Sofia Straudi1, Valentina Bonsangue1, Sonia Mele2, Laila Craighero2, Andrea Montis3, Felipe Fregni4, Susanna Lavezzi1, Nino Basaglia1. 1. a Neuroscience and Rehabilitation Department , Ferrara University Hospital , Ferrara , Italy. 2. b Biomedical and Specialty Surgical Sciences Department , Ferrara University , Ferrara , Italy. 3. c Sardinian Health Trust , Neurorehabilitation Unit, San Martino Hospital , Oristano , Italy. 4. d Department of Physical Medicine and Rehabilitation, Harvard Medical School , Neuromodulation Center, Spaulding Rehabilitation Hospital , Boston , MA , USA.
Abstract
OBJECTIVE: We tested the preliminary effects of bilateral anodal transcranial direct current stimulation (tDCS) in patients with disorders of consciousness. DESIGN: Open label pilot study. SUBJECTS: Ten chronic (greater than 12 months) patients in a minimally conscious state (MCS) following severe traumatic brain injury. METHODS: The patients received 10 sessions of bilateral M1 anodal tDCS. Behavioural changes were assessed with the Coma Recovery Scale-Revised (CRS-R) before stimulation (T-1, T0), after five sessions (T1), at the end of the stimulation (T2), after two weeks (T3) and after three months (T4). Moreover, an EEG assessment was conducted. RESULTS: Eight out of 10 patients showed new clinical signs of consciousness; specifically, a 2-point CRS-R improvement was detected in the last follow-up (p = 0.004). EEG upper α bandwidth was greater in the parietal site at T1 (p < 0.034). In addition, we found a significant correlation between behavioral and EEG indices at T1 (r = 0.89; p = 0.001). CONCLUSION: This preliminary study presents several limitations (small sample size and no control group). However, it provides important initial data that can be used to design randomized clinical trials testing this novel approach in MCS and to further explore EEG as a neural marker for the effects of tDCS.
OBJECTIVE: We tested the preliminary effects of bilateral anodal transcranial direct current stimulation (tDCS) in patients with disorders of consciousness. DESIGN: Open label pilot study. SUBJECTS: Ten chronic (greater than 12 months) patients in a minimally conscious state (MCS) following severe traumatic brain injury. METHODS: The patients received 10 sessions of bilateral M1 anodal tDCS. Behavioural changes were assessed with the Coma Recovery Scale-Revised (CRS-R) before stimulation (T-1, T0), after five sessions (T1), at the end of the stimulation (T2), after two weeks (T3) and after three months (T4). Moreover, an EEG assessment was conducted. RESULTS: Eight out of 10 patients showed new clinical signs of consciousness; specifically, a 2-point CRS-R improvement was detected in the last follow-up (p = 0.004). EEG upper α bandwidth was greater in the parietal site at T1 (p < 0.034). In addition, we found a significant correlation between behavioral and EEG indices at T1 (r = 0.89; p = 0.001). CONCLUSION: This preliminary study presents several limitations (small sample size and no control group). However, it provides important initial data that can be used to design randomized clinical trials testing this novel approach in MCS and to further explore EEG as a neural marker for the effects of tDCS.