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We investigated bilateral 30\u2010Hz low\u2010frequency stimulation designed to overdrive neuronal activity by dual pallido\u2010thalamic targeting, using the Coma Recovery Scale Revised (\n                      <jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>\n                      \u2010R) to assess conscious behavior.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a prospective, single center, observational 11\u2010month pilot study comprising four phases: baseline (2\u00a0months); surgery and titration (1\u00a0month); blind, random, crossover, 1.5\u2010month\n                      <jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">OFF<\/jats:styled-content>\n                      periods; and unblinded, 5\u2010month stimulation\n                      <jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content>\n                      . Five adult patients were included: one unresponsive\u2010wakefulness\u2010syndrome male (traumatic brain injury); and four patients in a minimally conscious state, one male (traumatic brain injury) and three females (two hemorrhagic strokes and one traumatic brain injury). Primary outcome measures focused on\n                      <jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>\n                      \u2010R scores. Secondary outcome measures focused notably on baseline brain metabolism and variation in activity (stimulation\n                      <jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content>\n                      \u2013 baseline) using normalized fluorodeoxyglucose positron emission tomography maps. Statistical analysis used random\u2010effect models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The two male patients (one minimally conscious and one unresponsive wakefulness syndrome) showed improved mean\n                      <jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>\n                      \u2010R scores (stimulation\n                      <jats:styled-content style=\"fixed-case\">ON<\/jats:styled-content>\n                      vs. baseline), in auditory, visual and oromotor\/verbal subscores, and visual subscores respectively. The metabolism of the medial cortices (low at baseline in all five patients) increased specifically in the two responders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Our findings show there were robust but limited individual clinical benefits, mainly in visual and auditory processes. Overall modifications seem linked to the modulation of thalamo\u2010cortico\u2010basal and tegmental loops activating default mode network cortices. Specifically, in the two responders there was an increase in medial cortex activity related to internal awareness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acn3.648","type":"journal-article","created":{"date-parts":[[2018,9,27]],"date-time":"2018-09-27T00:13:06Z","timestamp":1538007186000},"page":"1372-1384","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":75,"title":["Deep brain stimulation in five patients with severe disorders of consciousness"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4395-5328","authenticated-orcid":false,"given":"Jean\u2010Jacques","family":"Lemaire","sequence":"first","affiliation":[{"name":"Service de Neurochirurgie CHU Clermont\u2010Ferrand Clermont\u2010Ferrand F\u201063000 France"},{"name":"Universit\u00e9 Clermont Auvergne CNRS, SIGMA Clermont, Institut Pascal Clermont\u2010Ferrand F\u201063000 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Sontheimer","sequence":"additional","affiliation":[{"name":"Service de Neurochirurgie CHU Clermont\u2010Ferrand Clermont\u2010Ferrand F\u201063000 France"},{"name":"Universit\u00e9 Clermont Auvergne CNRS, SIGMA Clermont, Institut Pascal Clermont\u2010Ferrand F\u201063000 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Pereira","sequence":"additional","affiliation":[{"name":"Unit\u00e9 de Biostatistiques (D\u00e9l\u00e9gation Recherche Clinique &amp; 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