Can repetitive transcranial magnetic stimulation promote recovery of consciousness in patients with disorders of consciousness? A randomized controlled trial
Background: Disorders of consciousness (DoC) are characterized by a broad decline in background excitatory synaptic activity and varying levels of cerebral network disruption. Repetitive transcranial magnetic stimulation (rTMS), a neuromodulatory technique, is anticipated to assist the recovery of c...
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Elsevier
2025-01-01
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| Series: | NeuroImage: Clinical |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213158225000725 |
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| author | Zhenyu Liu Shanshan Wu Shuwei Wang Huijuan Wu Hongliang Gao Xiao Lu |
| author_facet | Zhenyu Liu Shanshan Wu Shuwei Wang Huijuan Wu Hongliang Gao Xiao Lu |
| author_sort | Zhenyu Liu |
| collection | DOAJ |
| description | Background: Disorders of consciousness (DoC) are characterized by a broad decline in background excitatory synaptic activity and varying levels of cerebral network disruption. Repetitive transcranial magnetic stimulation (rTMS), a neuromodulatory technique, is anticipated to assist the recovery of consciousness. Nonetheless, ongoing debates persist regarding its effectiveness, in light of the inconsistent results of recent research. Objective: The purpose of this study is to investigate the efficacy of rTMS in promoting recovery of consciousness in patients with DoC and to probe its impact on activity of cerebral functional networks. Methods: Forty-eight patients with DoC were included in this randomized controlled trial (Chinese Clinical Trial Registry: ChiCTR2100044930). Twenty-four patients in the control group accepted conventional therapy. Another 24 patients in the rTMS group received extra rTMS over the dorsolateral prefrontal cortex (DLPFC) once per workday during a 4-week intervention phase. Primary outcome was the proportion of patients emerging improvement on level of consciousness (LOC) based on coma recovery scale- revised (CRS-R) at the end of intervention. Furthermore, other behavioral scales such as the clinical global impression-improvement (CGI-I) and resting state-electroencephalography (rs-EEG) microstate were employed as secondary outcomes. Different microstates served as tools to detect the activity of respective corresponding resting state cerebral functional networks. Results: In comparison to the control group, the rTMS group exhibited a higher proportion of patients emerging improvement on LOC at post-intervention, with a risk ratio of 3.06 (95 % CI 1.54 to 6.09, P = 0.001). The distribution of patients with each grade of CGI-I across the groups also implied a trend that favored the rTMS group (common odds ratio:0.20, 95 % CI 0.065 to 0.63, P = 0.006). With respect to microstate E, the rTMS group had a significantly reduced global explained variance (GEV) was observed in the rTMS group (Z = -2.61, Pbonf = 0.027). Conclusion: High-frequency rTMS over the DLPFC could promote recovery of consciousness in patients with DoC. It might get involved in modulating the balance among cerebral functional networks and facilitating consciousness recovery. |
| format | Article |
| id | doaj-art-9c04f2bcda404ed6942a513210b784d5 |
| institution | DOAJ |
| issn | 2213-1582 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | NeuroImage: Clinical |
| spelling | doaj-art-9c04f2bcda404ed6942a513210b784d52025-08-20T03:19:56ZengElsevierNeuroImage: Clinical2213-15822025-01-014610380210.1016/j.nicl.2025.103802Can repetitive transcranial magnetic stimulation promote recovery of consciousness in patients with disorders of consciousness? A randomized controlled trialZhenyu Liu0Shanshan Wu1Shuwei Wang2Huijuan Wu3Hongliang Gao4Xiao Lu5Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu, China; Key Laboratory of Ultra-Weak Magnetic Field Measurement Technology, Ministry of Education, School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, ChinaDepartment of Critical Care Medicine, Nanjing Zijin Hospital, Nanjing, ChinaDepartment of Critical Care Medicine, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, ChinaDepartment of Critical Care Medicine, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China; Corresponding authors.Nanjing Zijin Hospital, Nanjing, China; Corresponding authors.Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu, China; Corresponding authors.Background: Disorders of consciousness (DoC) are characterized by a broad decline in background excitatory synaptic activity and varying levels of cerebral network disruption. Repetitive transcranial magnetic stimulation (rTMS), a neuromodulatory technique, is anticipated to assist the recovery of consciousness. Nonetheless, ongoing debates persist regarding its effectiveness, in light of the inconsistent results of recent research. Objective: The purpose of this study is to investigate the efficacy of rTMS in promoting recovery of consciousness in patients with DoC and to probe its impact on activity of cerebral functional networks. Methods: Forty-eight patients with DoC were included in this randomized controlled trial (Chinese Clinical Trial Registry: ChiCTR2100044930). Twenty-four patients in the control group accepted conventional therapy. Another 24 patients in the rTMS group received extra rTMS over the dorsolateral prefrontal cortex (DLPFC) once per workday during a 4-week intervention phase. Primary outcome was the proportion of patients emerging improvement on level of consciousness (LOC) based on coma recovery scale- revised (CRS-R) at the end of intervention. Furthermore, other behavioral scales such as the clinical global impression-improvement (CGI-I) and resting state-electroencephalography (rs-EEG) microstate were employed as secondary outcomes. Different microstates served as tools to detect the activity of respective corresponding resting state cerebral functional networks. Results: In comparison to the control group, the rTMS group exhibited a higher proportion of patients emerging improvement on LOC at post-intervention, with a risk ratio of 3.06 (95 % CI 1.54 to 6.09, P = 0.001). The distribution of patients with each grade of CGI-I across the groups also implied a trend that favored the rTMS group (common odds ratio:0.20, 95 % CI 0.065 to 0.63, P = 0.006). With respect to microstate E, the rTMS group had a significantly reduced global explained variance (GEV) was observed in the rTMS group (Z = -2.61, Pbonf = 0.027). Conclusion: High-frequency rTMS over the DLPFC could promote recovery of consciousness in patients with DoC. It might get involved in modulating the balance among cerebral functional networks and facilitating consciousness recovery.http://www.sciencedirect.com/science/article/pii/S2213158225000725Disorders of consciousnessTranscranial magnetic stimulationElectroencephalography |
| spellingShingle | Zhenyu Liu Shanshan Wu Shuwei Wang Huijuan Wu Hongliang Gao Xiao Lu Can repetitive transcranial magnetic stimulation promote recovery of consciousness in patients with disorders of consciousness? A randomized controlled trial NeuroImage: Clinical Disorders of consciousness Transcranial magnetic stimulation Electroencephalography |
| title | Can repetitive transcranial magnetic stimulation promote recovery of consciousness in patients with disorders of consciousness? A randomized controlled trial |
| title_full | Can repetitive transcranial magnetic stimulation promote recovery of consciousness in patients with disorders of consciousness? A randomized controlled trial |
| title_fullStr | Can repetitive transcranial magnetic stimulation promote recovery of consciousness in patients with disorders of consciousness? A randomized controlled trial |
| title_full_unstemmed | Can repetitive transcranial magnetic stimulation promote recovery of consciousness in patients with disorders of consciousness? A randomized controlled trial |
| title_short | Can repetitive transcranial magnetic stimulation promote recovery of consciousness in patients with disorders of consciousness? A randomized controlled trial |
| title_sort | can repetitive transcranial magnetic stimulation promote recovery of consciousness in patients with disorders of consciousness a randomized controlled trial |
| topic | Disorders of consciousness Transcranial magnetic stimulation Electroencephalography |
| url | http://www.sciencedirect.com/science/article/pii/S2213158225000725 |
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