title: Behavioral and neurophysiological effects of repetitive transcranial magnetic stimulation on the minimally conscious state: a case study.
abstract: BACKGROUND
  In 2007, Schiff et al reported a patient in a minimally conscious state (MCS) who responded to deep brain stimulation (DBS), but clinicians cannot predict which patients might respond prior to the implantation of electrodes.
  
  
  METHODS
  A patient in a MCS for 5 years participated in an ABA design alternating between repetitive transcranial magnetic stimulation (rTMS) and peripheral nerve stimulation. rTMS (condition A) involved the delivery of 10 trains of 100 stimuli at 20 Hz using a stimulator with a 70-mm figure-of-eight coil to elicit a contraction of the abductor pollicis brevis. Condition B used median nerve electrical stimulation.
  
  
  RESULTS
  After peripheral stimulation, the patient did not exhibit clinical, behavioral, or electroencephalographic (EEG) changes. The frequency of specific and meaningful behaviors increased after rTMS, along with the absolute and relative power of the EEG δ, β, and α bands.
  
  
  CONCLUSIONS
  These results suggest that rTMS may improve awareness and arousal in MCS. If these results are reproducible, rTMS may identify subgroups of MCS patients who might benefit from DBS.
authors.affiliation: Department of Neurorehabilitation, IRCCS S. Camillo, Venice, Italy. francesco.piccione@ospedalesancamillo.net
authors.forename: Francesco
authors.initials: F
authors.lastname: Piccione
authors.forename: Marianna
authors.initials: M
authors.lastname: Cavinato
authors.forename: Paolo
authors.initials: P
authors.lastname: Manganotti
authors.forename: Emanuela
authors.initials: E
authors.lastname: Formaggio
authors.forename: Silvia Francesca
authors.initials: SF
authors.lastname: Storti
authors.forename: Leontino
authors.initials: L
authors.lastname: Battistin
authors.forename: Annachiara
authors.initials: A
authors.lastname: Cagnin
authors.forename: Paolo
authors.initials: P
authors.lastname: Tonin
authors.forename: Mauro
authors.initials: M
authors.lastname: Dam
mesh_terms: D000368:Aged; D001703:Biophysics / Q000379:methods; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000502:physiology / Q000528:radiation effects; D046690:Deep Brain Stimulation / Q000379:methods*; D004569:Electroencephalography; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D018458:Persistent Vegetative State / Q000503:physiopathology* / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation