-1150https://doi.org/10.3109/02699052.2014.920522
- tDCS in patients with disorders of consciousness: sham-controlled randomised double blind study.Neurology. 2014; 82: 1112-1118
- New therapeutic options for the treatment of patients with disorders of consciousness: the field of neuromodulation.in: Schnakers C. Laureys S. Coma Disord. Conscious. Springer, London2017: 207-223
- The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility.Arch Phys Med Rehabil. 2004; 85: 2020-2029
- Willful modulation of brain activity in disorders of consciousness.N Engl J Med. 2010; 362: 579-589https://doi.org/10.1056/NEJMoa0905370
- Bedside detection of awareness in the vegetative state: a cohort study.Lancet. 2011; 378: 2088-2094https://doi.org/10.1016/S0140-6736(11)61224-5
- Recovery of consciousness after brain injury: a mesocircuit hypothesis.Trends Neurosci. 2010; 33: 1-9https://doi.org/10.1016/j.tins.2009.11.002
- Clinical response to tDCS depends on residual brain metabolism and grey matter integrity in patients with minimally conscious state.Brain Stimul. 2015; 8: 1116-1123https://doi.org/10.1016/j.brs.2015.07.024
Article Info
Publication History
Published online: February 07, 2018
Accepted:
February 2,
2018
Received in revised form:
January 29,
2018
Received:
January 21,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
