Skip to Main content Skip to Navigation
Journal articles

Deep brain stimulation in five patients with severe disorders of consciousness

Abstract : Objective: The efficacy of deep brain stimulation in disorders of consciousness remains inconclusive. We investigated bilateral 30‐Hz low‐frequency stimulation designed to overdrive neuronal activity by dual pallido‐thalamic targeting, using the Coma Recovery Scale Revised (CRS‐R) to assess conscious behavior. Methods: We conducted a prospective, single center, observational 11‐month pilot study comprising four phases: baseline (2 months); surgery and titration (1 month); blind, random, crossover, 1.5‐month ON and OFF periods; and unblinded, 5‐month stimulation ON. Five adult patients were included: one unresponsive‐wakefulness‐syndrome male (traumatic brain injury); and four patients in a minimally conscious state, one male (traumatic brain injury) and three females (two hemorrhagic strokes and one traumatic brain injury). Primary outcome measures focused on CRS‐R scores. Secondary outcome measures focused notably on baseline brain metabolism and variation in activity (stimulation ON – baseline) using normalized fluorodeoxyglucose positron emission tomography maps. Statistical analysis used random‐effect models. Results: The two male patients (one minimally conscious and one unresponsive wakefulness syndrome) showed improved mean CRS‐R scores (stimulation ON vs. baseline), in auditory, visual and oromotor/verbal subscores, and visual subscores respectively. The metabolism of the medial cortices (low at baseline in all five patients) increased specifically in the two responders. Interpretation: Our findings show there were robust but limited individual clinical benefits, mainly in visual and auditory processes. Overall modifications seem linked to the modulation of thalamo‐cortico‐basal and tegmental loops activating default mode network cortices. Specifically, in the two responders there was an increase in medial cortex activity related to internal awareness.
Complete list of metadata
Contributor : Jérôme Coste Connect in order to contact the contributor
Submitted on : Tuesday, November 20, 2018 - 1:44:15 PM
Last modification on : Tuesday, January 4, 2022 - 5:18:37 AM


Publication funded by an institution


Distributed under a Creative Commons Attribution - NonCommercial - NoDerivatives 4.0 International License



Jean-Jacques Lemaire, Anna Sontheimer, Bruno Pereira, Jerome Coste, Sarah Rosenberg, et al.. Deep brain stimulation in five patients with severe disorders of consciousness. Annals of Clinical and Translational Neurology, Wiley, 2018, 5 (11), pp.1372-1384. ⟨10.1002/acn3.648⟩. ⟨hal-01928180⟩



Record views


Files downloads