Behavioural and EEG arousal induced by stimulation of unspecific projection systems in a patient with post-traumatic apallic syndrome

Häßler, R.; Ore, G. Dalle; Dieckmann, G; Bricolo, Albino; Dolce, Giuliano

doi:10.1016/0013-4694(69)90060-1

Cited by 91 publications

(69 citation statements)

References 2 publications

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“…2) Unilateral DBS of the intact side of the thalamic centromedian-parafascicular complex can induce a very strong arousal response in VS patients. We consider that increased arousal level in VS patients is important for recovery from VS. 3,4,8,10,18,22) In contrast to VS patients, MCS patients retain some consciousness. Considering the persistence of physical limitations after recovery from VS treated by DBS, as we have already reported, 29,32) we selected cervical SCS rather than DBS, because SCS can increase CBF in the entire brain, and can induce muscle twitches, which cannot be induced by DBS, for the recovery of motor function.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Stimulation for Treatment of Patients in the Minimally Conscious State

Yamamoto

Katayama

Obuchi

et al. 2012

Neurol. Med. Chir.(Tokyo)

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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 º 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.

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Stimulation for Treatment of Patients in the Minimally Conscious State

Yamamoto

Katayama

Obuchi

et al. 2012

Neurol. Med. Chir.(Tokyo)

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“…DBS has been explored on patients with Persistent Vegetative State [PVS] or minimally conscious state [MinCS] following traumatic brain injury.In the late 1960-s, Hassler et al described the concept of using DBS to treat disorder of consciousness [18], and then in early 1990-s, two groups used this technique in a larger series of patients with vegetative state [19,20].In one case-series study, DBS of the midbrain reticular formation or central thalamus was conducted in patients with MinCS 4-8 months post-injury. They received continuous stimulation for 10 years.…”

Section: Deep Brain Stimulationmentioning

confidence: 99%

A Review of Neuromodulation in the Neurorehabilitation

Yin¹,

Slavin²

2015

Int J Neurorehabilitation Eng

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“…The printed issue of this groundbreaking paper, much publicized in the lay press at the time, quoted 23 references, none of which referred to any of the several previous studies on DBS for decreased consciousness, published by various workers between 1969 and 1993 in Germany, 45,100 in France, 19,29 and in Japan.…”

Section: Deep Brain Stimulation In Minimally Conscious Statesmentioning

confidence: 99%

Deep brain stimulation between 1947 and 1987: the untold story

Hariz

Blomstedt

Zrinzo

2010

FOC

193

120

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Deep brain stimulation (DBS) is the most rapidly expanding field in neurosurgery. Movement disorders are well-established indications for DBS, and a number of other neurological and psychiatric indications are currently being investigated. Numerous contemporary opinions, reviews, and viewpoints on DBS fail to provide a comprehensive account of how this method came into being. Misconceptions in the narrative history of DBS conveyed by the wealth of literature published over the last 2 decades can be summarized as follows: Deep brain stimulation was invented in 1987. The utility of high-frequency stimulation was also discovered in 1987. Lesional surgery preceded DBS. Deep brain stimulation was first used in the treatment of movement disorders and was subsequently used in the treatment of psychiatric and behavioral disorders. Reports of nonmotor effects of subthalamic nucleus DBS prompted its use in psychiatric illness. Early surgical interventions for psychiatric illness failed to adopt a multidisciplinary approach; neurosurgeons often worked “in isolation” from other medical specialists. The involvement of neuro-ethicists and multidisciplinary teams are novel standards introduced in the modern practice of DBS for mental illness that are essential in avoiding the unethical behavior of bygone eras. In this paper, the authors examined each of these messages in the light of literature published since 1947 and formed the following conclusions. Chronic stimulation of subcortical structures was first used in the early 1950s, very soon after the introduction of human stereotaxy. Studies and debate on the stimulation frequency most likely to achieve desirable results and avoid side effects date back to the early days of DBS; several authors advocated the use of “high” frequency, although the exact frequency was not always specified. Ablative surgery and electrical stimulation developed in parallel, practically since the introduction of human stereotactic surgery. The first applications of both ablative surgery and chronic subcortical stimulation were in psychiatry, not in movement disorders. The renaissance of DBS in surgical treatment of psychiatric illness in 1999 had little to do with nonmotor effects of subthalamic nucleus DBS but involved high-frequency stimulation of the very same brain targets previously used in ablative surgery. Pioneers in functional neurosurgery mostly worked in multidisciplinary groups, including when treating psychiatric illness; those “acting in isolation” were not neurosurgeons. Ethical concerns have indeed been addressed in the past, by neurosurgeons and others. Some of the questionable behavior in surgery for psychiatric illness, including the bygone era of DBS, was at the hands of nonneurosurgeons. These practices have been deemed as “dubious and precarious by yesterday's standards.”

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Behavioural and EEG arousal induced by stimulation of unspecific projection systems in a patient with post-traumatic apallic syndrome

Cited by 91 publications

References 2 publications

Spinal Cord Stimulation for Treatment of Patients in the Minimally Conscious State

Spinal Cord Stimulation for Treatment of Patients in the Minimally Conscious State

A Review of Neuromodulation in the Neurorehabilitation

Deep brain stimulation between 1947 and 1987: the untold story

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