Noninvasive brain stimulation (NIBS) techniques have been used to facilitate the recovery from prolonged unconsciousness as a result of brain injury. The aim of this study is to systematically assess the effects of NIBS in patients with a disorder of consciousness (DOC). We searched four databases for any randomized controlled trials on the effect of NIBS in patients with a DOC, which used the JFK Coma Recovery Scale-Revised (CRS-R) as the primary outcome measure. A random-effects meta-analysis was conducted to pool effect sizes. Fourteen studies with 273 participants were included in this review, of which 12 studies with sufficient data were included in the meta-analysis. Our meta-analysis showed a significant effect on increasing CRS-R scores in favor of real stimulation as compared to sham (Hedges’ g = 0.522; 95% confidence interval [CI], 0.318–0.726; P < 0.0001, I ² = 0.00%). Subgroup analysis demonstrated that only anodal transcranial direct current stimulation (tDCS) of the left dorsolateral prefrontal cortex (DLPFC) significantly enhances the CRS-R scores in patients with a DOC, as compared to sham (Hedges’ g = 0.703; 95% CI, 0.419–0.986; P < 0.001), and this effect was predominant in patients in a minimally conscious state (MCS) (Hedges’ g = 0.815; 95% CI, 0.429–1.200; P < 0.001). Anodal tDCS of the left DLPFC appears to be an effective approach for patients with MCS.

中文翻译：

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意识障碍患者的无创脑刺激：系统评价和荟萃分析。


无创脑刺激（NIBS）技术已被用于促进脑损伤导致的长时间昏迷状态的恢复。本研究的目的是系统评估 NIBS 对意识障碍 (DOC) 患者的影响。我们检索了四个数据库，查找有关 NIBS 对 DOC 患者影响的随机对照试验，该试验使用 JFK 昏迷恢复量表修订版 (CRS-R) 作为主要结局指标。进行了随机效应荟萃分析来汇总效应大小。本次综述纳入了 14 项研究，共 273 名受试者，其中 12 项数据充足的研究纳入荟萃分析。我们的荟萃分析显示，与假刺激相比，真实刺激对增加 CRS-R 分数有显着影响（Hedges' g = 0.522；95% 置信区间 [CI]，0.318–0.726； P < 0.0001， I ² = 0.00 %）。亚组分析表明，与假手术相比，只有左侧背外侧前额叶皮质 (DLPFC) 的阳极经颅直流电刺激 (tDCS) 才能显着提高 DOC 患者的 CRS-R 评分（Hedges' g = 0.703；95% CI， 0.419–0.986； P < 0.001），这种效应在最低意识状态（MCS）的患者中占主导地位（Hedges' g = 0.815；95% CI，0.429–1.200； P < 0.001）。左侧 DLPFC 的阳极 tDCS 似乎是治疗 MCS 患者的有效方法。