title: Spinal Cord Stimulation for Vegetative State and Minimally Conscious State: Changes in Consciousness Level and Motor Function.
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.
authors.affiliation: Divisions of Applied System Neuroscience, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan. yamamoto.takamitsu@nihon-u.ac.jp.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Divisions of Applied System Neuroscience, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Divisions of Applied System Neuroscience, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Obuchi
authors.affiliation: Divisions of Applied System Neuroscience, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Divisions of Applied System Neuroscience, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Oshima
authors.affiliation: Divisions of Applied System Neuroscience, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Chikashi
authors.initials: C
authors.lastname: Fukaya
authors.affiliation: Divisions of Applied System Neuroscience, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Yoshino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply*; D002560:Cerebrovascular Circulation; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation; D018458:Persistent Vegetative State / Q000503:physiopathology / Q000534:rehabilitation*; D062187:Spinal Cord Stimulation; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D055815:Young Adult
keywords: Auditory brainstem response; Minimally conscious state; Somatosensory evoked potential; Spinal cord stimulation; Vegetative state