AUTHOR=Xu Chengwei , Wu Wanchun , Zheng Xiaochun , Liang Qimei , Huang Xiyan , Zhong Haili , Xiao Qiuyi , Lan Yue , Bai Yang , Xie Qiuyou 

TITLE=Repetitive transcranial magnetic stimulation over the posterior parietal cortex improves functional recovery in nonresponsive patients: A crossover, randomized, double-blind, sham-controlled study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1059789

DOI=10.3389/fneur.2023.1059789

ISSN=1664-2295

ABSTRACT=Objective: Recently, patients with disorders of consciousness (DoC) were demonstrated benefiting from repetitive transcranial magnetic stimulation (rTMS). Posterior parietal cortex (PPC) has attracted more and more interest in neuroscience and DoC clinic for its key role in human consciousness formation. However, whether the rTMS on PPC could facilitate consciousness recovery has not been clearly investigated.
Method: We conducted a crossover, randomized, double-blind, sham-controlled clinical study to assess the efficacy and safety of 10 Hz rTMS over the left PPC in unresponsive patients. 20 unresponsive wakefulness syndrome patients were recurited. They were ramdomly assigned into two groups to receive either 10 consecutive days' active (n=10) or sham (n=10) rTMS treatment firstly, with crossing over after 10 days' washout. The rTMS protocol consisted of 2000 pulses/day with 10 Hz at 90% of resting motor threshold over the left PPC (P3 electrode sites). Evaluations were blindly performed with JFK Coma Recovery Scale-Revised (CRS-R) as a primary outcome, and relative EEG power assessment synchronously before and after each intervention stage.
Result: rTMS-active significantly improved the CRS-R total score (F=8.443, p=0.009) and relative alpha power (F=11.166, p=0.004) compared with rTMS-sham. Furthermore, 8 of 20 patients were classified as rTMS responders, who evolved to MCS by the rTMS-active. Relative alpha power significantly improved in responders (F=26.372, p=0.002), but not in non-responders (F= 0.704, p=0.421). No rTMS-related side effects were found in the study. 
Conclusions: 10 Hz rTMS on the left PPC significantly improves functional recovery of unresponsive patients.