Effects of short-term spinal cord stimulation on patients with prolonged disorder of consciousness: A pilot study

Abstract

BackgroundSpinal cord stimulation (SCS) can improve the level of awareness of prolonged disorder of consciousness (pDOC), but its application is restricted due to damage of invasive operation. Short-term spinal cord stimulation (st-SCS) in a minimally invasive manner will better balance the benefits and risks.ObjectivesThis study focuses on the safety and efficacy of st-SCS for pDOC and reveals the modulation characteristics of different frequencies of SCS.Methods31 patients received 2-week st-SCS treatment and 3-months follow-up. All patients were divided into two types of frequency treatment groups of 5 Hz and 70 Hz according to the postoperative electroencephalography (EEG) test. The efficacy was assessed based on the revised coma recovery scale (CRS-R).ResultsThe results showed a significant increase in CRS-R scores after treatment (Z = −3.668, p < 0.001) without significant adverse effects. Univariate analysis showed that the minimally conscious state minus (MCS–) benefits most from treatment. Furthermore, two frequency have a difference in the time-point of the CRS-R score increase. 5 Hz mainly showed a significant increase in CRS-R score at 2 weeks of treatment (p = 0.027), and 70 Hz additionally showed a delayed effect of a continued significant increase at 1 week after treatment (p = 0.004).Conclusionst-SCS was safe and effective in improving patients with pDOC levels of consciousness, and was most effective for MCS–. Both 5 Hz and 70 Hz st-SCS can promote consciousness recovery, with 70 Hz showing a delayed effect in particular.

Clinical effect of short-term spinal cord stimulation in the treatment of patients with primary brainstem hemorrhage-induced disorders of consciousness

“…Furthermore, clinical data such as age, sex, and history of the disease are important for clinical treatment (42). There was no significant difference between the efficacy and inefficacy groups in terms of age, sex, hypertension, or MISPT history in our study; this result is similar to that reported in the literature (33). In addition, a subdivision of the MCS diagnosis did not reveal any significant differences between the two groups, contrary to previous research.…”

“…Therefore, st-SCS stimulation strategies were drawn from others reported for DOC. According to previous reports, the CRS-R score significantly increased after 2 weeks of DOC treatment at 70 Hz (33,34); we selected this frequency for this study. According to previous studies, neuronal fatigue or damage was reduced if the stimulation time was shorter than the off-stimulation time (31).…”

“…Before SCS implantation, all patients underwent the following preoperative routine examinations: medical history, imaging examinations, and routine laboratory tests. Following the screening, all eligible patients were included in the study to receive SCS system (Medtronic Inc., Minneapolis, USA) implantation, as previously described (33,34). Following general anesthesia, the patients were placed in a prone position and their necks were flexed forward.…”

“…Therefore, short-term spinal cord stimulation (st-SCS) has been developed. Another study already applied this method for the recovery from DOC (33,34), but it was unclear whether it affected PBSH-induced DOC.…”

Review of spinal cord stimulation for disorders of consciousness

“…Zhuang et al conducted a pilot study to investigate the effects of short-term SCS. The results revealed that short-term SCS at 5 Hz could significantly improve CRS-R scores after 2 weeks, while stimulation at 70 Hz showed statistically significant effects after 1 week [46 ▪ ]. Those results suggest that higher SCS frequencies may achieve better clinical outcomes because of increased CBF.…”