From the Coma Science Group (A.T., M.-A.B., D.L., A.D., S.L.), Cyclotron Research Centre; and the Departments of Neurology (A.T., M.-A.B., A.D., S.L.) and General Intensive Care (D.L.), University Hospital of Liège, Belgium.
Neurology. 2014 Apr 1;82(13):1112-8. doi: 10.1212/WNL.0000000000000260. Epub 2014 Feb 26.
We assessed the effects of left dorsolateral prefrontal cortex transcranial direct current stimulation (DLPF-tDCS) on Coma Recovery Scale-Revised (CRS-R) scores in severely brain-damaged patients with disorders of consciousness.
In a double-blind sham-controlled crossover design, anodal and sham tDCS were delivered in randomized order over the left DLPF cortex for 20 minutes in patients in a vegetative state/unresponsive wakefulness syndrome (VS/UWS) or in a minimally conscious state (MCS) assessed at least 1 week after acute traumatic or nontraumatic insult. Clinical assessments were performed using the CRS-R directly before and after anodal and sham tDCS stimulation. Follow-up outcome data were acquired 12 months after inclusion using the Glasgow Outcome Scale-Extended.
Patients in MCS (n = 30; interval 43 ± 63 mo; 19 traumatic, 11 nontraumatic) showed a significant treatment effect (p = 0.003) as measured by CRS-R total scores. In patients with VS/UWS (n = 25; interval 24 ± 48 mo; 6 traumatic, 19 nontraumatic), no treatment effect was observed (p = 0.952). Thirteen (43%) patients in MCS and 2 (8%) patients in VS/UWS further showed postanodal tDCS-related signs of consciousness, which were observed neither during the pre-tDCS evaluation nor during the pre- or post-sham evaluation (i.e., tDCS responders). Outcome did not differ between tDCS responders and nonresponders.
tDCS over left DLPF cortex may transiently improve signs of consciousness in MCS following severe brain damage as measured by changes in CRS-R total scores.
This study provides Class II evidence that short-duration tDCS of the left DLPF cortex transiently improves consciousness as measured by CRS-R assessment in patients with MCS.
我们评估了左背外侧前额叶皮层经颅直流电刺激（DLPF-tDCS）对意识障碍的严重脑损伤患者昏迷恢复量表修订版（CRS-R）评分的影响。
在一项双盲假对照交叉设计中，在植物状态/无反应觉醒综合征（VS/UWS）或最小意识状态（MCS）患者中，以随机顺序给予左侧 DLPF 皮层的阳极和假 tDCS，时间为 20 分钟，这些患者在急性创伤性或非创伤性损伤后至少 1 周进行了评估。在阳极和假 tDCS 刺激前后直接进行临床评估，使用 CRS-R 进行评估。在纳入后 12 个月使用格拉斯哥结局量表-扩展获得随访结果数据。
MCS 患者（n=30；间隔 43±63 个月；19 例创伤性，11 例非创伤性）的 CRS-R 总分显示出显著的治疗效果（p=0.003）。VS/UWS 患者（n=25；间隔 24±48 个月；6 例创伤性，19 例非创伤性）中未观察到治疗效果（p=0.952）。13（43%）例 MCS 患者和 2（8%）例 VS/UWS 患者在接受阳极 tDCS 后出现与意识相关的迹象，这些迹象既不在预 tDCS 评估期间，也不在预 sham 评估或 post-sham 评估期间观察到（即 tDCS 反应者）。反应者和非反应者的结果没有差异。
左背外侧前额叶皮层的 tDCS 可能会短暂地改善严重脑损伤后 MCS 的意识状态，如 CRS-R 总分的变化所示。
这项研究提供了 II 级证据，表明左背外侧前额叶皮层的短时间 tDCS 可通过 CRS-R 评估改善 MCS 患者的意识。
