1. Electrical modulation of neuronal networks in brain-injured patients with disorders of consciousness: a systematic review.
- Author
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Lemaire JJ, Sontheimer A, Nezzar H, Pontier B, Luauté J, Roche B, Gillart T, Gabrillargues J, Rosenberg S, Sarret C, Feschet F, Vassal F, Fontaine D, and Coste J
- Subjects
- Animals, Arousal physiology, Brain Injuries complications, Brain Injuries physiopathology, Cats, Clinical Trials as Topic, Consciousness Disorders etiology, Consciousness Disorders physiopathology, Frontal Lobe physiopathology, Humans, Median Nerve physiopathology, Parietal Lobe physiopathology, Persistent Vegetative State physiopathology, Persistent Vegetative State therapy, Spinal Cord physiopathology, Thalamus physiopathology, Transcranial Magnetic Stimulation, Treatment Outcome, Brain Injuries therapy, Consciousness Disorders therapy, Deep Brain Stimulation, Nerve Net physiopathology
- Abstract
Six clinical studies of chronic electrical modulation of deep brain circuits published between 1968 and 2010 have reported effects in 55 vegetative or minimally conscious patients. The rationale stimulation was to activate the cortex through the reticular-thalamic complex, comprising the tegmental ascending reticular activating system and its thalamic targets. The most frequent intended target was the central intralaminar zone and adjacent nuclei. Hassler et al. also proposed to modulate the pallidum as part of the arousal and wakefulness system. Stimulation frequency varied from 8Hz to 250Hz. Most patients improved, although in a limited way. Schiff et al. found correlations between central thalamus stimulation and arousal and conscious behaviours. Other treatments that have offered some clinical benefit include drugs, repetitive magnetic transcranial stimulation, median nerve stimulation, stimulation of dorsal column of the upper cervical spinal cord, and stimulation of the fronto-parietal cortex. No one treatment has emerged as a gold standard for practice, which is why clinical trials are still on-going. Further clinical studies are needed to decipher the altered dynamics of neuronal network circuits in patients suffering from severe disorders of consciousness as a step towards novel therapeutic strategies., (Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)
- Published
- 2014
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