Abstract des Autors

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the efficacy and safety of non‐invasive brain stimulation (NIBS) for the treatment of patients with severe disorders of consciousness following an acquired brain injury.
Disorders of consciousness represent a challenging clinical entity, which is prone to misdiagnosis and lacks effective treatment options. This entity comprises, besides coma (that usually lasts from a few days to several weeks), two main pathologic states; the unresponsive wakefulness syndrome, also termed vegetative state (UWS/VS) (Laureys 2010), and the minimally conscious state (MCS) (Giacino 2002). Patients in the UWS/VS recover the ability to open their eyes, in contrast to patients in coma, but they do not express any signs of consciousness of themselves or of their environment. Patients in the MCS recover some small signs of consciousness (e.g. visual pursuit, following commands, localization to painful stimulus, contextualised smiles or tears). Nevertheless, by definition, they are not able to communicate, and therefore, no active rehabilitation treatment, such as conventional physical therapy or neuropsychological rehabilitation, can be used with this group of patients. When patients recover their ability to communicate functionally, either verbally or using a binary code, we say that they emerged from the MCS (Giacino 2002). The most common aetiologies are traumatic brain injury, anoxia (e.g. following a cardiac arrest) and stroke. In this review we will focus on patients in prolonged (more than 28 dyas) UWS/VS and MCS.