Repetitive transcranial magnetic stimulation induced slow wave activity modification: A possible role in disorder of consciousness differential diagnosis?
Slow wave activity (SWA) generation depends on cortico-thalamo-cortical loops that are disrupted in patients with chronic Disorders of Consciousness (DOC), including the Unresponsive Wakefulness Syndrome (UWS) and the Minimally Conscious State (MCS). We hypothesized that the modulation of SWA by means of a repetitive transcranial magnetic stimulation (rTMS) could reveal residual patterns of connectivity, thus supporting the DOC clinical differential diagnosis. We enrolled 10 DOC individuals who underwent a 24hh polysomnography followed by a real or sham 5Hz-rTMS over left primary motor area, and a second polysomnographic recording. A preserved sleep-wake cycle, a standard temporal progression of sleep stages, and a SWA perturbation were found in all of the MCS patients and in none of the UWS individuals, only following the real-rTMS. In conclusion, our combined approach may improve the differential diagnosis between MCS patients, who show a partial preservation of cortical plasticity, and UWS individuals, who lack such properties.
IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
Laura Rosa
LR
Pisani
IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
Antonino
A
Naro
IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
Antonino
A
Leo
Department of Neuroscience, University of Messina, Messina, Italy.
Irene
I
Aricò
Department of Neuroscience, University of Messina, Messina, Italy.
Francesco
F
Pisani
Department of Neuroscience, University of Messina, Messina, Italy.
Rosalia
R
Silvestri
IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
Placido
P
Bramanti
IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy. Electronic address: salbro77@tiscali.it.
Rocco Salvatore
RS
Calabrò
D000328:Adult; D000368:Aged; D058256:Brain Waves / Q000502:physiology*; D002540:Cerebral Cortex / Q000503:physiopathology*; D003244:Consciousness Disorders / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000503:physiopathology; D017286:Polysomnography; D013788:Thalamus / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
Disorders of consciousness; MCS; Polysomnography; Slow wave activity; Transcranial magnetic stimulation; UWS