Characterization of responders to transcranial direct current stimulation in disorders of consciousness: A retrospective study of 8 clinical trials.

A subset of patients in a minimally conscious state show improved behavioral responsiveness after transcranial direct current stimulation (tDCS) of the left dorsolateral prefrontal cortex, while those who are unresponsive show limited benefit. Among 131 patients, 32% of minimally conscious patients responded to tDCS, compared to 10% of unresponsive patients. A regression model using baseline diagnosis, Coma Recovery Scale-Revised Index, age, sex, and time since injury correctly identified responders 77% of the time. Patients in a minimally conscious state with better cognitive profiles and longer time since injury appear to respond better to tDCS, suggesting they are better candidates for this treatment.

Study at a glance

Abstract

The treatment for patients with disorders of consciousness challenges researchers and clinicians. The stimulation of the left dorsolateral prefrontal cortex with transcranial direct current stimulation (tDCS) may enhance behavioral responsiveness of a subset of patients in a minimally conscious state, while having limited effects in unresponsive patients. However, heterogeneity in responses raises questions about the effectiveness of tDCS. Our objective was to explore the characteristics of responders to tDCS based on previously published RCTs and investigate the heterogeneity of treatment effect to better direct future tDCS studies towards patient profiles that appear to be more responsive to the treatment. We explored clinical and demographical differences between responders (i.e., recovery of a new sign of consciousness after active stimulation) and non-responder and the predictors of treatment response with a LASSO logistic regression. We included 131 patients (44 women, 61 traumatic brain injury, 90 minimally conscious, mean age 46.13 years [SD ​= ​16], median time since injury 12.84 months [IQR: 5.25-35.10]) of which 33 responded to tDCS. While 32 ​% of minimally conscious patients responded to tDCS (95%CI 0.24, 0.43), 10 ​% (95%CI 0.04, 0.25) of those unresponsive responded. The regression model, using diagnosis at baseline, Coma Recovery Scale-Revised Index at baseline, age, sex and time since injury correctly discriminated between tDCS responders and non-responders (area under the curve of 0.77). Our findings suggest that patients in minimally conscious state, with a better cognitive profile and longer TSI respond better to tDCS, making them better candidates for the treatment.