Minimally Conscious State Clinical Trial
Official title:
Effect of Fronto-parietal Transcranial Direct Stimulation on the Level of Consciousness in Patients With Disorders of Consciousness
Previous studies showed that anodal transcranial direct current stimulation (tDCS) transiently improves performance of memory and attention. In severely brain injured patients with disorders of consciousness (DOC), a single stimulation over the left dorsolateral prefrontal cortex has shown to improve patients' sign of consciousness. Nevertheless, other brain areas could be stimulated in order to increase the number of responders. In this study, investigators will assess the effects of bilateral fronto-parietal tDCS on Coma Recovery Scale-Revised (CRS-R) scores in patients with DOC in a double-blind sham-controlled experimental design.
Following severe brain damage and coma, some patients may remain in a vegetative state (VS)
or minimally conscious state (MCS). At present, there are no evidence-based guidelines
regarding the treatment of patients with disorders of consciousness (DOC). A previous study
showed that a single stimulation (using transcranial direct current stimulation - tDCS) of
the left prefrontal cortex induces an behavioral improvement in some patients in DOC.
Nevertheless, only 43% of patients in MCS responded to the stimulation. Therefore, it is
needed to find new protocols to increase the number of responders and improve the effect of
tDCS in patients with DOC.
In this study, investigators aim to assess the effect of single session anodal (i.e.,
excitatory) transcranial direct current stimulation (tDCS) over right and left
fronto-temporal cortices (using 4 anodes and 4 cathodes), on the level of consciousness of
patients with DOC, in a double blind randomized sham controlled study. The anodes will be
placed over F3, F3, CP5 and CP6.
tDCS is a form of safe non-invasive cortical stimulation, modulating cortical excitability
under the electrodes, via weak polarizing currents. It has been reported that anodal tDCS
transiently improves working memory and attention by stimulating the left DLPF in healthy
subjects and patients with stroke, Parkinson's or Alzheimer's disease. By increasing the
surface of the stimulated area, it is expected to increase the number of responders as
patients' brain lesion are very heterogeneous and widespread.
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