Excitatory Prefrontal Weak Current Stimulation in Vegetative Patients

Disorder of Consciousness Clinical Trial

— VEG-TDCS  

Official title:

Excitatory Prefrontal Weak Current Stimulation in Vegetative Patients:Potential to Induce Modulation in Neurocognitive Features of Awareness

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04614792
• Other study ID #: 335-19
• Status: Completed
• Phase: N/A
• Start date: April 30, 2014
• Est. completion date: December 27, 2023

Study information

• Verified date: February 2024
• Source: Herzog Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

In response to "conscious" EEG findings related to detectable cognitive function that reliably denote awareness in vegetative state patients, in the current study, we will assess the covert conscious EEG activity (as well as standard clinical overt measures) and neuroplasctic propensity (i.e., changes in EEG spectral power synchronization values following tDCS intervention) in vegetative-state patients receiving repetitive transcranial direct current stimulation (tDCS) treatment over frontal motor areas for a period of two weeks. In support of this approach, a recent tDCS study with vegetative and minimally conscious patients implied that a twenty minutes anodal stimulation (i.e., excitatory stimulation) to the left dorsolateral prefrontal cortex (DLPFC) significantly increased CRS-R scores versus sham (placebo: non-active stimulation) stimulation condition. It was noted that this tDCS effect was more pronounced in minimally conscious state patients versus vegetative state patients excluding effects of chronicity or etiology. Thus, the investigators in this study suggested that tDCS could be effective in improving cognitive recovery in severely brain-injured patients. However, their findings would benefit neural activation correlates that could support their conclusion regarding the effectiveness of this type of non-invasive intervention in promoting neurocognitive recovery. Most importantly, tDCS is safe for use in humans, has no adverse effects, is considered the most non-invasive transcranial stimulation method because it uses extremely weak currents (0.5 to 2 mA), and, is known to only temporarily shift the neuron's membrane potential towards excitation/inhibition. In regard to the method's potential to induce functional recovery in vegetative state patients, recent clinical studies indicate that tDCS could counteract the negative effects of brain damage by influencing neurophysiological mechanisms, and is likely to contribute to the "formation of functionally meaningful connections and the maintenance of existing pathways" .

Recruitment information / eligibility

• Status: Completed
• Enrollment: 16
• Est. completion date: December 27, 2023
• Est. primary completion date: December 27, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 90 Years

Eligibility

Inclusion Criteria:

• Anoxic brain damage/TBI/CVA/progressive dementia/encephalopathy
• Vegetative state patients or minimally conscious state according to CRS-R criteria
• Ages 18 to 90
• Consent for participation in clinical study (e.g., informed consent) by legal guardian of patients.

Exclusion Criteria:

• Intracranial metal implants
• Implanted devices that may be affected by tDCS (pacemaker, medication pump, cochlear implant, implanted brain stimulator)
• Active medical condition that would preclude medical stability for the study, including significant ECG abnormalities, cardiac arrhythmia, uncontrolled high blood pressure
• Participation in other research studies

Related Conditions & MeSH terms

• Anoxic Brain Damage
• Brain Injuries
• Brain Injuries, Traumatic
• Consciousness Disorders
• Cortical Atrophy
• Disorder of Consciousness
• EEG; Paroxysms, Occipital, Epilepsy of Childhood
• Hypoxia, Brain
• MMN
• Modification of Cognitive Status Indication
• Persistent Vegetative State
• Trauma, Brain
• Vegetative State

Intervention

Device:
• Transcranial direct current stimulation
Non-invasive brain stimulation or neuromodulation.

Locations

Country	Name	City	State
Israel	Herzog Medical Center	Jerusalem

Sponsors (2)

Lead Sponsor	Collaborator
Oded Meiron	Neurosteer Ltd.

Country where clinical trial is conducted

Israel, 

References & Publications (1)

Angelakis E, Liouta E, Andreadis N, Korfias S, Ktonas P, Stranjalis G, Sakas DE. Transcranial direct current stimulation effects in disorders of consciousness. Arch Phys Med Rehabil. 2014 Feb;95(2):283-9. doi: 10.1016/j.apmr.2013.09.002. Epub 2013 Sep 11. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	JFK COMA RECOVERY SCALE - REVISED	JFK Coma recovery Scale - Revised scores for diagnosing disorders of consciousness. This cynical assessment scale examines reflexive behaviors such as response to pain and startle, and touch. The CRS consists of 25 hierarchically arranged items that comprise 6 subscales addressing auditory, visual, motor, oro- motor, communication, and arousal processes. Scoring is based on the presence or absence of specific behavioral responses to sensory stimuli administered in a standardized manner. The lowest item on each subscale represents reflexive activity, whereas the highest items represent cognitively mediated behaviors. sub scales represent motor function, auditory function, visual function sub scales and arousal sub scales. The low scores indicate low levels of functioning and the higher score indicate high levels of function an awareness. Maximum score is 23 and a minimal score is 0.	24 months
Secondary	MMN ERP amplitudes	Prefronal-Temopral cortex neuroplasticity and reactivity to sound : size of early auditory processing ERP amplitudes. If the negative change in ERP amplitudes is larger than in indicates better change-detection and neurplasticity.	2 weeks