title: Electrical modulation of neuronal networks in brain-injured patients with disorders of consciousness: a systematic review.
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.
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Service de neurochirurgie, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France. Electronic address: jjlemaire@chu-clermontferrand.fr.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Lemaire
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Service de neurochirurgie, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Sontheimer
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Service d'ophtalmologie, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: H
authors.initials: H
authors.lastname: Nezzar
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Service de médecine physique et de réadaptation, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: B
authors.initials: B
authors.lastname: Pontier
authors.affiliation: Service de médecine physique et de réadaptation, hospices civils de Lyon, 3, quai des Célestins, BP 2251, 69229 Lyon cedex 02, France.
authors.forename: J
authors.initials: J
authors.lastname: Luauté
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: B
authors.initials: B
authors.lastname: Roche
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Service de réanimation médico-chirurgicale, hôpital Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: T
authors.initials: T
authors.lastname: Gillart
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Unité de neuroradiologie, hôpital Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Gabrillargues
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Unité d'électroencéphalographie et d'exploration fonctionnelle en neurologie, hôpital Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: S
authors.initials: S
authors.lastname: Rosenberg
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Service de neuropédiatrie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58 rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Sarret
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: F
authors.initials: F
authors.lastname: Feschet
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Service de neurochirurgie, CHU de Saint-Étienne, 42055 Saint-Étienne, France.
authors.forename: F
authors.initials: F
authors.lastname: Vassal
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Service de neurochirurgie, CHU de Nice, 06006 Nice cedex 1, France.
authors.forename: D
authors.initials: D
authors.lastname: Fontaine
authors.affiliation: IGCNC - EA 728, Image-Guided Clinical Neuroscience and Connectomics, université d'Auvergne, Clermont université, hôpital Gabriel Montpied, 2(e) étage, HC; 58, rue Montalembert, 63003 Clermont-Ferrand, France; Service de neurochirurgie, hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Coste
mesh_terms: D000818:Animals; D001143:Arousal / Q000502:physiology; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002415:Cats; D002986:Clinical Trials as Topic; D003244:Consciousness Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D046690:Deep Brain Stimulation; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D008475:Median Nerve / Q000503:physiopathology; D009415:Nerve Net / Q000503:physiopathology*; D010296:Parietal Lobe / Q000503:physiopathology; D018458:Persistent Vegetative State / Q000503:physiopathology / Q000628:therapy; D013116:Spinal Cord / Q000503:physiopathology; D013788:Thalamus / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
keywords: Brain injury; Conscience; Consciousness; Deep brain stimulation; Dommage cérébral; Neuromodulation; Stimulation cérébrale; Thalamus