Article

OBJECTIVE: To assess the efficacy of transcranial direct current stimulation
(tDCS) on improving consciousness in patients with persistent unresponsive
wakefulness syndrome (UWS) (previously termed persistent vegetative state [PVS])
or in a minimally conscious state (MCS). DESIGN: Prospective, case series trial
with follow-up at 12 months. SETTING: General and research hospital.
PARTICIPANTS: Inpatients in a PVS/UWS or MCS (N=10; 7 men, 3 women; age range,
19-62y; etiology: traumatic brain injury, n=5; anoxia, n=4; postoperative
infarct, n=1; duration of PVS/UWS or MCS range, 6mo-10y). No participant withdrew
because of adverse effects. INTERVENTION: All patients received sham tDCS for 20
minutes per day, 5 days per week, for 1 week, and real tDCS for 20 minutes per
day, 5 days per week, for 2 weeks. An anodal electrode was placed over the left
primary sensorimotor cortex or the left dorsolateral prefrontal cortex, with
cathodal stimulation over the right eyebrow. One patient in an MCS received a
second round of 10 tDCS sessions 3 months after initial participation. MAIN
OUTCOME MEASURE: JFK Coma Recovery Scale-Revised. RESULTS: All patients in an MCS
showed clinical improvement immediately after treatment. The patient who received
a second round of tDCS 3 months after initial participation showed further
improvement and emergence into consciousness after stimulation, with no change
between treatments. One patient who was in an MCS for <1 year before treatment
(postoperative infarct) showed further improvement and emergence into
consciousness at 12-month follow-up. No patient showed improvement before
stimulation. No patient in a PVS/UWS showed immediate improvement after
stimulation, but 1 patient who was in a PVS/UWS for 6 years before treatment
showed improvement and change of status to an MCS at 12-month follow-up.
Conclusions: tDCS seems promising for the rehabilitation of patients with severe
disorders of consciousness. Severity and duration of pathology may be related to
the degree of tDCS' beneficial effects.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
- tDCS

Langue : ANGLAIS