Controlled clinical trial of repeated left prefrontal transcranial direct current stimulation in patients with chronic minimally conscious state

A recent study showed that single-session anodal transcranial direct current stimulation (tDCS) applied to the left dorsolateral prefrontal cortex (LDLPF) transiently improves consciousness in 43% of patients in minimally conscious state (MCS) (Thibaut et al., 2014). We here test the potential effects and safety of repeated tDCS in severely brain-damaged patients with MCS. In this double-blind cross-over sham-controlled experimental design, we delivered two sessions of repeated (5 days of stimulation) tDCS, either anodal or sham in a randomized order. We stimulated the LDLPF cortex during twenty minutes in 20 MCS patients (12 men, aged 48±16 years, time since onset 78±95 months, 12 post-traumatic). Consciousness was assessed by the French adaptation of the Coma Recovery Scale Revised (CRS-R; Schnakers et al., 2008) before and after each stimulation. A treatment effect was observed for the comparison between CRS-R total scores at baseline and after 5 days of real tDCS (p<0.01). Behaviorally, 10/20 patients showed a tDCS-related improvement; 5 patients responded after the first stimulation and 5 other patients responded after 2, 3 or 4 days of stimulation. No side effect (e.g. epilepsy) was reported. Our results demonstrate that repeated (5 days) anodal LDLPF tDCS is safe and might improve signs of consciousness in about half of patients in MCS. It is important to note that the first session is not predictive for a future positive effect of the efficacy of the non-invasive electrical stimulation

Near-death experiences in non-life-threatening events and coma of different etiologies.

Near death experiences (NDEs) are increasingly being reported as a clearly identifiable physiological and psychological reality of clinical significance. Empirical studies of NDEs have mostly been conducted in patients with life threatening situations such as cardiac arrest [1-5] or (albeit more rarely) in patients with severe traumatic brain injury[6]. To the best of our knowledge, no study has formally compared the influence of the cause of coma to the intensity or content of the NDE. Using the Greyson NDE scale [7], the present retrospective study aimed at: (1) exploring the NDE intensity and content in “NDE-like” accounts following non-life-threatening events versus “real NDE” following coma; (2) comparing the “real NDE” characteristics according to the etiology of the brain damage (anoxic, traumatic or other) and; (3) comparing our retrospectively obtained data in anoxic coma to historical previously published prospectively collected post-anoxic NDEs

Near-Death Experiences in patients with locked-in syndrome: Not always a blissful journey

Memories of Near-Death Experiences (NDEs) most often are recounted as emotionally positive events. At present, no satisfactory explanatory model exists to fully account for the rich phenomenology of NDEs following a severe acute brain injury. The particular population of patients with locked-in syndrome (LIS) provides a unique opportunity to study NDEs following infratentorial brain lesions. We here retrospectively characterized the content of NDEs in 8 patients with LIS caused by an acute brainstem lesion (i.e., ‘‘LIS NDEs’’) and 23 NDE experiencers after coma with supratentorial lesions (i.e., ‘‘classical NDEs’’). Compared to ‘‘classical NDEs’’, ‘‘LIS NDEs’’ less frequently experienced a feeling of peacefulness or well-being. It could be hypothesized that NDEs containing less positive emotions might have a specific neuroanatomical substrate related to impaired pontine/paralimbic connectivity or alternatively might be related to the emotional distress caused by the presence of conscious awareness in a paralyzed body

Zeatin is indispensable for the G₂-M transition in tobacco BY-2 cells

AbstractThe importance of N6-isoprenoid cytokinins in the G2-M transition of Nicotiana tabacum BY-2 cells was investigated. Both cytokinin biosynthesis and entry in mitosis were partially blocked by application at early or late G2 of lovastatin (10 μM), an inhibitor of mevalonic acid synthesis.LC-MS/MS quantification of endogenous cytokinins proved that lovastatin affects cytokinin biosynthesis by inhibiting HMG-CoA reductase. Out of eight different aminopurines and a synthetic auxin tested for their ability to override lovastatin inhibition of mitosis, only zeatin was active. Our data point to a key role for a well-defined cytokinin (here, zeatin) in the G2-M transition of tobacco BY-2 cells

Controlled clinical trial of repeated prefrontal tDCS in patients with chronic minimally conscious state.

peer reviewedOBJECTIVES: To assess the effects of repeated transcranial direct current stimulation (tDCS) sessions on the level of consciousness in chronic patients in minimally conscious state (MCS). METHODS: In this randomized double-blind sham-controlled crossover study, we enrolled 16 patients in chronic MCS. For 5 consecutive days, each patient received active or sham tDCS over the left prefrontal cortex (2 mA during 20 min). Consciousness was assessed with the Coma Recovery Scale-Revised (CRS-R) before the first stimulation (baseline), after each stimulation (day 1-day 5) and 1 week after the end of each session (day 12). RESULTS: A treatment effect (p = 0.013; effect size = 0.43) was observed at the end of the active tDCS session (day 5) as well as 1 week after the end of the active tDCS session (day 12; p = 0.002; effect size = 0.57). A longitudinal increase of the CRS-R total scores was identified for the active tDCS session (p < 0.001), while no change was found for the sham session (p = 0.64). Nine patients were identified as responders (56%). CONCLUSION: Our results suggest that repeated (5 days) left prefrontal tDCS improves the recovery of consciousness in some chronic patients in MCS, up to 1 week after the end of the stimulations

ვასილ მჟავანაძე და გივი ჯავახიშვილი

ცენტრში: გივი ჯავახიშვილი, ვასილ მჟავანაძეგივი ჯავახიშვილი - საქართველოს მინისტრთა საბჭოს თავმჯდომარე. ვასილ მჟავანაძე - ქართველი საბჭოთა პარტიული მოღვაწე, გენერალ-ლეიტენანტი (1944). საქართველოს სსრ კომპარტიის პირველი მდივანი 1953-1972 წლებში

Brain function during catatonic stupor and after clinical remission

suppl 1, Abstract P.1.22info:eu-repo/semantics/publishe

A voxel-based analysis of brain metabolism during catatonic stupor and after clinical remission

info:eu-repo/semantics/nonPublishe

Souvenirs d’une expérience de mort imminente chez les patients critiques : incidence, facteurs associés et impact à long terme

peer reviewe

Near‐death experience in all categories ICU survivors: incidence, influencing factors, and long‐term impact.

peer reviewe