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A Pilot Trial Examining the Merits of Combining Amantadine and Repetitive Transcranial Magnetic Stimulation as an Intervention for Persons With Disordered Consciousness After TBI. | LitMetric
The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr VA Hospital, Hines, Illinois (Drs Bender Pape, Herrold, Livengood, Guernon, Walsh, Kletzel, and Pacheco); Departments of Physical Medicine and Rehabilitation (Drs Bender Pape and Livengood), Neurological Surgery (Dr Rosenow), Radiology (Mr Higgins and Dr Parrish), and Psychiatry and Behavioral Sciences (Dr Herrold), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Research Department, Marianjoy Rehabilitation Hospital-part of Northwestern Medicine, Wheaton, Illinois (Dr Guernon); Department of Psychiatry, Biostatistical Research Center, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago (Drs R. Bhaumik and D. K. Bhaumik); Cooperative Studies Program Coordinating Center, Research Service, Edward Hines Jr VA Hospital, Hines, Illinois (Dr D. K. Bhaumik); Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington (Ms Weaver and Dr Mallinson); Department of Neurology, Edward Hines Jr VA Hospital, Hines, Illinois, and Department of Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois (Dr Patil); Chicago Medical School, Rosalind Franklin University of Science and Medicine, and Department of Radiology and Nuclear Medicine, Captain James A Lovell Federal Health Care Center, North Chicago, Illinois (Dr Conneely).
Published: September 2021
AI Article Synopsis
Article Abstract
Objective: Report pilot findings of neurobehavioral gains and network changes observed in persons with disordered consciousness (DoC) who received repetitive transcranial magnetic stimulation (rTMS) or amantadine (AMA), and then rTMS+AMA.
Participants: Four persons with DoC 1 to 15 years after traumatic brain injury (TBI).
Main Measures: For group and individual neurobehavioral analyses, predetermined thresholds, based on mixed linear-effects models and conditional minimally detectable change, were used to define meaningful neurobehavioral change for the Disorders of Consciousness Scale-25 (DOCS) total and Auditory-Language measures. Resting-state functional connectivity (rsFC) of the default mode and 6 other networks was examined.
Results: Meaningful gains in DOCS total measures were observed for 75% of treatment segments and auditory-language gains were observed after rTMS, which doubled when rTMS preceded rTMS+AMA. Neurobehavioral changes were reflected in rsFC for language, salience, and sensorimotor networks. Between networks interactions were modulated, globally, after all treatments.
Conclusions: For persons with DoC 1 to 15 years after TBI, meaningful neurobehavioral gains were observed after provision of rTMS, AMA, and rTMS+AMA. Sequencing and combining of treatments to modulate broad-scale neural activity, via differing mechanisms, merits investigation in a future study powered to determine efficacy of this approach to enabling neurobehavioral recovery.
