Electrical treatment of coma via the median nerve

Cooper, Edwin; Cooper, JD

doi:10.1007/978-3-7091-6081-7_2

Cited by 20 publications

(16 citation statements)

References 11 publications

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“…Brain perfusion increased due to RMNS in all six cases and the elevation of neurotransmitters in CSF was found in five out of six patients. A number of well-documented prospective single case studies, mainly in Asia (Japan), have confirmed on class 3 evidence the previous clinical results [39,90,146,172,173]. [7, 12, 22-30, 32-38, 40-51, 55-58, 68, 69, 72, 78, 91, 100-102, 104, 105, 118-122, 127, 128, 132, 137, 139, 143, 144, 150-157, 162, 163, 165, 166, 169, 175, 178, 182-186] The main demand is to provide every AS patient, independent of his/her functional stage, with the medical treatment and rehabilitative measures needed over time (during early, postacute and long-term rehabilitation and activating nursing).…”

Section: Functional Electrical Right Median Nerve Stimulation (Rmns)supporting

confidence: 61%

“…FES-RMNS was introduced by Cooper et al [172,173] in 1973 and is now recommended (class III A evidence) for arousal of comatose and apallic patients by increasing the brain blood flow and metabolism as it was shown by regional CBF studies and with the aid of biochemical analysis during stimulation therapy by means of increased central dopamine level and the regional concentration of Acetylcholine (Ach), a parasympathomimetical neurotransmitter substance in CSF and functional MRT within the area of the upper brain stem and basal ganglia [173]. In Cooper's prospective-controlled clinical study (class II evidence) on comatose TBI patients with the aid of battery powered, electrical neuromuscular stimulators trains of asymmetric biphasic pulses were supplied, delivered to the volar aspect of the right distal forearm over the median nerve surface rubber electrode measuring 2.5 cm 2 at an amplitude of 20 mA with a pulse width of 300 mys at 40 Hz for 20 s/min at each day for 2 weeks by either 12 or 8 h of stimulation.…”

Section: Functional Electrical Right Median Nerve Stimulation (Rmns)mentioning

confidence: 99%

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Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Wild

Gerstenbrand²,

Dolce

et al. 2007

Eur J Trauma Emerg Surg

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Management of AS aims at the social reintegration of patients or has to guarantee humanistic active nursing if treatment fails. Outcome depends on the cause and duration of AS/VS as well as patient's age. There is no single AS/VS specific laboratory investigation, no specific regimen or stimulating intervention to be recommended for improving higher cerebral functioning. Quality management requires at least 3 years of advanced training and permanent education to gain approval of qualification for AS/VS treatment and expertise. Sine qua non areas covering AS/VS institutions for early and long-term rehabilitation are required on a population base (prevalence of 2/100.000/year) to quicken functional restoration and to prevent or treat complications. Caring homes are needed for respectful humane nursing including basal sensor-motor stimulating techniques. Passive euthanasia is considered an act of mercy by physicians in terms of withholding treatment; however, ethical and legal issues with regard to withdrawal of nutrition and hydration and end of life discussions raise deep concerns. The aim of the guideline is to provide management guidance (on the best medical evidence class II and III or task force expertise) for neurologists, neurosurgeons, other physicians working with AS/VS patients, neurorehabilitation personnel, patients, next-of-kin, and health authorities.

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Section: Functional Electrical Right Median Nerve Stimulation (Rmns)supporting

confidence: 61%

Section: Functional Electrical Right Median Nerve Stimulation (Rmns)mentioning

confidence: 99%

Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Wild

Gerstenbrand²,

Dolce

et al. 2007

Eur J Trauma Emerg Surg

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“…5,6,7,9,11 The right median nerve was selected to be a portal to the reticular activating system, the thalamus, and the cortex of the dominant left cerebral hemisphere. The right median nerve was selected, not only because of its large cortical representation, but also because most humans are left hemisphere dominant whether the person is right-or left-handed.…”

Section: Discussionmentioning

confidence: 99%

“…Rational and methods of RMNS technique have been described in detail elsewehere. 7 In brief, the electrical treatment was delivered via a pair of lubricated 1-inch square rubber surface electrodes pasted on the volar aspect of the right distal forearm over the median nerve. An electrical neuromuscular stimulator (Verity Medical Ltd., UK) supplied trains of asymmetric biphasic pluses at an amplitude of 10-20 milliamps (10-15 mA for children and adolescents less than 18 years and 15-20 mA for adult patients) with a pulse width of 300 microseconds at 40 Hz for 20 sec/ min.…”

Section: Treatment Protocolmentioning

confidence: 99%

“…Experts from the United States and Japan reported that electrical stimulation of the right median nerve had the effect of hastening the awakening of coma patients. [5][6][7] The right median nerve was stimulated based on its role as a peripheral portal to the central nervous system. The electrical currents transdermally (converted to nerve impulses) applied may reach the brainstem, thalamus, and the cerebrum.…”

Section: Introductionmentioning

confidence: 99%

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Right Median Nerve Electrical Stimulation for Acute Traumatic Coma Patients

Jin

Wang

Gao

et al. 2015

Journal of Neurotrauma

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The right median nerve as a peripheral portal to the central nervous system can be electrically stimulated to help coma arousal after traumatic brain injury (TBI). The present study set out to examine the efficacy and safety of right median nerve electrical stimulation (RMNS) in a cohort of 437 comatose patients after severe TBI from August 2005 to December 2011. The patients were enrolled 2 weeks after their injury and assigned to the RMNS group (n=221) receiving electrical stimulation for 2 weeks or the control group (n = 216) treated by standard management according to the date of birth in the month. The baseline data were similar. After the 2-week treatment, the RMNS-treated patients demonstrated a more rapid increase of the mean Glasgow Coma Score, although statistical significance was not reached (8.43 ± 4.98 vs. 7.47 ± 5.37, p = 0.0532). The follow-up data at 6-month post-injury showed a significantly higher proportion of patients who regained consciousness (59.8% vs. 46.2%, p = 0.0073). There was a lower proportion of vegetative persons in the RMNS group than in the control group (17.6% vs. 22.0%, p = 0.0012). For persons regaining consciousness, the functional independence measurement (FIM) score was higher among the RMNS group patients (91.45 ± 8.65 vs. 76.23 ± 11.02, p < 0.001). There were no unique complications associated with the RMNS treatment. The current study, although with some limitations, showed that RMNS may serve as an easy, effective, and noninvasive technique to promote the recovery of traumatic coma in the early phase.

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Functional Electrical Stimulation for Spinal Cord Injury Rehabilitation at the University of Virginia and Duke University

Cooper

McElhaney

Han³

et al.

Minimally Invasive Neurosurgery and Multidisciplinary Neurotraumatology

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Functional electrical stimulation (FES) has applications in spinal cord injury to help restore function to patients with quadriplegic hands or paraplegic legs. Early experiences at the University of Virginia and Duke University are presented. Further progress has been obtained at multiple centers with computerized stimulation, miniaturization of components, and mind/machine interfacing. Knowledge gained from the early projects led to the concept of electrical stimulation of the median nerve to hasten awakening from coma.

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Electrical treatment of coma via the median nerve

Cited by 20 publications

References 11 publications

Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Right Median Nerve Electrical Stimulation for Acute Traumatic Coma Patients

Functional Electrical Stimulation for Spinal Cord Injury Rehabilitation at the University of Virginia and Duke University

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