Repeated transcranial direct current stimulation in prolonged disorders of consciousness: A double-blind cross-over study.
OBJECTIVE
To evaluate effects of 5 sessions of transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in patients with prolonged disorders of consciousness (DOC).


METHODS
Seven patients in vegetative state (VS) and 6 in minimally conscious state (MCS), at ≥3months after brain injury, were randomized into two groups: group 1 received one week of active tDCS and 1week of sham stimulation, separated by 1 resting week; group 2 received active and sham stimulation in reverse order. We performed clinical and EEG evaluations before and after the first stimulation session, two hours after the last weekly stimulation, twice during the resting week, and during a 3-month follow-up.


RESULTS
We observed small changes of patients' conditions after the first tDCS session and immediately after the 5 active stimulations. Substantial clinical and EEG changes were observed in 5/13 patients (3 in MCS and 2 in VS) starting after entire (active and sham) stimulation protocol and further progressing during the next months. No baseline features distinguished patients who improved from patients who did not improve.


CONCLUSIONS
Repeated tDCS did not exert remarkable short-term clinical and EEG effects in patients with prolonged DOC. Further studies should ascertain whether tDCS might promote clinical recovery in the long-term period.
Neurorehabilitation Unit and Research Lab. for Disorder of Consciousness, Maugeri ICS, Telese Terme, Italy. Electronic address: anna.estraneo@fsm.it.
Anna
A
Estraneo
Neurorehabilitation Unit and Research Lab. for Disorder of Consciousness, Maugeri ICS, Telese Terme, Italy.
Angelo
A
Pascarella
Neurorehabilitation Unit and Research Lab. for Disorder of Consciousness, Maugeri ICS, Telese Terme, Italy.
Pasquale
P
Moretta
Neurorehabilitation Unit and Research Lab. for Disorder of Consciousness, Maugeri ICS, Telese Terme, Italy.
Orsola
O
Masotta
Neurorehabilitation Unit and Research Lab. for Disorder of Consciousness, Maugeri ICS, Telese Terme, Italy.
Salvatore
S
Fiorenza
Neurorehabilitation Unit and Research Lab. for Disorder of Consciousness, Maugeri ICS, Telese Terme, Italy.
Grazia
G
Chirico
Neurorehabilitation Unit and Research Lab. for Disorder of Consciousness, Maugeri ICS, Telese Terme, Italy.
Emanuela
E
Crispino
Neurorehabilitation Unit and Research Lab. for Disorder of Consciousness, Maugeri ICS, Telese Terme, Italy.
Vincenzo
V
Loreto
Neurorehabilitation Unit and Research Lab. for Disorder of Consciousness, Maugeri ICS, Telese Terme, Italy; Neuropsychology Lab., Dept. of Psychology, Second University of Naples, Caserta, Italy.
Luigi
L
Trojano
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications; D003244:Consciousness Disorders / Q000209:etiology / Q000628:therapy*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D016896:Treatment Outcome
Minimally conscious state; Neurorehabilitation; Transcranial direct current stimulation; Vegetative state