Cordula Werner1, Manuela Byhahn2, Stefan Hesse1. 1. Medical Park Berlin Humboldtmühle, Neurologische Rehabilitation, Charité - Universitätsmedizin Berlin, Germany. 2. Haus Havelblick, Department for intensive care nursing, Havelschanze, Berlin, Germany.
Abstract
PURPOSE: In order to promote alertness and awareness in patients with severe disorders of consciousness (DOC) frontal nearinfrared laser stimulation (N-LT) or transcranial focused shock wave therapy (F-SWT) might be an option. The study compared both techniques in severe chronic DOC patients. METHODS:Sixteen DOC patients were allocated to two groups (A and B). A three week baseline either followed a frontal N-LT (0,1 mJ/mm2, 10 min per session), five times a week over four weeks (group A), or a F-SWT (0,1 mJ/mm2, 4000 stimuli per session) three times a week over four weeks (group B). The primary variable was the revised Coma Recovery Scale (r-CRS, 0-23), blindly assessed. RESULTS: Both groups improved in the r-CRS over time, but revealed no differences between groups. One patient of group B had a focal seizure in the third therapy week. One patient with akinetic mutism improved most and three patients with global hypoxia did not improve at all. CONCLUSIONS: Both options might be an option to increase alertness and awareness of chronic DOC patients. An akinetic mutism seems to be a positive and severe cerebral hypoxia a negative predictor. Epileptic seizures are a potential unwanted side effect. More clinical studies are warranted.
RCT Entities:
PURPOSE: In order to promote alertness and awareness in patients with severe disorders of consciousness (DOC) frontal near infrared laser stimulation (N-LT) or transcranial focused shock wave therapy (F-SWT) might be an option. The study compared both techniques in severe chronic DOC patients. METHODS: Sixteen DOC patients were allocated to two groups (A and B). A three week baseline either followed a frontal N-LT (0,1 mJ/mm2, 10 min per session), five times a week over four weeks (group A), or a F-SWT (0,1 mJ/mm2, 4000 stimuli per session) three times a week over four weeks (group B). The primary variable was the revised Coma Recovery Scale (r-CRS, 0-23), blindly assessed. RESULTS: Both groups improved in the r-CRS over time, but revealed no differences between groups. One patient of group B had a focal seizure in the third therapy week. One patient with akinetic mutism improved most and three patients with global hypoxia did not improve at all. CONCLUSIONS: Both options might be an option to increase alertness and awareness of chronic DOC patients. An akinetic mutism seems to be a positive and severe cerebral hypoxia a negative predictor. Epilepticseizures are a potential unwanted side effect. More clinical studies are warranted.