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New prospects in treatment of consciousness disorders

Study investigates potential of transcranial direct current stimulation (tDCS) after serious brain injury

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New research into the potential of brain stimulation in treating patients with consciousness disorders has been hailed as a “major advance” in care options. 

Treating patients with impaired consciousness after severe brain injury is a significant challenge for healthcare professionals, and given the rarity of this condition, conducting large-scale clinical trials is highly complex.

But in a new international study, led by the University of Liège, has revealed the potential of transcranial direct current stimulation (tDCS) on a large number of patients with consciousness disorders following severe brain injury. 

Patients in a minimally conscious state, as opposed to a non-responsive state, and those with traumatic – rather than anoxic or vascular – brain injury were able to benefit from the technique.

Unlike previous single-centre studies involving small samples, a new GIGA-led study collected data from 62 patients from ten centres in five countries (Belgium, Germany, Italy, Russia and Spain).

“tDCS was administered in rehabilitation centres for four consecutive weeks, and its effects were measured using the Coma Recovery Scale-Revised for up to three months after the intervention,” explains Dr Aurore Thibaut, co-director of the Coma Science Group at Liège. 

“Although no overall beneficial effect was observed during the treatment phase, specific subgroups of patients responded at the three-month follow-up and showed a significant improvement in their behavioural responses compared with the control group.”

“These promising results represent a major advance in how we consider and treat these patients,” says Dr Géraldine Martens, research fellow at the Coma Science Group.

“We must move beyond the generic term ‘patients with disorders of consciousness’ and embrace the complex nuances within this population, integrating diagnosis and aetiology as determining factors in refining our therapeutic strategies.”

For more than ten years, the Coma Science Group has been exploring tDCS. Initial work has already shown that tDCS can improve the behavioural responses observed at the bedside of specific patients. 

The technique promotes brain plasticity by modulating the excitability of neurons with low electrical currents. This method, which is simple to use and safe, is particularly suitable for patients suffering from post-coma consciousness disorders in hospitals and at home.

The use of tDCS in a multi-centre trial involved challenges around regulations, data sharing and quality, and protocol adherence, but has been able to break new ground  in this study through the involvement of all parties.  

“Evidence-based treatment options to promote the recovery of sub-acute and chronic disorders of consciousness remain extremely limited,” says Dr Thibaut. 

“As a result, care teams face serious challenges, and patients’ relatives are left uncertain about how to care for their loved ones. There is a crying need for large-scale, comprehensive multi-centre studies to address these concerns.”

“We are impressed and grateful for the power of this teamwork,” says Dr Nicolas Lejeune, postdoctoral fellow at the Coma Science Group.

“We brought together clinicians and researchers from diverse backgrounds working in different healthcare contexts and adhered rigorously to a strict protocol, providing robust evidence. This success offers hope for future ambitious clinical trials.

“This study proves, once again, that joining forces is the best solution to investigate new therapeutic options for rare and severe conditions such as post-coma patients who remain in a disorder of consciousness.”

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