title: Dorsal column stimulation in persistent vegetative state.
abstract: Objectives.  The problem of treating patients in a vegetative state remains grossly unresolved, and spinal cord stimulation (SCS) had seemed promising in some studies, suggesting, to us, further study. Materials and Methods.  A prospective uncontrolled and nonrandomized observational study for 20 consecutive years (1986-2005) was performed on the effect of SCS in 214 patients in persistent vegetative state (PVS) that resulted from global anoxia and/or, stroke and/or head injury. After confirming the condition of PVS, a spinal cord stimulator, at the C2-C4 level, was implanted, stimulating according to a protocol of 15-min on/15-min off during daytime only. The results were evaluated using an efficacy scale designed by us for our study, detecting signs of awareness of self and surrounding. Results.  Excellent and positive results were obtained in 109 of 201 patients (54%), but better in those patients below the age of 35, those of PVS of traumatic origin and those patients with regional cerebral blood flow over 20 mL/100 g/min. Conclusions.  These findings, though inconclusive of actual benefit of SCS for PVS, indicate to us that further evidence-based, randomized controlled trials are needed to confirm efficacy of the treatment and define those who are going to benefit from this treatment method.
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Aichi, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kanno
authors.forename: Isao
authors.initials: I
authors.lastname: Morita
authors.forename: Sachiko
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kamei
authors.forename: S M
authors.initials: SM
authors.lastname: Anil
authors.forename: Kostadin L
authors.initials: KL
authors.lastname: Karagiozov