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Hu Y, Hu L, Wang Y, Luo X, Zhao X, He L. The effects of non-invasive brain stimulation on disorder of consciousness in patients with brain injury: A systematic review and meta-analysis of randomized controlled trial. Brain Res 2024; 1822:148633. [PMID: 37839670 DOI: 10.1016/j.brainres.2023.148633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/30/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Disorders of consciousness (DOC) result from neural system injury and manifest as changes in arousal or awareness. This systematic review and meta-analysis aimed to investigate the therapeutic effects of non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), on consciousness dysfunction in patients with brain disorders. METHODS Literature was systematically searched in Medline, Embase, Cochrane database, Web of Science, EBSCO from inception to May 2023. Only randomized controlled trial with NIBS as an intervention and participants with DOC were included. RESULTS A total of 7 studies with 313 participants were included for meta-analysis. Compared with sham- or placebo-stimulation, NIBS can improve the Coma Recovery Scale-Revised scores significantly (mean difference [MD] = 1.96, 95 % confidence interval [CI] = [1.49; 2.43], P <.0001). CONCLUSION NIBS has a significant positive effect in enhancing the symptoms of DOC. Nevertheless, it is imperative for further investigations comprising high-quality research designs and larger sample sizes in order to comprehensively elucidate the effects of NIBS techniques on diverse targets of stimulation within the population of individuals suffering from DOC.
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Affiliation(s)
- Yu Hu
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Linzhe Hu
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Yuchan Wang
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Xiaozhou Luo
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Xin Zhao
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Lin He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu 610041, China.
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Nekrasova J, Kanarskii M, Borisov I, Pradhan P, Shunenkov D, Vorobiev A, Smirnova M, Pasko V, Petrova MV, Luginina E, Pryanikov I. One-Year Demographical and Clinical Indices of Patients with Chronic Disorders of Consciousness. Brain Sci 2021; 11:brainsci11050651. [PMID: 34065687 PMCID: PMC8156613 DOI: 10.3390/brainsci11050651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/27/2022] Open
Abstract
This work aims to evaluate the prognostic value of the demographical and clinical data on long-term outcomes (up to 12 months) in patients with severe acquired brain injury with vegetative state/unresponsive wakefulness syndrome (VS/UWS/UWS) or a minimally conscious state (MCS). Patients (n = 211) with VS/UWS/UWS (n = 123) and MCS (n = 88) were admitted to the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology after anoxic brain injury (n = 53), vascular lesions (n = 59), traumatic brain injury (n = 93), and other causes (n = 6). At the beginning of the 12-month study, younger age and a higher score by the Coma Recovery Scale-Revised (CRS-R) predicted a survival. However, no reliable markers of significant positive dynamics of consciousness were found. Based on the etiology, anoxic brain injury has the most unfavorable prognosis. For patients with vascular lesions, the first three months after injury have the most important prognostic value. No correlations were found between survival, increased consciousness, and gender. The demographic and clinical characteristics of patients with chronic DOC can be used to predict long-term mortality in patients with chronic disorders of consciousness. Further research should be devoted to finding reliable predictors of recovery of consciousness.
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Affiliation(s)
- Julia Nekrasova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Mikhail Kanarskii
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Ilya Borisov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Pranil Pradhan
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
- Correspondence: ; Tel.: +7-(977)-709-4468
| | - Denis Shunenkov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Alexey Vorobiev
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Maria Smirnova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Vera Pasko
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Marina V. Petrova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
- Department of Anestesiology-Reanimatology, People’s Friendship University of Russia, 117198 Moscow, Russia
| | - Elena Luginina
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
| | - Igor Pryanikov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (J.N.); (M.K.); (I.B.); (D.S.); (A.V.); (I.P.); (M.S.); (V.P.); (M.V.P.); (E.L.)
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Toscano M, Ricci M, Celletti C, Paoloni M, Ruggiero M, Viganò A, Jannini TB, Altarocca A, Liberatore M, Camerota F, Di Piero V. Motor Recovery After Stroke: From a Vespa Scooter Ride Over the Roman Sampietrini to Focal Muscle Vibration (fMV) Treatment. A 99mTc-HMPAO SPECT and Neurophysiological Case Study. Front Neurol 2020; 11:567833. [PMID: 33281704 PMCID: PMC7705992 DOI: 10.3389/fneur.2020.567833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/19/2020] [Indexed: 01/19/2023] Open
Abstract
Focal repetitive muscle vibration (fMV) is a safe and well-tolerated non-invasive brain and peripheral stimulation (NIBS) technique, easy to perform at the bedside, and able to promote the post-stroke motor recovery through conditioning the stroke-related dysfunctional structures and pathways. Here we describe the concurrent cortical and spinal plasticity induced by fMV in a chronic stroke survivor, as assessed with 99mTc-HMPAO SPECT, peripheral nerve stimulation, and gait analysis. A 72-years-old patient was referred to our stroke clinic for a right leg hemiparesis and spasticity resulting from a previous (4 years before) hemorrhagic stroke. He reported a subjective improvement of his right leg's spasticity and dysesthesia that occurred after a30-min ride on a Vespa scooter as a passenger over the Roman Sampietrini (i.e., cubic-shaped cobblestones). Taking into account both the patient's anecdote and the current guidelines that recommend fMV for the treatment of post-stroke spasticity, we then decided to start fMV treatment. 12 fMV sessions (frequency 100 Hz; amplitude range 0.2–0.5 mm, three 10-min daily sessions per week for 4 consecutive weeks) were applied over the quadriceps femoris, triceps surae, and hamstring muscles through a specific commercial device (Cro®System, NEMOCOsrl). A standardized clinical and instrumental evaluation was performed before (T0) the first fMV session and after (T1) the last one. After fMV treatment, we observed a clinically relevant motor and functional improvement, as assessed by comparing the post-treatment changes in the score of the Fugl-Meyer assessment, the Motricity Index score, the gait analysis, and the Ashworth modified scale, with the respective minimal detectable change at the 95% confidence level (MDC95). Data from SPECT and peripheral nerve stimulation supported the evidence of a concurrent brain and spinal plasticity promoted by fMV treatment trough activity-dependent changes in cortical perfusion and motoneuron excitability, respectively. In conclusion, the substrate of post-stroke motor recovery induced by fMV involves a concurrently acting multisite plasticity (i.e., cortical and spinal plasticity). In our patient, operant conditioning of both cortical perfusion and motoneuron excitability throughout a month of fMV treatment was related to a clinically relevant improvement in his strength, step symmetry (with reduced limping), and spasticity.
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Affiliation(s)
- Massimiliano Toscano
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Maria Ricci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Claudia Celletti
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, "Sapienza" University of Rome, Rome, Italy
| | - Marco Ruggiero
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | | | - Tommaso B Jannini
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Altarocca
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Mauro Liberatore
- Department of Radiological, oncological and pathological Sciences - Radiometabolic Division, Umberto I Hospital, Rome, Italy
| | - Filippo Camerota
- Physical Medicine and Rehabilitation Division, Umberto I Hospital, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
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