Anarlf meetingElectrical modulation of neuronal networks in brain-injured patients with disorders of consciousness: A systematic reviewModulation électrique de réseaux neuronaux de patients cérébro-lésés avec trouble de la conscience : revue de la littérature☆,☆☆
Section snippets
The literature from 1968 to 2010
McLardy et al. [14] reported the very first case of DBS in 1968, in a vegetative 19-year-old male, implanted about 8 months after head injury. They intended to place one electrode in the intralaminar thalamic nuclei and the reticular formation of the midbrain, in the left hemisphere. Stimulation frequency was 250 Hz. Only the effects of the midbrain contacts were reported: left orientation of the head, movements of the left hand, and slight modifications of the electroencephalogram (EEG). The
Analysis and prospects
Despite small-sized series samples, different DBS settings, different times to implant after injury and outcome assessments, the evidence suggests DBS could promote recovery in brain-injured patients with disorders of consciousness. All the results, bar the very first attempted DBS by McLardy et al. [14], show limited but measurable improvement in patient conditions in most cases. The main concern is methodology weaknesses in most reports, as observational studies deliver a low grade of
Conclusion
DBS is a challenging therapeutic option for post-injury severe consciousness disorders, and must be weighed up in a context of the clinical course over time, from resuscitation to rehabilitation. The goal is to alleviate the “invisible barrier” blocking goal-oriented behaviours. However, in the brain injury setting, isolated consciousness disorder is still a fairly conceptual condition that relies heavily on the hypothesis of absence of extended brain lesions. This makes it absolutely vital to
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
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Cited by (21)
Neural correlates of consciousness and related disorders: From phenotypic descriptors of behavioral and relative consciousness to cortico-subcortical circuitry
2022, NeurochirurgieCitation Excerpt :We should also consider that DOC stricto sensu are also truly present following progressive diseases, even if they are not fully qualified or interpreted as such, in multifactorial neurologic and psychiatric diseases, e.g. neurodegenerative diseases such as dementia whatever the context. The neural correlates of consciousness, at least from the medical viewpoint, must also consider the biology of neurotransmitters as several drugs can alleviate signs of DOC (see e.g. for a review [136], but no cross-fertilization with the data collected by studies of structural and functional dysconnectivity has yet occurred, and we do not know how these drugs act. The tremendous growth of knowledge collected on consciousness over recent decades contrasts with the still limited therapeutic breakthroughs achieved, and, consequently, still very limited benefits for patients.
The centromedian nucleus: Anatomy, physiology, and clinical implications
2019, Journal of Clinical NeuroscienceCitation Excerpt :These studies constitute fewer than 50 patients and further studies and further studies are needed to confirm the aforementioned findings [90]. An intriguing application of CM DBS takes advantage of cognitive neuromodulation in restoring consciousness in patients in a persistent vegetative or minimally conscious state [41,91,92]. The underlying mechanism likely involves the ability of high frequency CM-Pf complex stimulation to induce EEG cortical desynchrony with an increase in regional cerebral metabolic rate and blood flow [93,94].
Specific subcortical structures are activated during seizure-induced death in a model of sudden unexpected death in epilepsy (SUDEP): A manganese-enhanced magnetic resonance imaging study
2017, Epilepsy ResearchCitation Excerpt :In these seizure models it has been shown that the acoustic stimulus activates the subcortical auditory structures, which interact with specific sensorimotor-limbic (SML) regions that results in behavioral seizures (Faingold et al., 1986a,b; Faingold et al., 1988; Garcia-Cairasco, 2002), and these structures were considered as potential regions of interest in the current study. Respiratory deficits that occur post-ictally in the DBA/1 mouse and lead to S-IRA may also potentially affect subcortical structures that are known to be involved in the respiratory network (Forster et al., 2012; Garcia-Rill et al., 2013; Lemaire et al., 2014; Sebille et al., 2016; Sowers et al., 2013; Welsh et al., 2002; Zeng et al., 2015). Therefore, the present MEMRI study also examined if changes in neural activity occur at respiratory structures.
35th Congress of the French association of neuro-anesthesiology and critical care
2014, Annales Francaises d'Anesthesie et de ReanimationReview of spinal cord stimulation for disorders of consciousness
2023, Current Opinion in NeurologyClinical neuromodulatory effects of deep brain stimulation in disorder of consciousness: A literature review
2023, CNS Neuroscience and Therapeutics
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French NeuroAnesthesia and Intensive Care society Meeting, Paris, November 2013, 21st and 22nd: “The acutely brain-injured patient: consciousness and neuroethic”.
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This article is published under the responsibility of the Scientific Committee of the “35e Journée de l’Association des neuro-anesthésistes réanimateurs de langue françaises” de la SFAR. The editorial board of the Annales françaises d’anesthésie et de réanimation was not involved in the conception and validation of its content.