One of the most frustrating and mysterious medical conditions affecting the mind is impaired consciousness, as can occur with brain damage. Patients in a coma or a vegetative or minimally conscious state sometimes spontaneously recover to varying degrees, but in most cases there is little that doctors can do to help. Now a rigorous study by a group at Liège University Hospital Center in Belgium has found that a simple treatment called transcranial direct-current stimulation (tDCS) can temporarily raise awareness in minimally conscious patients.
In tDCS, electrodes are glued to the scalp, and a weak electric current is passed through them to stimulate the underlying brain tissue. Scientists led by neurologist Steven Laureys applied the electric current for 20 minutes to patients' left prefrontal cortex, an area known to be involved in attentiveness and working memory. Afterward, the effects on consciousness were measured by doctors who did not know whether the patient had received real tDCS or a sham treatment, in which the apparatus ran, but no current was delivered.
For patients in a vegetative state, who display no communication or purposeful behavior, the stimulation might have led to improvement in two patients, but no statistically compelling evidence emerged. Yet 13 of 30 patients in a minimally conscious state—defined by occasional moments of low-level awareness—showed measurable gains in their responses to questions and sensory stimuli. Some had only recently been injured, but others had been minimally conscious for months.
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The improvements lasted just a few minutes, but researchers are encouraged—the tDCS apparatus is inexpensive, easy to use, safe and lacking in side effects. Laureys is planning new studies to see if the stimulation can be configured to spur a more lasting recovery. Even if the effects remain temporary, the ability to trigger a brief period of awareness could be invaluable, perhaps allowing patients to communicate in a meaningful way with their loved ones.