• Francesco Piccione, Marianna Cavinato, Paolo Manganotti, Emanuela Formaggio, Silvia Francesca Storti, Leontino Battistin, Annachiara Cagnin, Paolo Tonin, and Mauro Dam.
• Department of Neurorehabilitation, IRCCS S. Camillo, Venice, Italy. francesco.piccione@ospedalesancamillo.net
• Neurorehabil Neural Repair. 2011 Jan 1;25(1):98-102.

BackgroundIn 2007, Schiff et al reported a patient in a minimally conscious state (MCS) who responded to deep brain stimulation (DBS), but clinicians cannot predict which patients might respond prior to the implantation of electrodes.MethodsA patient in a MCS for 5 years participated in an ABA design alternating between repetitive transcranial magnetic stimulation (rTMS) and peripheral nerve stimulation. rTMS (condition A) involved the delivery of 10 trains of 100 stimuli at 20 Hz using a stimulator with a 70-mm figure-of-eight coil to elicit a contraction of the abductor pollicis brevis. Condition B used median nerve electrical stimulation.ResultsAfter peripheral stimulation, the patient did not exhibit clinical, behavioral, or electroencephalographic (EEG) changes. The frequency of specific and meaningful behaviors increased after rTMS, along with the absolute and relative power of the EEG δ, β, and α bands.ConclusionThese results suggest that rTMS may improve awareness and arousal in MCS. If these results are reproducible, rTMS may identify subgroups of MCS patients who might benefit from DBS.

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