Author: Bourdillon P1,2,3,4,5, Hermann B2,3,4,5,6, Sitt JD3,4,5, Naccache L2,3,4,5,7
Affiliation:
1Department of Neurosurgery, Adolphe de Rothschild Foundation, Paris, France.
2Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France.
3Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France.
4Inserm U 1127, Paris, France.
5CNRS, UMR 7225, Paris, France.
6Department of Neurology, Neuro ICU, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.
7Department of Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.
Conference/Journal: Front Neurosci.
Date published: 2019 Mar 18
Other:
Volume ID: 13 , Pages: 223 , Special Notes: doi: 10.3389/fnins.2019.00223. eCollection 2019. , Word Count: 283
Severe brain injury is a common cause of coma. In some cases, despite vigilance improvement, disorders of consciousness (DoC) persist. Several states of impaired consciousness have been defined, according to whether the patient exhibits only reflexive behaviors as in the vegetative state/unresponsive wakefulness syndrome (VS/UWS) or purposeful behaviors distinct from reflexes as in the minimally conscious state (MCS). Recently, this clinical distinction has been enriched by electrophysiological and neuroimaging data resulting from a better understanding of the physiopathology of DoC. However, therapeutic options, especially pharmacological ones, remain very limited. In this context, electroceuticals, a new category of therapeutic agents which act by targeting the neural circuits with electromagnetic stimulations, started to develop in the field of DoC. We performed a systematic review of the studies evaluating therapeutics relying on the direct or indirect electro-magnetic stimulation of the brain in DoC patients. Current evidence seems to support the efficacy of deep brain stimulation (DBS) and non-invasive brain stimulation (NIBS) on consciousness in some of these patients. However, while the latter is non-invasive and well tolerated, the former is associated with potential major side effects. We propose that all chronic DoC patients should be given the possibility to benefit from NIBS, and that transcranial direct current stimulation (tDCS) should be preferred over repetitive transcranial magnetic stimulation (rTMS), based on the literature and its simple use. Surgical techniques less invasive than DBS, such as vagus nerve stimulation (VNS) might represent a good compromise between efficacy and invasiveness but still need to be further investigated.
KEYWORDS: consciousness; deep brain stimulation; disorders of consciousness; transcranial alternative current stimulation; transcranial direct current stimulation; transcranial electric stimulation; transcranial magnetic stimulation; vagus nerve stimulation
PMID: 30936822 PMCID: PMC6432925 DOI: 10.3389/fnins.2019.00223
