Spinal Cord Stimulation for Vegetative State and Minimally Conscious State: Changes in Consciousness Level and Motor Function.
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.
21例植物状态（VS）和10例最小意识状态（MCS）患者在脑损伤后3个月以上，先行电生理评估，然后进行脊髓电刺激治疗（Spinal Cord Stimulation, SCS）。4触点柔性电极插入颈椎硬膜外间隙，并放置在颈椎C2-C4水平。在白天，30分钟内，5Hz刺激5 min，强度以引起上肢肌肉抽搐。21例植物状态患者中8例患者，10例最小意识状态患者中9例患者均存在听觉脑干诱发电（ABR）Ⅴ波和上肢体感诱发电位（SEP）的N20波。3例植物状态患者和7例MCS患者在脑损伤后9个月，经SCS治疗恢复了意识，这些患者均保留了ABR和SEP的N20波。SCS治疗1年后，3例恢复意识的植物状态患者仍然处于卧床状态，而7例最小意识状态的患者则脱离了卧床状态。5Hz的颈椎SCS能够明显增加脑血流量，同时诱导了上肢的抖动，MCS患者在意识上表现出显著的恢复，并且上肢的功能恢复较下肢更加明显。因此SCS可能成为一种全新的神经调节和神经康复技术，而MCS患者可能是SCS治疗更好的选择。