Long-term functional outcomes improved with deep brain stimulation in patients with disorders of consciousness

Abstract

BackgroundDeep brain stimulation (DBS) has been preliminarily applied to treat patients with disorders of consciousness (DoCs). The study aimed to determine whether DBS was effective for treating patients with DoC and identify factors related to patients’ outcomes.MethodsData from 365 patients with DoCs who were consecutively admitted from 15 July 2011 to 31 December 2021 were retrospectively analysed. Multivariate regression and subgroup analysis were performed to adjust for potential confounders. The primary outcome was improvement in consciousness at 1 year.ResultsAn overall improvement in consciousness at 1 year was achieved in 32.4% (12/37) of the DBS group compared with 4.3% (14/328) of the conservative group. After full adjustment, DBS significantly improved consciousness at 1 year (adjusted OR 11.90, 95% CI 3.65–38.46, p<0.001). There was a significant treatment×follow up interaction (H=14.99, p<0.001). DBS had significantly better effects in patients with minimally conscious state (MCS) compared with patients with vegetative state/unresponsive wakefulness syndrome (p for interaction <0.001). A nomogram based on age, state of consciousness, pathogeny and duration of DoCs indicated excellent predictive performance (c-index=0.882).ConclusionsDBS was associated with better outcomes in patients with DoC, and the effect was likely to be significantly greater in patients with MCS. DBS should be cautiously evaluated by nomogram preoperatively, and randomised controlled trials are still needed.

Clinical neuromodulatory effects of deep brain stimulation in disorder of consciousness: A literature review

“…Neuroimaging techniques (CT, MRI, PET, fMRI, MEG) were used, as well as neurophysiological assessments (EEG, somatosensory evoked potentials [SEP], motor evoked potentials [MEP], mismatched negativity [MMN], brainstem auditory evoked potentials [BAEPs], functional near‐infrared spectroscopy [fNIRS]). 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 Strict exclusion criteria were applied, including infectious or metabolic brain injury, additional neurological diseases not related to DOC, life expectancy of less than 1 year due to non‐neurological disease, persistent incurable infections, pregnancy, use of sedative drugs, thalamus site injuries indicated by imaging data, and legal representative requests to exclude patients from the study. 23 , 28 , 31 …”

“… 13 Yang's research considered a CRS‐R score increase of more than 3 points or a change in diagnosis from vegetative state (VS) to minimally conscious state (MCS) as indicative of effective stimulation. 29 …”

“…A retrospective analysis of postoperative follow‐up data was used to propose a prediction model for DBS treatment efficacy, adding to the comprehensive evaluation of DBS outcomes. 29 These diverse evaluation metrics contribute to a more comprehensive understanding of the long‐term effects and potential benefits of DBS for patients with disorders of consciousness.…”

“…The two main targets, the Centromedian‐parafascicular complex (CM‐pf) and the Central Thalamus (CT), have shown promising results in improving arousal levels and behavioral responsiveness in patients with DOC. 13 , 22 , 28 , 29 , 31 , 45 CM‐pf stimulation can directly influence the thalamocortical system, while CT stimulation has been associated with improved executive function and arousal regulation.…”

Brain Temporal-Spectral Functional Variability Reveals Neural Improvements of DBS Treatment for Disorders of Consciousness

“…In [9], Magrassi et al found that DBS could improve the clinical status of patients in the vegetative state and minimally conscious state. In [10], Yang et al demonstrated that DBS led to significant functional improvements of DOC patients and had better effects in patients with minimally conscious state than patients with vegetative state. Besides DBS, other treatment methods for DOC include rehabilitative therapies, sensory stimulation, pharmacological interventions, etc [11]- [13].…”