title: Spinal cord stimulation for treatment of patients in the minimally conscious state.
abstract: Minimally conscious state (MCS) is characterized by inconsistent but clearly discernible behavioral evidence of consciousness, and can be distinguished from coma and the vegetative state (VS). Ten MCS patients were evaluated neurologically and electrophysiologically over 3 months after the onset of brain injury, and were treated by spinal cord stimulation (SCS). A flexible four-contact, cylinder electrode was inserted into the epidural space of the cervical vertebrae, and placed at the C2-C4 levels. Stimulation was applied for 5 minutes every 30 minutes during the daytime at an intensity that produced motor twitches of the upper extremities. We used 5 Hz for SCS, considering that the induced muscle twitches can be a useful functional neurorehabilitation for MCS patients. Eight of the 10 MCS patients satisfied the electrophysiological inclusion criteria, which we proposed on the basis of the results of deep brain stimulation for the treatment of patients in the VS. Seven patients recovered from MCS following SCS therapy, and were able to carry out functional interactive communication and/or demonstrate the functional use of two different objects. Cervical SCS increased cerebral blood flow (CBF) diffusely in the brain, and CBF increased by 22.2% during the stimulation period compared with CBF before stimulation in MCS patients (p < 0.0001, paired t-test). Five-Hz cervical SCS could increase CBF and induce muscle twitches of the upper extremities. This SCS therapy method may be suitable for treating MCS.
authors: Division of Applied System Neuroscience, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan. yamamoto.takamitsu@nihon-u.ac.jp
authors: Takamitsu
authors: T
authors: Yamamoto
authors: Yoichi
authors: Y
authors: Katayama
authors: Toshiki
authors: T
authors: Obuchi
authors: Kazutaka
authors: K
authors: Kobayashi
authors: Hideki
authors: H
authors: Oshima
authors: Chikashi
authors: C
authors: Fukaya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000150:complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D020127:Recovery of Function / Q000502:physiology*; D062187:Spinal Cord Stimulation / Q000295:instrumentation / Q000379:methods*; D013995:Time; D055815:Young Adult