Article

The level of consciousness is regulated by the activation of the
frontal parietal network since a disruption within this interregional cortical
connectivity is associated with a consciousness breakdown.
The primary
aim of the present study was to examine the feasibility and the safety of a
single session of repetitive transcranial magnetic stimulation (rTMS), delivered
over the dorsolateral prefrontal cortex (DLPFC), in patients with unresponsive
wakefulness syndrome (UWS). As a secondary aim, we investigated the efficacy of
rTMS over DLPFC on cortico-cortical connectivity as tested with paired-pulse and
dual-coil TMS techniques. METHODS: We enrolled 10 healthy and 10 postanoxic UWS
subjects. After clinical assessment, subjects underwent a single/paired pulse TMS
paradigm evaluating the inhibitory and facilitatory intracortical circuits. In
addition, several interregional interactions between primary motor, dorsal and
ventral premotor, supplementary motor, and posterior parietal cortex areas were
investigated by means of dual-coil TMS technique. These parameters were evaluated
at baseline, immediately after, and 60 minutes after a protocol of 10-Hz rTMS
delivered at the level of the DLPFC. RESULTS: rTMS over DLPFC did not cause any
adverse events. We showed that rTMS over DLPFC did not induce, at group level,
any clinical improvement or intra-/intercortical connectivity changes.
Interestingly, in 3 patients rTMS induced a significant, although transient,
clinical improvement associated with a short-lasting reshaping of brain connectivity. CONCLUSIONS: We demonstrated that a single session of 10-Hz rTMS
over the right DLPFC may transiently improve consciousness and partially restore the connectivity within several cortical areas in some patients with UWS.
CI - (c) The Author(s) 2014.

Langue : ANGLAIS