Effects of 20 Hz Repetitive Transcranial Magnetic Stimulation on Disorders of Consciousness: A Resting-State Electroencephalography Study

Fangping He, Min Wu, Fanxia Meng, Yangfan Hu, Jian Gao, Zhongqin Chen, Wangxiao Bao, Kehong Liu, Benyan Luo, Gang Pan, Fangping He, Min Wu, Fanxia Meng, Yangfan Hu, Jian Gao, Zhongqin Chen, Wangxiao Bao, Kehong Liu, Benyan Luo, Gang Pan

Abstract

Repetitive transcranial magnetic stimulation (rTMS) has been proposed as an experimental approach for the treatment of disorders of consciousness (DOC). To date, there has been little research into the use of rTMS in DOC and the therapeutic effects have been variously documented. This study aimed to examine the effects of 20 Hz rTMS on the electroencephalography (EEG) reactivity and clinical response in patients with DOC and to explore the neuromodulatory effects of high-frequency rTMS. In this randomized, sham-controlled, crossover study, real or sham 20 Hz rTMS was applied to the left primary motor cortex (M1) of patients with DOC for 5 consecutive days. Evaluations were blindly performed at the baseline (T0), immediately after the end of the 5 days of treatment (T1) and 1 week after the treatment (T2) using the JFK coma recovery scale-revised (CRS-R) and resting-state EEG. Only one patient, with a history of 2 months of traumatic brain injury, showed long-lasting (T1, T2) behavioral and neurophysiological modifications after the real rTMS stimulation. The 5 remaining patients presented brain reactivity localized at several electrodes, and the EEG modification was not significant. rTMS stimulation may improve awareness and arousal of DOC. Additionally, EEG represents a potential biomarker for the therapeutic efficacy of rTMS. This trial is registered with (NCT03385278).

Figures

Figure 1
Figure 1
rTMS protocol for the patients. (a) The study design. All patients received active 20 Hz rTMS and sham stimulation for 5 consecutive days over the left primary motor cortex (M1), in separate sessions spaced one week. Clinical evaluation and EEG data were assessed at the baseline (T0), immediately after the end of the 5 days of treatment (T1) and 1 week after the treatment (T2). (b) rTMS procedure. A session of 1000 pulses were delivered in 20 trains. Each stimulation train lasted 2.5 s with a 28 s intertrain pause.
Figure 2
Figure 2
Delta, theta, alpha, and beta relative powers (%) prereal and postreal rTMS at T0 (beginning of the exam), T1 (after rTMS), and T2 (1 week after rTMS) in patient number 4. Almost all powers at F3, F4, C3, and C4 electrode sites increased after real rTMS treatment, especially at F3 and C3.
Figure 3
Figure 3
Delta, theta, alpha, and beta relative powers (%) presham and postsham rTMS at T0, T1, and T2 in patient number 5. The beta power at four electrode sites increased after sham rTMS treatment (T1) and decreased within one week (T2).
Figure 4
Figure 4
Grand average (5 patients, patients' numbers 1, 2, 3, 5, and 6) of delta, theta, alpha, and beta relative powers (%) prereal and postreal and presham and postsham rTMS at T0, T1, and T2.

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