Excitatory Prefrontal Weak Current Stimulation in Vegetative Patients

NCT04614792 | Completed

• 1 other identifier: 335-19
• Study Type: interventional
• Target: 16
• Locations: 1 country
• Sites: 1

Brief Summary

In response to "conscious" EEG findings related to detectable cognitive function that reliably denote awareness in vegetative state patients, in the current study, we will assess the covert conscious EEG activity (as well as standard clinical overt measures) and neuroplasctic propensity (i.e., changes in EEG spectral power synchronization values following tDCS intervention) in vegetative-state patients receiving repetitive transcranial direct current stimulation (tDCS) treatment over frontal motor areas for a period of two weeks. In support of this approach, a recent tDCS study with vegetative and minimally conscious patients implied that a twenty minutes anodal stimulation (i.e., excitatory stimulation) to the left dorsolateral prefrontal cortex (DLPFC) significantly increased CRS-R scores versus sham (placebo: non-active stimulation) stimulation condition. It was noted that this tDCS effect was more pronounced in minimally conscious state patients versus vegetative state patients excluding effects of chronicity or etiology. Thus, the investigators in this study suggested that tDCS could be effective in improving cognitive recovery in severely brain-injured patients. However, their findings would benefit neural activation correlates that could support their conclusion regarding the effectiveness of this type of non-invasive intervention in promoting neurocognitive recovery. Most importantly, tDCS is safe for use in humans, has no adverse effects, is considered the most non-invasive transcranial stimulation method because it uses extremely weak currents (0.5 to 2 mA), and, is known to only temporarily shift the neuron's membrane potential towards excitation/inhibition. In regard to the method's potential to induce functional recovery in vegetative state patients, recent clinical studies indicate that tDCS could counteract the negative effects of brain damage by influencing neurophysiological mechanisms, and is likely to contribute to the "formation of functionally meaningful connections and the maintenance of existing pathways" .

Conditions

Disorder of Consciousness; MMN; Modification of Cognitive Status Indication; Anoxic Brain Damage; Trauma, Brain; Vegetative State; EEG; Paroxysms, Occipital, Epilepsy of Childhood; Cortical Atrophy

Outcome Measures

Primary Outcomes (1)

• JFK COMA RECOVERY SCALE - REVISED

  JFK Coma recovery Scale - Revised scores for diagnosing disorders of consciousness. This cynical assessment scale examines reflexive behaviors such as response to pain and startle, and touch. The CRS consists of 25 hierarchically arranged items that comprise 6 subscales addressing auditory, visual, motor, oro- motor, communication, and arousal processes. Scoring is based on the presence or absence of specific behavioral responses to sensory stimuli administered in a standardized manner. The lowest item on each subscale represents reflexive activity, whereas the highest items represent cognitively mediated behaviors. sub scales represent motor function, auditory function, visual function sub scales and arousal sub scales. The low scores indicate low levels of functioning and the higher score indicate high levels of function an awareness. Maximum score is 23 and a minimal score is 0.

  24 months

Secondary Outcomes (1)

• MMN ERP amplitudes

  2 weeks

Study Arms (1)

active treatment

EXPERIMENTAL

open label experimental treatment

Device: Transcranial direct current stimulation

Interventions

Transcranial direct current stimulation DEVICE

Non-invasive brain stimulation or neuromodulation.

active treatment

Eligibility Criteria

• Age: 18 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Anoxic brain damage/TBI/CVA/progressive dementia/encephalopathy
• Vegetative state patients or minimally conscious state according to CRS-R criteria
• Ages 18 to 90
• Consent for participation in clinical study (e.g., informed consent) by legal guardian of patients.

You may not qualify if:

• Intracranial metal implants
• Implanted devices that may be affected by tDCS (pacemaker, medication pump, cochlear implant, implanted brain stimulator)
• Active medical condition that would preclude medical stability for the study, including significant ECG abnormalities, cardiac arrhythmia, uncontrolled high blood pressure
• Participation in other research studies

Sponsors & Collaborators

• Oded Meiron: lead
• Neurosteer Ltd.: collaborator

Study Sites (1)

Herzog Medical Center

Jerusalem, 91035, Israel

Location

Related Publications (1)

• Angelakis E, Liouta E, Andreadis N, Korfias S, Ktonas P, Stranjalis G, Sakas DE. Transcranial direct current stimulation effects in disorders of consciousness. Arch Phys Med Rehabil. 2014 Feb;95(2):283-9. doi: 10.1016/j.apmr.2013.09.002. Epub 2013 Sep 11.

  PMID: 24035769 BACKGROUND

MeSH Terms

Conditions

Consciousness Disorders; Hypoxia, Brain; Brain Injuries, Traumatic; Persistent Vegetative State

Interventions

Transcranial Direct Current Stimulation

Condition Hierarchy (Ancestors)

Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Neurocognitive Disorders; Mental Disorders; Brain Diseases; Central Nervous System Diseases; Hypoxia; Signs and Symptoms, Respiratory; Brain Injuries; Craniocerebral Trauma; Trauma, Nervous System; Wounds and Injuries; Brain Damage, Chronic; Unconsciousness

Intervention Hierarchy (Ancestors)

Electric Stimulation Therapy; Therapeutics; Convulsive Therapy; Psychiatric Somatic Therapies; Behavioral Disciplines and Activities; Electroshock; Psychological Techniques

Study Officials

• Efraim Jaul, MD

  Herzog Medical Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Director of Non-invasive Brain Stimulation Center

Model Details: open lable treatment

Study Record Dates

• First Submitted: October 29, 2020
• First Posted: November 4, 2020
• Study Start: April 30, 2014
• Primary Completion: December 27, 2023
• Study Completion: December 27, 2023
• Last Updated: February 28, 2024

Record last verified: 2024-02

Data Sharing

• IPD Sharing: Will not share

Locations

IL (1)