Safety of Transcranial Direct Current Stimulation With a Programmable Ventriculoperitoneal Shunt: A Case Report.

Area of Science:

• Neuroscience
• Neurology
• Biomedical Engineering

Background:

• Disorders of consciousness (DoC) post-brain injury have limited treatment options.
• Noninvasive brain stimulation (NIBS) like TMS and tDCS shows promise for improving consciousness.
• Programmable ventriculoperitoneal (VP) shunts present challenges for NIBS due to electromagnetic interference risks.

Purpose of the Study:

• To assess the feasibility and safety of high-definition transcranial direct current stimulation (HD-tDCS) in a pediatric patient with a DoC and a programmable VP shunt.
• To explore HD-tDCS as a potential neuromodulatory alternative for patients with implanted VP shunts.

Main Methods:

• A 9-year-old girl with a minimally conscious state and a programmable VP shunt received 15 sessions of neuronavigation-guided HD-tDCS targeting the left dorsolateral prefrontal cortex.
• Stimulation involved gradual current titration up to 1 mA, with continuous clinical monitoring and serial imaging to assess VP shunt function.
• Computational modeling optimized the stimulation montage.

Main Results:

• No major adverse events were recorded during the 15 HD-tDCS sessions.
• Serial imaging confirmed stable VP shunt position and pressure settings throughout the intervention.
• Subtle clinical improvements were observed, including enhanced motor and visual responsiveness, despite no significant change in Coma Recovery Scale-Revised scores.

Conclusions:

• HD-tDCS is potentially safe and feasible for patients with programmable VP shunts requiring neuromodulation.
• tDCS may be a viable alternative to TMS in patients with contraindications related to VP shunts.
• Further systematic investigation is warranted to confirm these findings.