Skip to main content
  • 282 Accesses

Abstract

Disorders of consciousness (DoC) is a state where consciousness has been affected by severe damage to the brain, including acute or prolonged DoC (pDoC). The pDoC means that the loss of consciousness lasts for more than 28 days, with the first cause being cerebral trauma, followed by stroke and hypoxic encephalopathy. pDoC is classified into vegetative state (VS) and minimally conscious state (MCS) according to the level of residual consciousness. VS refers to a state in which basic brainstem reflexes and sleep-wakefulness cycles are preserved, with spontaneous or stimulated eye-opening, but with no consciousness. MCS refers to the presence of clear signs of consciousness with discontinuity and fluctuation in patients after severe brain injury. It is more difficult for patients in VS to recover consciousness, while MCS patients have good recovery potential. New clinical and imaging data suggest that some pDoC patients may still benefit from therapeutic interventions several years after the onset of the disease. Most studies aimed at improving the level of consciousness and functional recovery of patients are open trials or case reports about behavior or brain imaging. The results of a few randomized controlled trials, especially on noninvasive neurostimulation treatments, have been published. It suggests that new therapies such as neurostimulation are valuable for the treatment of DoC, while the stimulation method and parameters still need further testing and validation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Baker JL, Ryou JW, Wei XF et al (2016) Robust modulation of arousal regulation, performance, and frontostriatal activity through central thalamic deep brain stimulation in healthy nonhuman primates. J Neurophysiol 116:2383–2404

    Article  PubMed  PubMed Central  Google Scholar 

  • Barra A, Rosenfelder M, Mortaheb S et al (2022) Transcranial pulsed-current stimulation versus transcranial direct current stimulation in patients with disorders of consciousness: a pilot, sham-controlled cross-over double-blind study. Brain Sci 12:429

    Article  PubMed  PubMed Central  Google Scholar 

  • Bourdillon P, Hermann B, Sitt JD et al (2019) Electromagnetic brain stimulation in patients with disorders of consciousness. Front Neurosci 13:223

    Article  PubMed  PubMed Central  Google Scholar 

  • Briand M-M, Gosseries O, Staumont B et al (2020) Transcutaneous auricular vagal nerve stimulation and disorders of consciousness: a hypothesis for mechanisms of action. Front Neurol 11:933

    Article  PubMed  PubMed Central  Google Scholar 

  • Cain JA, Spivak NM, Coetzee JP et al (2022) Ultrasonic deep brain neuromodulation in acute disorders of consciousness: a proof-of-concept. Brain Sci 12:428

    Article  PubMed  PubMed Central  Google Scholar 

  • Corazzol M, Lio G, Lefevre A et al (2017) Restoring consciousness with vagus nerve stimulation. Curr Biol 27:R994–R996

    Article  CAS  PubMed  Google Scholar 

  • Della Pepa GM, Fukaya C, La Rocca G et al (2013) Neuromodulation of vegetative state through spinal cord stimulation: where are we now and where are we going? Stereotact Funct Neurosurg 91:275–287

    Article  PubMed  Google Scholar 

  • Functional Neurosurgery Group of the Chinese Neurosurgery Medical Association, Professional Committee of Neurorepair of Chinese Medical Doctor Association, Chinese Society of Consciousness and Disorders of Consciousness (2019) Neurosurgery treatment of chronic disorders of consciousness Chinese Expert Consensus. Chin J Neurosurg 35:5

    Google Scholar 

  • Giacino JT, Kalmar K, Whyte J (2004) The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 85:2020–2029

    Article  PubMed  Google Scholar 

  • Giacino JT, Katz DI, Schiff ND et al (2018) Practice guideline update recommendations summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology 91:450–460

    Article  PubMed  PubMed Central  Google Scholar 

  • Group of Disorders of Consciousness and Conscious-Promotion, Professional Committee of Neurorepair of Chinese Medical Doctor Association (2021) Diagnoses and treatments of prolonged disorders of consciousness: an experts consensus. Chin J Neuromed 19:977–982

    Google Scholar 

  • He F, Wu M, Meng F et al (2018) Effects of 20 Hz repetitive transcranial magnetic stimulation on disorders of consciousness: a resting-state electroencephalography study. Neural Plast 2018:5036184

