Barra Alice, Huerta-Gutierrez Rodrigo, Annen Jitka, Martens Geraldine, Laureys Steven, Llorens Roberto, Kurth Tobias, Thibaut Aurore
NeuroRecovery Lab, GIGA-Consciousness, GIGA Institute, University of Liège, Liège, Belgium; IRENEA - Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, València, Spain.
Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Neurotherapeutics. 2025 Jul;22(4):e00587. doi: 10.1016/j.neurot.2025.e00587. Epub 2025 Apr 18.
The treatment for patients with disorders of consciousness challenges researchers and clinicians. The stimulation of the left dorsolateral prefrontal cortex with transcranial direct current stimulation (tDCS) may enhance behavioral responsiveness of a subset of patients in a minimally conscious state, while having limited effects in unresponsive patients. However, heterogeneity in responses raises questions about the effectiveness of tDCS. Our objective was to explore the characteristics of responders to tDCS based on previously published RCTs and investigate the heterogeneity of treatment effect to better direct future tDCS studies towards patient profiles that appear to be more responsive to the treatment. We explored clinical and demographical differences between responders (i.e., recovery of a new sign of consciousness after active stimulation) and non-responder and the predictors of treatment response with a LASSO logistic regression. We included 131 patients (44 women, 61 traumatic brain injury, 90 minimally conscious, mean age 46.13 years [SD = 16], median time since injury 12.84 months [IQR: 5.25-35.10]) of which 33 responded to tDCS. While 32 % of minimally conscious patients responded to tDCS (95%CI 0.24, 0.43), 10 % (95%CI 0.04, 0.25) of those unresponsive responded. The regression model, using diagnosis at baseline, Coma Recovery Scale-Revised Index at baseline, age, sex and time since injury correctly discriminated between tDCS responders and non-responders (area under the curve of 0.77). Our findings suggest that patients in minimally conscious state, with a better cognitive profile and longer TSI respond better to tDCS, making them better candidates for the treatment.
意识障碍患者的治疗对研究人员和临床医生而言是一项挑战。经颅直流电刺激（tDCS）刺激左侧背外侧前额叶皮质可能会增强部分处于最小意识状态患者的行为反应能力，而对无反应患者的效果有限。然而，反应的异质性引发了对tDCS有效性的质疑。我们的目标是基于先前发表的随机对照试验探索tDCS反应者的特征，并调查治疗效果的异质性，以便更好地指导未来的tDCS研究针对那些似乎对该治疗反应更佳的患者特征。我们通过套索逻辑回归探索了反应者（即主动刺激后出现新的意识迹象）和无反应者之间的临床和人口统计学差异以及治疗反应的预测因素。我们纳入了131例患者（44名女性，61例创伤性脑损伤，90例处于最小意识状态，平均年龄46.13岁[标准差=16]，受伤后中位时间12.84个月[四分位间距：5.25 - 35.10]），其中33例对tDCS有反应。虽然32%的最小意识状态患者对tDCS有反应（95%置信区间0.24，0.43），但无反应患者中有10%（95%置信区间0.04，0.25）有反应。使用基线诊断、基线昏迷恢复量表修订指数、年龄、性别和受伤后时间的回归模型能够正确区分tDCS反应者和无反应者（曲线下面积为0.77）。我们的研究结果表明，认知状况较好且受伤后时间间隔较长的最小意识状态患者对tDCS反应更佳，使其成为该治疗的更佳候选者。
