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Transcranial Alternating Current Stimulation in Patients with Chronic Disorder of Consciousness: A Possible Way to Cut the Diagnostic Gordian Knot?

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Abstract

Unresponsive wakefulness syndrome (UWS) is a chronic disorder of consciousness (DOC) characterized by a lack of awareness and purposeful motor behaviors, owing to an extensive brain connectivity impairment. Nevertheless, some UWS patients may retain residual brain connectivity patterns, which may sustain a covert awareness, namely functional locked-in syndrome (fLIS). We evaluated the possibility of bringing to light such residual neural networks using a non-invasive neurostimulation protocol. To this end, we enrolled 15 healthy individuals and 26 DOC patients (minimally conscious state—MCS- and UWS), who underwent a γ-band transcranial alternating current stimulation (tACS) over the right dorsolateral prefrontal cortex. We measured the effects of tACS on power and partial-directed coherence within local and long-range cortical networks, before and after the protocol application. tACS was able to specifically modulate large-scale cortical effective connectivity and excitability in all the MCS participants and some UWS patients, who could be, therefore, considered as suffering from fLIS. Hence, tACS could be a useful approach in supporting a DOC differential diagnosis, depending on the level of preservation of the cortical large-scale effective connectivity.

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Acknowledgments

We want to thank Prof. Anthony Pettignano for having edited the manuscript in the English language.

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  1. IRCCS Centro Neurolesi “Bonino-Pulejo” Messina, S.S.113, Contrada Casazza, 98124, Messina, Italy

    Antonino Naro, Placido Bramanti, Antonino Leo, Margherita Russo & Rocco Salvatore Calabrò

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  1. Antonino Naro
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  2. Placido Bramanti
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  3. Antonino Leo
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Naro, A., Bramanti, P., Leo, A. et al. Transcranial Alternating Current Stimulation in Patients with Chronic Disorder of Consciousness: A Possible Way to Cut the Diagnostic Gordian Knot?. Brain Topogr 29, 623–644 (2016). https://doi.org/10.1007/s10548-016-0489-z

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