• Laura Rosa Pisani, Antonino Naro, Antonino Leo, Irene Aricò, Francesco Pisani, Rosalia Silvestri, Placido Bramanti, and Rocco Salvatore Calabrò.
• IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
• Conscious Cogn. 2015 Dec 15; 38: 1-8.

AbstractSlow wave activity (SWA) generation depends on cortico-thalamo-cortical loops that are disrupted in patients with chronic Disorders of Consciousness (DOC), including the Unresponsive Wakefulness Syndrome (UWS) and the Minimally Conscious State (MCS). We hypothesized that the modulation of SWA by means of a repetitive transcranial magnetic stimulation (rTMS) could reveal residual patterns of connectivity, thus supporting the DOC clinical differential diagnosis. We enrolled 10 DOC individuals who underwent a 24hh polysomnography followed by a real or sham 5Hz-rTMS over left primary motor area, and a second polysomnographic recording. A preserved sleep-wake cycle, a standard temporal progression of sleep stages, and a SWA perturbation were found in all of the MCS patients and in none of the UWS individuals, only following the real-rTMS. In conclusion, our combined approach may improve the differential diagnosis between MCS patients, who show a partial preservation of cortical plasticity, and UWS individuals, who lack such properties. Copyright © 2015 Elsevier Inc. All rights reserved.

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