Non-invasive brain stimulation to promote alertness and awareness in chronic patients with disorders of consciousness: Low-level, near-infrared laser stimulation vs. focused shock wave therapy
Affiliations: [a] Medical Park Berlin Humboldtmühle, Neurologische Rehabilitation, Charité – Universitätsmedizin Berlin, Germany
| [b] Haus Havelblick, Department for intensive care nursing, Havelschanze, Berlin, Germany
Correspondence:
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Corresponding author: Cordula Werner, Medical Park Berlin, Charité – Universitätsmedizin Berlin, An der Mühle 2-9, 13507 Berlin, Germany. Tel.: +49 030 300 240 9271; Fax: +49 030 300 240 9319; E-mail: [email protected].
Abstract: Purpose: In order to promote alertness and awareness in patients with severe disorders of consciousness (DOC) frontal near infrared laser stimulation (N-LT) or transcranial focused shock wave therapy (F-SWT) might be an option. The study compared both techniques in severe chronic DOC patients. Methods: Sixteen DOC patients were allocated to two groups (A and B). A three week baseline either followed a frontal N-LT (0,1 mJ/mm2, 10 min per session), five times a week over four weeks (group A), or a F-SWT (0,1 mJ/mm2, 4000 stimuli per session) three times a week over four weeks (group B). The primary variable was the revised Coma Recovery Scale (r-CRS, 0–23), blindly assessed. Results: Both groups improved in the r-CRS over time, but revealed no differences between groups. One patient of group B had a focal seizure in the third therapy week. One patient with akinetic mutism improved most and three patients with global hypoxia did not improve at all. Conclusions: Both options might be an option to increase alertness and awareness of chronic DOC patients. An akinetic mutism seems to be a positive and severe cerebral hypoxia a negative predictor. Epileptic seizures are a potential unwanted side effect. More clinical studies are warranted.
