Deep-brain stimulation in a persistent vegetative state: follow-up results and criteria for selection of candidates.
Eight cases of a persistent vegetative state caused by brain damage were treated by chronic deep-brain stimulation (stimulation target: the mesencephalic reticular formation and/or non-specific thalamic nucleus) over a period of more than 6 months. Three of the patients are currently able to communicate and to express their demands by voice and one other patient has recovered very close to this state. These four cases showed changeable spectrograms with desynchronization on continuous EEG recording and all components of the BSR and SER could be recorded except for prolonged latency of both N20 (SER) and the V wave (BSR) 2 months after the initial coma. Following chronic deep-brain stimulation, EEG and behavioural arousal responses were observed with increased r-CBF, r-CMRO2 and r-CMRGL in the whole brain tissue. After 3-6 months of chronic deep brain stimulation, the prolonged coma scale rose in four of the eight cases and three cases emerged from the persistent vegetative state. Transmitter substances and their metabolites were also found to be increased in the CSF after chronic deep-brain stimulation. Based on these findings, chronic deep-brain stimulation represents a useful kind of treatment that can lead to emergence from a persistent vegetative state, if the candidate is selected by electrophysiological studies 2 months after the initial insult and if the stimulation is applied for more than 6-8 months using a high-safety chronic deep-brain stimulating instrument.
Tsubokawa
T
T
Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
Yamamoto
T
T
Katayama
Y
Y
Hirayama
T
T
Maejima
S
S
Moriya
T
T
D000328:Adult; D000368:Aged; D001143:Arousal / Q000502:physiology; D001925:Brain Damage, Chronic / Q000503:physiopathology / Q000628:therapy*; D002540:Cerebral Cortex / Q000098:blood supply; D002560:Cerebrovascular Circulation / Q000502:physiology; D003128:Coma / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000295:instrumentation; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000295:instrumentation; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008636:Mesencephalon / Q000503:physiopathology*; D008875:Middle Aged; D009460:Neurologic Examination; D010101:Oxygen Consumption / Q000502:physiology; D012154:Reticular Formation / Q000503:physiopathology*; D013787:Thalamic Nuclei / Q000503:physiopathology*