• Efthymios Angelakis, Evangelia Liouta, Nikos Andreadis, Stephanos Korfias, Periklis Ktonas, George Stranjalis, and Damianos E Sakas.
• Hellenic Center for Neurosurgical Research "Prof. Petros Kokkalis," Athens, Greece; Evangelismos Hospital, Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: eaggelak@med.uoa.gr.
• Arch Phys Med Rehabil. 2014 Feb 1;95(2):283-9.

ObjectiveTo assess the efficacy of transcranial direct current stimulation (tDCS) on improving consciousness in patients with persistent unresponsive wakefulness syndrome (UWS) (previously termed persistent vegetative state [PVS]) or in a minimally conscious state (MCS).DesignProspective, case series trial with follow-up at 12 months.SettingGeneral and research hospital.ParticipantsInpatients in a PVS/UWS or MCS (N=10; 7 men, 3 women; age range, 19-62y; etiology: traumatic brain injury, n=5; anoxia, n=4; postoperative infarct, n=1; duration of PVS/UWS or MCS range, 6mo-10y). No participant withdrew because of adverse effects.InterventionAll patients received sham tDCS for 20 minutes per day, 5 days per week, for 1 week, and real tDCS for 20 minutes per day, 5 days per week, for 2 weeks. An anodal electrode was placed over the left primary sensorimotor cortex or the left dorsolateral prefrontal cortex, with cathodal stimulation over the right eyebrow. One patient in an MCS received a second round of 10 tDCS sessions 3 months after initial participation.Main Outcome MeasureJFK Coma Recovery Scale-Revised.ResultsAll patients in an MCS showed clinical improvement immediately after treatment. The patient who received a second round of tDCS 3 months after initial participation showed further improvement and emergence into consciousness after stimulation, with no change between treatments. One patient who was in an MCS for <1 year before treatment (postoperative infarct) showed further improvement and emergence into consciousness at 12-month follow-up. No patient showed improvement before stimulation. No patient in a PVS/UWS showed immediate improvement after stimulation, but 1 patient who was in a PVS/UWS for 6 years before treatment showed improvement and change of status to an MCS at 12-month follow-up.ConclusionstDCS seems promising for the rehabilitation of patients with severe disorders of consciousness. Severity and duration of pathology may be related to the degree of tDCS' beneficial effects.Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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