Neuromodulation and Disorders of Consciousness: Systematic Review and Pathophysiology.
Rajeev R Dutta1, Sheila Abdolmanafi2, Alex Rabizadeh2
1School of Medicine, University of California Irvine, Irvine, CA, USA.
Summary
Neuromodulation, including deep brain stimulation and repetitive transcranial magnetic stimulation, shows potential for treating disorders of consciousness (DoC). While outcomes vary, deep brain stimulation appears more effective, though less invasive options like rTMS also show promise.
Area of Science:
- Neuroscience
- Neurology
- Rehabilitation Medicine
Background:
- Disorders of consciousness (DoC) affect hundreds of thousands, with limited pharmacotherapies.
- Neuromodulation is explored as an alternative treatment for DoC.
- Systematic review to assess evidence for neuromodulation in DoC treatment.
Purpose of the Study:
- To systematically review evidence on neuromodulation techniques for treating disorders of consciousness.
- To evaluate the efficacy and invasiveness of different neuromodulation modalities.
Main Methods:
- Systematic literature review following PRISMA guidelines.
- Searched PubMed, Scopus, and Web of Science databases (1990-2023).
- Included human and animal studies targeting DoC, excluding those not focused on DoC.
Main Results:
- 69 studies (58 human, 11 animal) met criteria, involving over 1000 patients and 150 animals.
- Deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS) were most studied in humans.
- Animal studies primarily used DBS and TMS.
Conclusions:
- Deep brain stimulation showed greater improvements in DoC compared to other methods.
- Repetitive transcranial magnetic stimulation (rTMS) demonstrated clinical potential with lower invasiveness.
- Clinical outcomes were mixed and potentially confounded by natural recovery or pharmacologic interventions.
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