Clinical application of neuromodulation therapy in patients with disorder of consciousness: A pooled analysis of 544 participants

Article type: Research Article

Authors: Zheng, Ruizhe^{a; b; c; d; e; f; 1} | Qi, Zengxin^{a; b; c; d; e; f; 1} | Thibaut, Aurore^{g; h; 1} | Wang, Zhe^{a; b; c; d; e; f} | Xu, Zeyu^{a; b; c; d; e; f} | Di, Haiboⁱ | Wu, Xuehai^{a; b; c; d; e; f; 2; *} | Mao, Ying^{a; b; c; d; e; f; 2; *} | Laureys, Steven^{g; h; i; j}

Affiliations: [a] Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China | [b] National Center for Neurological Disorders, Shanghai, China | [c] Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China | [d] Neurosurgical Institute of Fudan University, Shanghai, China | [e] Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China | [f] School of Basic Medical Sciences, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and Ministry of Education’s (MOE) Frontiers Center for Brain Science, Fudan University, Shanghai, China | [g] GIGA Consciousness Research Unit, Coma Science Group, Liège University, Liège, Belgium | [h] GIGA Consciousness, Centre du Cerveau, Liège University Hospital, Liège, Belgium | [i] International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China | [j] Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Laval University, Quebec, QC, Canada

Correspondence: [*] Address for correspondence: Prof. Xuehai Wu and Prof. Ying Mao, PhD, Department of Neurosurgery, Huashan Hospital, Fudan University, 12# Wulumuqi Zhong Road, Shanghai 200040, China. E-mails: wuxuehai@fudan.edu.cn (XHW) and maoying@fudan.edu.cn (YM).

Note: [1] These authors contributed equally to this work.

Note: [2] Xuehai Wu and Ying Mao are co-corresponding authors of this study.

Abstract: BACKGROUND:The number of patients with disorders of consciousness (DoC) has increased dramatically with the advancement of intensive care and emergency medicine, which brings tremendous economic burdens and even ethical issues to families and society. OBJECTIVE:To evaluate the effectiveness of neuromodulation therapy for patients with DoC. METHODS:First, we conducted a literature review of individual patient data (IPD) on PubMed, EMBASE, and Cochrane-controlled trials following PRISMA guidelines. Then, we collected neuromodulation cases from our institution. Finally, we conducted a pooled analysis using the participants from the medical literature (n = 522) and our local institutions (n = 22). RESULTS:In this pooled analysis of 544 patients with DoC with a mean age of 46.33 years, our results revealed that patients have improved CRS-R scores [1.0 points (95% CI, 0.57–1.42)] after neuromodulation. Among them, patients have better effectiveness in traumatic than non-traumatic etiology (P < 0.05). The effectiveness of consciousness improvement could be affected by the age, baseline consciousness state, and duration of stimulation. Compared with non-invasive intervention, an invasive intervention can bring more behavioral improvement (P < 0.0001) to MCS rather than UWS/VS patients. Importantly, neuromodulation is a valuable therapy even years after the onset of DoC. CONCLUSION:This pooled analysis spotlights that the application of neuromodulation can improve the behavioral performance of patients with DoC. A preliminary trend is that age, etiology, baseline consciousness state, and stimulation duration could impact its effectiveness.

Keywords: Neuromodulation, brain injury, disorder of consciousness, pooled analysis

DOI: 10.3233/NRE-230103

Journal: NeuroRehabilitation, vol. 53, no. 4, pp. 491-503, 2023