For the first time, researchers in Britain will try non-invasive brain stimulation alongside advanced brain imaging techniques in patients who have minimal consciousness or are in a vegetative state.
In recent years, with the Vincent Lambert case, we have heard a lot about the “vegetative state”. This can follow a coma and last for months or even years. Recent studies have shown that 20% of non-responsive patients following brain damage retain a much higher level of consciousness than would be expected given their clinical diagnosis. Unfortunately, they remain unable to demonstrate their consciousness, stuck in their paralyzed bodies.
Now, for the first time, noninvasive brain stimulation will be tried alongside advanced brain imaging techniques in patients who have minimal consciousness or are in a vegetative state. The objective being to identify and treat the damaged connections in the brain and, in the long term, to offer these patients a better rate of rehabilitation. The study, titled RAINDROP, was announced at the conference Prolonged Disorders of Consciousness: From Scientific Discovery to Clinical Practice which took place in London, England on Thursday 17 October.
A recent study at the Center for Human Brain Health at the University of Birmingham (UK) suggested that non-invasive brain stimulation may improve rehabilitation success in non-responsive patients. Building on these findings, researchers are now planning to use advanced brain imaging technologies to track the effects of noninvasive brain stimulation in five patients at Wellington Hospital’s Prolonged Disorders of Consciousness Unit (PDoCU) ( UK).
Improve brain connections
During treatment, researchers will place electrodes on the patient’s head to pass low levels of direct current through a region responsible for motor control in the brain and to the thalamus, an area that relays motor signals and controls consciousness. During stimulation, scientists will use multimodal brain imaging to see what is happening in brain function.
“Different regions of our brain need to have good connections to each other in order to perform different functions. By finding the right ways to stimulate this network, we can improve these connections, help the brain compensate for damaged pathways and improve the patient’s ability to respond”, explains Dr Davinia Fernández-Espejo who is leading this study. “We have already been able to show that these techniques have potential in healthy subjects. This important next step will allow us to test their effects in patients,” he continues.
“With RAINDROP, we hope to better understand how the stimulation of certain regions of the brain by non-invasive techniques can lead to improvements in the rehabilitation of patients. This will pave the way for us to do research in neuroscience applied to neurological rehabilitation at Wellington Hospital,” adds Dr. Antonio Incisa, Senior Clinical Neuropsychologist and Principal Investigator in the Prolonged Disorders of Consciousness Unit at Wellington Hospital.
Hoping for better rehabilitation
And Eric Reichle, the general manager of the hospital concludes: “At Wellington Hospital, we feel incredibly privileged to be involved in such an important research program. Improving patient outcomes is very important in everything we do, which is why we have high hopes for how outcomes can shape care and improve patient rehabilitation.”
If the study is successful, it will form the basis of a large clinical trial which will recruit patients from several specialist centers across Britain where the proportion of patients in a vegetative state is believed to be fourteen per million.
In France, in the absence of a national register, the precise number of individuals concerned is unknown. The vegetative state, however, differs slightly from that of minimal consciousness. While patients all alternate between waking and sleeping (unlike coma), in the second case certain signs of consciousness are there such as visual pursuit, smiles or crying in the appropriate situation. In people in chronic vegetative state on the other hand, as was Vincent Lambert, the only movements observed are reflexes. No communication or response to stimuli is currently possible.
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