Aurore Thibaut1, Andrea Piarulli2, Géraldine Martens3, Camille Chatelle4, Steven Laureys5. 1. Coma Science Group, University Hospital of Liège, Liège, Belgium; GIGA-Consciousness, University of Liège, Liège, Belgium. Electronic address: athibaut@ulg.ac.be. 2. Coma Science Group, University Hospital of Liège, Liège, Belgium; Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy. 3. Coma Science Group, University Hospital of Liège, Liège, Belgium. 4. Coma Science Group, University Hospital of Liège, Liège, Belgium; GIGA-Consciousness, University of Liège, Liège, Belgium; Laboratory for NeuroImaging of Coma and Consciousness - Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 5. Coma Science Group, University Hospital of Liège, Liège, Belgium; GIGA-Consciousness, University of Liège, Liège, Belgium.
Abstract
BACKGROUND:Spasticity management in severely brain-injured patients with disorders of consciousness (DOC) is a major challenge because it leads to complications and severe pain that can seriously affect quality of life. OBJECTIVES: We aimed to determine the feasibility of a single session of transcranial direct current stimulations (tDCS) to reduce spasticity in chronic patients with DOC. METHODS: We enrolled 14 patients in this double-blind, sham-controlled randomized crossover pilot study. Two cathodes were placed over the left and right primary motor cortex and 2 anodes over the left and right prefrontal cortex. Hypertonia of the upper limbs and level of consciousness were assessed by the Modified Ashworth Scale (MAS) and the Coma Recovery Scale-Revised (CRS-R). Resting state electroencephalography was also performed. RESULTS: At the group level, spasticity was reduced in only finger flexors. Four responders (29%) showed reduced hypertonicity in at least 2 joints after active but not sham stimulation. We found no behavioural changes by the CRS-R total score. At the group level, connectivity values in beta2 were higher with active versus sham stimulation. Relative power in the theta band and connectivity in the beta band were higher for responders than non-responders after the active stimulation. CONCLUSION: This pilot study highlights the potential benefit of using tDCS for reducing upper-limb hypertonia in patients with chronic DOC. Large-sample clinical trials are needed to optimize and validate the technique.
RCT Entities:
BACKGROUND:Spasticity management in severely brain-injured patients with disorders of consciousness (DOC) is a major challenge because it leads to complications and severe pain that can seriously affect quality of life. OBJECTIVES: We aimed to determine the feasibility of a single session of transcranial direct current stimulations (tDCS) to reduce spasticity in chronic patients with DOC. METHODS: We enrolled 14 patients in this double-blind, sham-controlled randomized crossover pilot study. Two cathodes were placed over the left and right primary motor cortex and 2 anodes over the left and right prefrontal cortex. Hypertonia of the upper limbs and level of consciousness were assessed by the Modified Ashworth Scale (MAS) and the Coma Recovery Scale-Revised (CRS-R). Resting state electroencephalography was also performed. RESULTS: At the group level, spasticity was reduced in only finger flexors. Four responders (29%) showed reduced hypertonicity in at least 2 joints after active but not sham stimulation. We found no behavioural changes by the CRS-R total score. At the group level, connectivity values in beta2 were higher with active versus sham stimulation. Relative power in the theta band and connectivity in the beta band were higher for responders than non-responders after the active stimulation. CONCLUSION: This pilot study highlights the potential benefit of using tDCS for reducing upper-limb hypertonia in patients with chronic DOC. Large-sample clinical trials are needed to optimize and validate the technique.
Authors: Alice Barra; Martin Rosenfelder; Sepehr Mortaheb; Manon Carrière; Geraldine Martens; Yelena G Bodien; Leon Morales-Quezada; Andreas Bender; Steven Laureys; Aurore Thibaut; Felipe Fregni Journal: Brain Sci Date: 2022-03-24