New therapeutic options for the treatment of patients with disorders of consciousness: The field of neuromodulation
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© Springer International Publishing AG 2018. Neuromodulation techniques aimed at normalizing the neurophysiologic disturbance produced by brain lesions or dysfunction have been studied for years in attempts to modulate brain activity to treat several neurological diseases. The field of (non)invasive brain stimulation offers a valuable alternative to improve the recovery of severely brain-injured patients with disorders of consciousness, a population that lacks of effective treatment options, especially at the chronic stage. We here describe invasive and noninvasive brain stimulation techniques, namely, deep brain stimulation (DBS) and transcranial direct current stimulation (tDCS), as therapeutic options for patients with DOC. DBS has shown to induce extensive behavioral improvement after the implantation of an electrical stimulator in the intralaminar nuclei in case reports. However, large controlled clinical trials have to be conducted in order to confirm the clinical benefit of this treatment. Regarding tDCS, the first studies, targeting the left prefrontal cortex, have shown encouraging results, with significant behavioral improvements, in both acute and chronic patients. Besides behavioral improvements, mechanisms underlying the effects of these neuromodulation techniques need to be further investigated. The mesocircuit model, by integrating the fronto-striato-thalamic loop, provides a conceptual foundation to explain the effects of several treatments having shown some effectiveness in the recovery of patients with DOC.
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