Место издания:Blackwell Publishing Inc United Kingdom
Первая страница:481
Аннотация:Background and aims: Navigated rTMS is a perspective
tool for modulation of the cerebral networks activity, and
resting FMRI allows estimating the neural networks
activation that may indicate the target for precise
stimulation. Patients after anoxia or trauma who survived
coma, show selective activation of default mode network,
particularly, gyrus angularis, as the level of consciousness
increases. We studied effects of navigated rTMS on gyrus
angularis as a new approach for DOC neurorehabilitation.
Methods: We included 3 patients with post-anoxic VS
(median age 24, CRS-R 4); 3 post-anoxic MCS-(median
age 46, CRS-R 14, 16, and 18), and 2 traumatic MCS+
(median age 31, CRS-R 19, 20). RFMRI individual
activation represented DMN including left gyrus angularis
in MCS patients, with no DMN in VS patients. We provided
standard rehabilitation program (motomed letto II-assisted
mechanical therapy, massage, passive joints movements)
high-frequency rTMS on the gyrus angularis (10 sessions of
stimulation, 20Hz, 2400 stimulus 90% MT). Consciousness
level was blind assessed with CRS-R scale.
Results: CRS-R score increased in the patients with the
residual signs of consciousness behaviour (i.e., MCS).
Median increase in CRS-R score after neurorehabilitation
course was 2 points. However, we found no change in
clinical assessment in the VS. No side effects of rTMS were
observed.
CRS-R score in permanent disorders of consciousness before and after
rTMS course on gyrus angularis
Conclusion: The course of the high-frequency TMS on
gyrus angularis is a potentially effective method of
rehabilitation in permanent DOC. We obtained clinical
effect for minimal signs of consciousness states, but not in
VS. These results are advisable to continue researches in
studies of this new protocol's effectiveness
Disclosure: The study is supported by Russian Science
Foundation, grant No 16-15-00274