    Article  PubMed  PubMed Central  Google Scholar 

  • Kanno T, Kamel Y, Yokoyama T et al (1989) Effects of dorsal column spinal cord stimulation (DCS) on reversibility of neuronal function-experience of treatment for vegetative states. Pac Clin Electrophysiol 12:733–738

    Article  CAS  Google Scholar 

  • Kondziella D, Bender A, Diserens K et al (2020) European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol 27:741–756

    Article  CAS  PubMed  Google Scholar 

  • Liu X, Meng F, Gao J et al (2018) Behavioral and resting state functional connectivity effects of high frequency rTMS on disorders of consciousness: a Sham-controlled study. Front Neurol 9:982

    Article  PubMed  PubMed Central  Google Scholar 

  • Mattogno PP, Barbagallo G, Iacopino G et al (2017) Recovery from chronic diseases of consciousness: state of the art in neuromodulation for persistent vegetative state and minimally conscious state, vol 124. Springer International Publishing, Cham, pp 19–25

    Google Scholar 

  • McLardy T, Ervin F, Mark V et al (1968) Attempted inset-electrodes-arousal from traumatic coma: neuropathological findings. Trans Am Neurol Assoc 93:25–30

    CAS  PubMed  Google Scholar 

  • O’Neal CM, Schroeder LN, Wells AA et al (2021) Patient outcomes in disorders of consciousness following transcranial magnetic stimulation: a systematic review and meta-analysis of individual patient data. Front Neurol 12:694970

    Article  PubMed  PubMed Central  Google Scholar 

  • Schiff ND, Giacino JT, Kalmar K et al (2007) Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature 448:600–603

    Article  CAS  PubMed  Google Scholar 

  • Thibaut A, Bruno M-A, Ledoux D et al (2014) tDCS in patients with disorders of consciousness: Sham-controlled randomized double-blind study. Neurology 82:1112–1118

    Article  PubMed  Google Scholar 

  • Thibaut A, Schiff N, Giacino J et al (2019) Therapeutic interventions in patients with prolonged disorders of consciousness. Lancet Neurol 18:600–614

    Article  PubMed  Google Scholar 

  • Tsubokawa T, Yamamoto T, Katayama Y et al (1990) Deep-brain stimulation in a persistent vegetative state: follow-up results and criteria for selection of candidates. Brain Injury 4:315–327

    Article  CAS  PubMed  Google Scholar 

  • Ward LM (2011) The thalamic dynamic core theory of conscious experience. Conscious Cogn 20:464–486

    Article  PubMed  Google Scholar 

  • Xia X, Bai Y, Zhou Y et al (2017) Effects of 10 Hz repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex in disorders of consciousness. Front Neurol 8:182

    Article  PubMed  PubMed Central  Google Scholar 

  • Xia X, Yang Y, Guo Y et al (2018) Current status of neuromodulatory therapies for disorders of consciousness. Neurosci Bull 34:615–625

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Xia XY, Yang Y, Dang YY et al (2019) Therapeutic effect of spinal cord stimulation on chronic disorders of consciousness after brain injury: a report of 110 cases. Chin J Neurosurg 35:5

    Google Scholar 

  • Yamamoto T, Katayama Y, Kobayashi K et al (2010) Deep brain stimulation for the treatment of vegetative state: DBS for the treatment of VS. Eur J Neurosci 32:1145–1151

    Article  PubMed  Google Scholar 

  • Yamamoto T, Katayama Y, Obuchi T et al (2013) Deep brain stimulation and spinal cord stimulation for vegetative state and minimally conscious state. World Neurosurg 80:S30.e1–S30.e9

    Article  PubMed  Google Scholar 

  • Yu Y, Yang Y, Gan S et al (2021) Cerebral hemodynamic correlates of transcutaneous auricular vagal nerve stimulation in consciousness restoration: an open-label pilot study. Front Neurol 12:684791

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

He, J., Dang, Y. (2023). Disorders of Consciousness. In: Wang, Y. (eds) Therapeutics of Neural Stimulation for Neurological Disorders. Springer, Singapore. https://doi.org/10.1007/978-981-99-4538-2_27

Download citation

  • DOI: https://doi.org/10.1007/978-981-99-4538-2_27

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-4537-5

  • Online ISBN: 978-981-99-4538-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics