Effect of transcranial direct current stimulation for patients with disorders of consciousness: A systematic review and meta-analysis

Hui Ma; Kehong Zhao; Chengsen Jia; Jiuhong You; Mei Zhou; Tingting Wang; Cheng Huang

doi:10.3389/fnins.2022.1081278

Effect of transcranial direct current stimulation for patients with disorders of consciousness: A systematic review and meta-analysis

Front Neurosci. 2023 Jan 23:16:1081278. doi: 10.3389/fnins.2022.1081278. eCollection 2022.

Authors

Hui Ma^{1

2

3}, Kehong Zhao^{1

2

3}, Chengsen Jia^{1

3}, Jiuhong You^{1

2

3}, Mei Zhou^{1

2

3}, Tingting Wang^{1

3}, Cheng Huang^{1

3}

Affiliations

¹ Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
² School of Rehabilitation Medicine, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
³ Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China.

Abstract

Introduction: Transcranial direct current stimulation (tDCS) could potentially facilitate consciousness improvement in patients with disorders of consciousness (DOC). The aim of this study was to investigate the therapeutic efficacy of tDCS on consciousness recovery for patients with DOC.

Methods: Eight databases were systematically searched from their inception to June 2022. Quality of included studies were assessed using PEDro score and Cochrane's risk of bias assessment. All statistical analyses were performed using RevMan software. Seventeen studies with 618 patients were identified eligible for this study, and fifteen studies with sufficient data were pooled in the meta-analysis.

Results: The results of meta-analysis showed a significant effect on increasing GCS scores (MD = 1.73; 95% CI, 1.28-2.18; P < 0.01) and CRS-R scores (MD = 1.28; 95% CI = 0.56-2.00; P < 0.01) in favor of the real stimulation group as compared to sham. The results of subgroup analysis demonstrated that only more than 20 sessions of stimulation could significantly enhance the improvement of GCS scores and the CRS-R scores. Moreover, the effect of tDCS on CRS-R score improvement was predominant in patients with minimal conscious state (MCS) (MD = 1.84; 95% CI = 0.74-2.93; P < 0.01).

Conclusion: Anodal tDCS with sufficient stimulation doses appears to be an effective approach for patients with MCS, in terms of CRS-R scores.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022336958.

Keywords: coma recovery scale-revised; disorders of consciousness; meta-analysis; systematic review; transcranial direct current stimulation.

Publication types

Systematic Review

Grants and funding

This study was supported by grants from the 1⋅3⋅5 project for disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (2021HXFH063) and the Key Project of the Science and Technology Department in Sichuan Province (2021YJ0184). These funding sources were not involved in the literature review, systematic review, meta-analysis, and writing of the report.