Repetitive transcranial magnetic stimulation induced slow wave activity modification: A possible role in disorder of consciousness differential diagnosis?

•SWA depends on multiple cortico–thalamo-cortical loops.•Thalamo-cortical loops that are widely disconnected in DOC patients.•Experimental SWA modulation could unmask such residual loops, thus supporting DOC differentiation. Slow wave activity (SWA) generation depends on cortico–thalamo-cortical loo...

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Published in:Consciousness and cognition 2015-12, Vol.38, p.1-8
Main Authors: Pisani, Laura Rosa, Naro, Antonino, Leo, Antonino, Aricò, Irene, Pisani, Francesco, Silvestri, Rosalia, Bramanti, Placido, Calabrò, Rocco Salvatore
Format: Article
Language:English
Subjects:
Adult
Aged
Brain
Brain Waves - physiology
Cerebral Cortex - physiopathology
Consciousness
Consciousness Disorders - physiopathology
Disorders of consciousness
Female
Humans
Male
MCS
Medical diagnosis
Middle Aged
Neurobiology
Persistent Vegetative State - physiopathology
Polysomnography
Slow wave activity
Thalamus - physiopathology
Transcranial magnetic stimulation
Transcranial Magnetic Stimulation - methods
UWS
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Summary:•SWA depends on multiple cortico–thalamo-cortical loops.•Thalamo-cortical loops that are widely disconnected in DOC patients.•Experimental SWA modulation could unmask such residual loops, thus supporting DOC differentiation. Slow wave activity (SWA) generation depends on cortico–thalamo-cortical loops that are disrupted in patients with chronic Disorders of Consciousness (DOC), including the Unresponsive Wakefulness Syndrome (UWS) and the Minimally Conscious State (MCS). We hypothesized that the modulation of SWA by means of a repetitive transcranial magnetic stimulation (rTMS) could reveal residual patterns of connectivity, thus supporting the DOC clinical differential diagnosis. We enrolled 10 DOC individuals who underwent a 24hh polysomnography followed by a real or sham 5Hz-rTMS over left primary motor area, and a second polysomnographic recording. A preserved sleep-wake cycle, a standard temporal progression of sleep stages, and a SWA perturbation were found in all of the MCS patients and in none of the UWS individuals, only following the real-rTMS. In conclusion, our combined approach may improve the differential diagnosis between MCS patients, who show a partial preservation of cortical plasticity, and UWS individuals, who lack such properties.
ISSN:1053-8100
1090-2376
DOI:10.1016/j.concog.2015.09.012