Data_Sheet_1_Electroencephalography and Functional Magnetic Resonance Imaging-Guided Simultaneous Transcranial Direct Current Stimulation and Repetiti.pdf (105.72 kB)

Data_Sheet_1_Electroencephalography and Functional Magnetic Resonance Imaging-Guided Simultaneous Transcranial Direct Current Stimulation and Repetitive Transcranial Magnetic Stimulation in a Patient With Minimally Conscious State.pdf

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posted on 31.07.2019 by Yicong Lin, Tiaotiao Liu, Qian Huang, Yingying Su, Weibi Chen, Daiquan Gao, Xin Tian, Taicheng Huang, Zonglei Zhen, Tao Han, Hong Ye, Yuping Wang
Objective

A minimally conscious state (MCS) is characterized by discernible behavioral evidence of consciousness that cannot be reproduced consistently. This condition is highly challenging to treat. Recent studies have demonstrated the potential therapeutic effect of non-invasive brain stimulation in patients with MCS. In one patient in an MCS, we delivered simultaneous transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) based on an individual brain network analysis and evaluated the therapeutic effect.

Methods

The directional transfer function (DTF) was calculated based on electroencephalograph (EEG) analysis. Global brain connectivity was calculated based on functional magnetic resonance imaging (fMRI) analysis. By referring to the EEG and fMRI results, we identified inferior parietal lobes (IPLs) as targets. In the 2-week treatment period, 14 sessions were applied to the identified bilateral parietal regions. Simultaneous 1.5-mA anodal tDCS and 5-Hz rTMS were delivered for 20 min per hemisphere in each session. Clinical evaluation scores were recorded weekly throughout the treatment. A second patient given the routine treatment was evaluated as a control.

Results

The clinical scores of patient 1 with MCS improved after 2 weeks of stimulation treatment, and the effect lasted for up to 1 month. EEG analysis showed a significant increase (p < 0.001) in the DTF value in the gamma band in a bilateral set of posterior regions, and fMRI showed a trend toward normalized activity in the IPLs. The clinical scores of patient 2 with coma did not improve much after 2 weeks of routine treatment. The EEG analysis showed a significant increase (p = 0.021) in the DTF value in the gamma band in a bilateral set of posterior regions.

Conclusion

The application of EEG and fMRI to characterize the functional connectivity features of the network in an MCS patient provided a reasonable and accurate stimulation target and verified the changes in functional connectivity resulting from stimulation.

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