Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive tool and has been effectively used for the treatment of neurological disorders. This study was conducted to clarify whether or not rTMS can improve neurological status in patients with prolonged consciousness disturbance by examining changes in the cerebral blood flow (CBF) and the cathecholamine metabolites in the cerebrospinal fluid (CSF). We examined 13 patients who suffered from prolonged (more than 45 days after the ictus) impaired consciousness. The rTMS was applied at medium energy capacity and 0.5 Hz for 10 minutes. Before and after the rTMS, concentrations of cathecholamine and cathecholamine metabolites (epinephrine, norepinephrine, dopamine, 5-hydroxy-3-indole acid, homovanilicacid and 3,4-dihydroxyphenyl acetic acid) in the CSF were determined using HPLC and the CBF values were determined using the ^<99m>Tc-ECD Patlak plot method. The rTMS increased the CBF values in the unaffected hemisphere and the dopamine concentration in the CSF in a group of patients showing an improvement of their consciousness disturbance. The application of rTMS is a potential therapeutic tool for patients with prolonged consciousness disturbance. rTMS is also a useful diagnostic procedure to evaluate and predict the outcome in patients with consciousness disturbance.
