Electromagnetic Brain Stimulation in Patients With Disorders of Consciousness
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/unresponsiv...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-03-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fnins.2019.00223/full |
| _version_ | 1818480444776120320 |
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| author | Pierre Bourdillon Pierre Bourdillon Pierre Bourdillon Pierre Bourdillon Pierre Bourdillon Bertrand Hermann Bertrand Hermann Bertrand Hermann Bertrand Hermann Bertrand Hermann Jacobo D. Sitt Jacobo D. Sitt Jacobo D. Sitt Lionel Naccache Lionel Naccache Lionel Naccache Lionel Naccache Lionel Naccache |
| author_facet | Pierre Bourdillon Pierre Bourdillon Pierre Bourdillon Pierre Bourdillon Pierre Bourdillon Bertrand Hermann Bertrand Hermann Bertrand Hermann Bertrand Hermann Bertrand Hermann Jacobo D. Sitt Jacobo D. Sitt Jacobo D. Sitt Lionel Naccache Lionel Naccache Lionel Naccache Lionel Naccache Lionel Naccache |
| author_sort | Pierre Bourdillon |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T11:23:41Z |
| format | Article |
| id | doaj.art-e2f8b199768248c08025117390f31c7c |
| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-12-10T11:23:41Z |
| publishDate | 2019-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neuroscience |
| spelling | doaj.art-e2f8b199768248c08025117390f31c7c2022-12-22T01:50:51ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2019-03-011310.3389/fnins.2019.00223445903Electromagnetic Brain Stimulation in Patients With Disorders of ConsciousnessPierre Bourdillon0Pierre Bourdillon1Pierre Bourdillon2Pierre Bourdillon3Pierre Bourdillon4Bertrand Hermann5Bertrand Hermann6Bertrand Hermann7Bertrand Hermann8Bertrand Hermann9Jacobo D. Sitt10Jacobo D. Sitt11Jacobo D. Sitt12Lionel Naccache13Lionel Naccache14Lionel Naccache15Lionel Naccache16Lionel Naccache17Department of Neurosurgery, Adolphe de Rothschild Foundation, Paris, FranceSorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, FranceInstitut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, FranceInserm U 1127, Paris, FranceCNRS, UMR 7225, Paris, FranceSorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, FranceInstitut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, FranceInserm U 1127, Paris, FranceCNRS, UMR 7225, Paris, FranceDepartment of Neurology, Neuro ICU, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, FranceInstitut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, FranceInserm U 1127, Paris, FranceCNRS, UMR 7225, Paris, FranceSorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, FranceInstitut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, FranceInserm U 1127, Paris, FranceCNRS, UMR 7225, Paris, FranceDepartment of Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, FranceSevere 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.https://www.frontiersin.org/article/10.3389/fnins.2019.00223/fullconsciousnessdisorders of consciousnessdeep brain stimulationvagus nerve stimulationtranscranial magnetic stimulationtranscranial electric stimulation |
| spellingShingle | Pierre Bourdillon Pierre Bourdillon Pierre Bourdillon Pierre Bourdillon Pierre Bourdillon Bertrand Hermann Bertrand Hermann Bertrand Hermann Bertrand Hermann Bertrand Hermann Jacobo D. Sitt Jacobo D. Sitt Jacobo D. Sitt Lionel Naccache Lionel Naccache Lionel Naccache Lionel Naccache Lionel Naccache Electromagnetic Brain Stimulation in Patients With Disorders of Consciousness Frontiers in Neuroscience consciousness disorders of consciousness deep brain stimulation vagus nerve stimulation transcranial magnetic stimulation transcranial electric stimulation |
| title | Electromagnetic Brain Stimulation in Patients With Disorders of Consciousness |
| title_full | Electromagnetic Brain Stimulation in Patients With Disorders of Consciousness |
| title_fullStr | Electromagnetic Brain Stimulation in Patients With Disorders of Consciousness |
| title_full_unstemmed | Electromagnetic Brain Stimulation in Patients With Disorders of Consciousness |
| title_short | Electromagnetic Brain Stimulation in Patients With Disorders of Consciousness |
| title_sort | electromagnetic brain stimulation in patients with disorders of consciousness |
| topic | consciousness disorders of consciousness deep brain stimulation vagus nerve stimulation transcranial magnetic stimulation transcranial electric stimulation |
| url | https://www.frontiersin.org/article/10.3389/fnins.2019.00223/full |
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