title: Transcranial direct current stimulation effects in disorders of consciousness.
abstract: OBJECTIVE
  To assess the efficacy of transcranial direct current stimulation (tDCS) on improving consciousness in patients with persistent unresponsive wakefulness syndrome (UWS) (previously termed persistent vegetative state [PVS]) or in a minimally conscious state (MCS).
  
  
  METHODS
  Prospective, case series trial with follow-up at 12 months.
  
  
  METHODS
  General and research hospital.
  
  
  METHODS
  Inpatients in a PVS/UWS or MCS (N=10; 7 men, 3 women; age range, 19-62y; etiology: traumatic brain injury, n=5; anoxia, n=4; postoperative infarct, n=1; duration of PVS/UWS or MCS range, 6mo-10y). No participant withdrew because of adverse effects.
  
  
  METHODS
  All patients received sham tDCS for 20 minutes per day, 5 days per week, for 1 week, and real tDCS for 20 minutes per day, 5 days per week, for 2 weeks. An anodal electrode was placed over the left primary sensorimotor cortex or the left dorsolateral prefrontal cortex, with cathodal stimulation over the right eyebrow. One patient in an MCS received a second round of 10 tDCS sessions 3 months after initial participation.
  
  
  METHODS
  JFK Coma Recovery Scale-Revised.
  
  
  RESULTS
  All patients in an MCS showed clinical improvement immediately after treatment. The patient who received a second round of tDCS 3 months after initial participation showed further improvement and emergence into consciousness after stimulation, with no change between treatments. One patient who was in an MCS for <1 year before treatment (postoperative infarct) showed further improvement and emergence into consciousness at 12-month follow-up. No patient showed improvement before stimulation. No patient in a PVS/UWS showed immediate improvement after stimulation, but 1 patient who was in a PVS/UWS for 6 years before treatment showed improvement and change of status to an MCS at 12-month follow-up.
  
  
  CONCLUSIONS
  tDCS seems promising for the rehabilitation of patients with severe disorders of consciousness. Severity and duration of pathology may be related to the degree of tDCS' beneficial effects.
authors.affiliation: Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece; Evangelismos Hospital, Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: eaggelak@med.uoa.gr.
authors.forename: Efthymios
authors.initials: E
authors.lastname: Angelakis
authors.affiliation: Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece; Evangelismos Hospital, Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Liouta
authors.affiliation: Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Andreadis
authors.affiliation: Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece; Evangelismos Hospital, Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Stephanos
authors.initials: S
authors.lastname: Korfias
authors.affiliation: Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece.
authors.forename: Periklis
authors.initials: P
authors.lastname: Ktonas
authors.affiliation: Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece; Evangelismos Hospital, Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Stranjalis
authors.affiliation: Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece; Evangelismos Hospital, Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Damianos E
authors.initials: DE
authors.lastname: Sakas
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000534:rehabilitation*; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome
keywords: CRS-R; Coma Recovery Scale-Revised; DLPFC; Deep brain stimulation; FDG-PET; MCS; MCS+; MCS–; PVS; Persistent vegetative state; Rehabilitation; TBI; UWS; VS; [(18)F]-fluorodeoxyglucose positron emission tomography; dorsolateral prefrontal cortex; fMRI; functional magnetic resonance imaging; minimally conscious state; minimally conscious state minus; minimally conscious state plus; persistent vegetative state; rCBF; regional cerebral blood flow; tDCS; transcranial direct current stimulation; traumatic brain injury; unresponsive wakefulness syndrome; vegetative state