Abstract
Twenty-one vegetative state (VS) patients and 10 minimally conscious state (MCS) patients were treated by spinal cord stimulation (SCS) following an electrophysiological evaluation 3 months or more after the onset of brain injury.
A flexible four-contact cylindrical electrode was inserted into the epidural space of the cervical vertebrae, and placed at cervical levels C2–C4. Five-hertz stimulation was applied for 5 min every 30 min during the daytime at an intensity that produced muscle twitches of the upper extremities.
Both the fifth wave in the auditory brainstem response (ABR) and N20 in the somatosensory evoked potential (SEP) were detected in 8 of the 21 VS patients and 9 of the 10 MCS patients. Of the 3 VS patients and 7 MCS patients who recovered following SCS therapy, all showed a preserved fifth wave in the ABR and N20 in the SEP, and all had received SCS therapy within 9 months after the onset of brain injury. Although the 3 patients who recovered from VS remained in a bedridden state, all 7 patients who recovered from MCS were able to emerge from the bedridden state within 12 months after the start of SCS.
Five-hertz cervical SCS caused increased cerebral blood flow (CBF) and induced muscle twitches of the upper extremities, and MCS patients showed a remarkable recovery of consciousness and motor function in the upper extremities compared with the lower extremities. This SCS method could be a new neuromodulation and neurorehabilitation technique, and MCS patients may be good candidates for SCS therapy.
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References
Campos RJ, Dimitrijevic MM, Faganel J, Sharkey PC (1981) Clinical evaluation of the effect of spinal cord stimulation on motor performance in patients with upper motor neuron lesions. Appl Neurophysiol 44:141–151
Chohadon F, Richer E (1993) Stimulation cerebrale profonde chez des patients etat vegetatif post traumatique. Neurochirurgia 39:281–292
Fujii M, Sadamitsu D, Maekawa T, Uesugi S, Ozaki S, Koizumi S et al (1998) Spinal cord stimulation therapy at an early stage for unresponsive patients with hypoxic encephalopathy. No Shinkei Geka 26:315–321 (Jpn, with Eng abstract)
Funahashi K, Komai N, Ogura M, Kuwata T, Nakai M, Tsuji N (1989) Effects and indications of spinal cord stimulation on the vegetative syndrome. No Shinkei Geka 17:917–923 (Jpn, with Eng abstract)
Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI et al (2002) The minimally conscious state: definition and diagnostic criteria. Neurology 58:349–353
Hassler R, Ore GD, Dieckmann G, Bricolo A, Dolce G (1969) Behavioural and EEG arousal induced by stimulation of unspecific projection systems in a patient with post-traumatic apallic syndrome. Electroencephalogr Clin Neurophysiol 27:306–310
Hosobuchi Y (1985) Electrical stimulation of the cervical spinal cord increase cerebral blood flow in humans. Appl Neurophysiol 48:372–376
Jasper HH, Naquet R, King LE (1995) Thalamocortical recruiting responses in sensory receiving areas in the cat. Electroencephalogr Clin Neurophysiol 7:99–114
Jennett B, Plum F (1972) Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1(7753):734–737
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1(7950):480–484
Kanno T, Morita I, Yamaguchi S, Yokoyama T, Kamei Y, Anil SM, Karagiozov KL (2009) Dorsal column stimulation in persistent vegetative state. Neuromodulation 12:33–38
Kanno T, Kamel Y, Yokoyama T, Shoda M, Tanji H, Nomura M (1989) Effects of dorsal column spinal cord stimulation (DCS) on reversibility of neuronal function – experience of treatment for vegetative states. Pacing Clin Electrophysiol 12:733–738
Liu JT, Tan WC, Liao WJ (2008) Effects of electrical cervical spinal cord stimulation on cerebral blood perfusion, cerebrospinal fluid cathecholamine lecels, and oxidative stress in comatose patients. Acta Neurochir Suppl 101:71–76
Matsui T, Asano T, Takakura K, Yamada R, Hosobuchi Y (1989) Beneficial effects of cervical spinal cord stimulation (cSCS) on patients with impaired consciousness: a preliminary report. Pacing Clin Electrophysiol 12:718–725
Megrio M, Cioni B, Rossi GF (1989) Spinal cord stimulation in management of chronic pain. A 9-year experience. J Neurosurg 70:519–524
Moruzzi G, Magoun HW (1948) Brain stem reticular formation and activation of the EEG. Electroencephalogr Clin Neurophysiol 1:455–473
Nakamura S, Tsubokawa T (1985) Evaluation of spinal cord stimulation for postapoplectic spastic hemiplegia. Neurosurgery 17:253–259
Sánchez-Ledesma MJ, García-March G, Diaz-Cascajo P, Gómez-Moreta J, Broseta J (1989) Spinal cord stimulation in deafferentation pain. Stereotact Funct Neurosurg 53:40–45
Schiff ND, Giacino JT, Kalmar K, Victor JD, Baker K, Gerver M et al (2007) Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature 448:600–603
Strum V, Kuhner A, Schmitt P, Assmus H, Stock G (1979) Chronic electrical stimulation of the thalamic unspecific activating system in a patient with coma due to midbrain and upper brain stem infarction. Acta Neurochir 47:235–244
The Multi-Society Task Force on PVS (1994) Medical aspects of the persistent vegetative state. (First of two parts). N Engl J Med 330:1499–1508
The Multi-Society Task Force on PVS (1994) Medical aspects of the persistent vegetative state. (Second of two parts). N Engl J Med 330:1572–1579
Tsubokawa T, Yamamoto Y, Katayama Y, Hirayama T, Maejima S, Moriya T (1990) Deep brain stimulation in a persistent vegetative state: follow-up results and criteria for selection of candidates. Brain Inj 4:315–327
Tsubokawa T, Yamamoto Y, Katayama Y (1990) Prediction of the outcome of prolonged coma caused by brain damage. Brain Inj 4:329–337
Yamamoto T, Katayama Y (2005) Deep brain stimulation therapy for the vegetative state. Neuropsychol Rehabil 15:406–413
Yamamoto T, Katayama Y, Kobayashi K, Oshima H, Fukaya C, Tsubokawa T (2010) Deep brain stimulation for the treatment f vegetative state. Eur J Neurosci 32:1145–1151
Yamamoto T, Katayana Y, Obuchi T, Kobayashi K, Oshima H, Fukaya C (2012) Spinal cord stimulation for treatment of patients in the minimally conscious state. Neurol Med Chir (Tokyo) 52:475–481
Yamamoto T, Katayama Y, Obuchi T, Kabayashi K, Oshima H, Fukaya C (2013) DBS and SCS for vegetative state and minimally conscious state. World Neurosurg 80:S30.e1–9
Acknowledgments
This work was supported by the MEXT-Supported Program for Strategic Research Foundation at Private Universities, and a Grant-in-Aid for Scientific Research (C-15K10375) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan.
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Yamamoto, T. et al. (2017). Spinal Cord Stimulation for Vegetative State and Minimally Conscious State: Changes in Consciousness Level and Motor Function. In: Visocchi, M., Mehdorn, H.M., Katayama, Y., von Wild, K.R.H. (eds) Trends in Reconstructive Neurosurgery. Acta Neurochirurgica Supplement, vol 124. Springer, Cham. https://doi.org/10.1007/978-3-319-39546-3_6
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