TY - JOUR
T1 - A pilot trial examining the merits of combining amantadine and repetitive transcranial magnetic stimulation as an intervention for persons with disordered consciousness after TBI
AU - Bender Pape, Theresa L.
AU - Herrold, Amy A.
AU - Livengood, Sherri L.
AU - Guernon, Ann
AU - Weaver, Jennifer A.
AU - Higgins, James P.
AU - Rosenow, Joshua M.
AU - Walsh, Elyse
AU - Bhaumik, Runa
AU - Pacheco, Marilyn
AU - Patil, Vijaya K.
AU - Kletzel, Sandra
AU - Conneely, Mark
AU - Bhaumik, Dulal K.
AU - Mallinson, Trudy
AU - Parrish, Todd
N1 - Publisher Copyright:
Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc.
PY - 2020/11
Y1 - 2020/11
N2 - Objective: Report pilot findings of neurobehavioral gains and network changes observed in persons with disordered consciousness (DoC) who received repetitive transcranial magnetic stimulation (rTMS) or amantadine (AMA), and then rTMS+AMA. Participants: Four persons with DoC 1 to 15 years after traumatic brain injury (TBI). Design: Alternate treatment-order, within-subject, baseline-controlled trial. Main Measures: For group and individual neurobehavioral analyses, predetermined thresholds, based on mixed linear-effects models and conditional minimally detectable change, were used to define meaningful neurobehavioral change for the Disorders of Consciousness Scale-25 (DOCS) total and Auditory-Language measures. Resting-state functional connectivity (rsFC) of the default mode and 6 other networks was examined. Results: Meaningful gains in DOCS total measures were observed for 75% of treatment segments and auditory-language gains were observed after rTMS, which doubled when rTMS preceded rTMS+AMA. Neurobehavioral changes were reflected in rsFC for language, salience, and sensorimotor networks. Between networks interactions were modulated, globally, after all treatments. Conclusions: For persons with DoC 1 to 15 years after TBI, meaningful neurobehavioral gains were observed after provision of rTMS, AMA, and rTMS+AMA. Sequencing and combining of treatments to modulate broad-scale neural activity, via differing mechanisms, merits investigation in a future study powered to determine efficacy of this approach to enabling neurobehavioral recovery.
AB - Objective: Report pilot findings of neurobehavioral gains and network changes observed in persons with disordered consciousness (DoC) who received repetitive transcranial magnetic stimulation (rTMS) or amantadine (AMA), and then rTMS+AMA. Participants: Four persons with DoC 1 to 15 years after traumatic brain injury (TBI). Design: Alternate treatment-order, within-subject, baseline-controlled trial. Main Measures: For group and individual neurobehavioral analyses, predetermined thresholds, based on mixed linear-effects models and conditional minimally detectable change, were used to define meaningful neurobehavioral change for the Disorders of Consciousness Scale-25 (DOCS) total and Auditory-Language measures. Resting-state functional connectivity (rsFC) of the default mode and 6 other networks was examined. Results: Meaningful gains in DOCS total measures were observed for 75% of treatment segments and auditory-language gains were observed after rTMS, which doubled when rTMS preceded rTMS+AMA. Neurobehavioral changes were reflected in rsFC for language, salience, and sensorimotor networks. Between networks interactions were modulated, globally, after all treatments. Conclusions: For persons with DoC 1 to 15 years after TBI, meaningful neurobehavioral gains were observed after provision of rTMS, AMA, and rTMS+AMA. Sequencing and combining of treatments to modulate broad-scale neural activity, via differing mechanisms, merits investigation in a future study powered to determine efficacy of this approach to enabling neurobehavioral recovery.
KW - Amantadine
KW - Clinical trial
KW - Default mode network
KW - Disorders of consciousness
KW - Functional MRI
KW - Intervention
KW - Neurobehavioral
KW - Transcranial magnetic stimulation
KW - Traumatic brain injury
KW - Vegetative state
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U2 - 10.1097/HTR.0000000000000634
DO - 10.1097/HTR.0000000000000634
M3 - Article
C2 - 33165151
AN - SCOPUS:85095977226
SN - 0885-9701
VL - 35
SP - 371
EP - 387
JO - Journal of Head Trauma Rehabilitation
JF - Journal of Head Trauma Rehabilitation
IS - 6
ER -