Long‐term functional prognosis and related factors of spinal cord stimulation in patients with disorders of consciousness

Yang, Yi; He, Qiheng; Xia, Xiaoyu; Dang, Yuanyuan; Chen, Xueling; He, Jianghong; Zhao, Jizong

doi:10.1111/cns.13870

Cited by 18 publications

(24 citation statements)

References 45 publications

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“…Subsequently, DellaPepa et al summarized multiple SCS studies and found that 51.6% patients with pDOC showed recovery of consciousness and inferred the treatment effect is that SCS activates the thalamocortical pathway and increases cerebral blood flow through the ascending reticular activating system (12). Our research team also reported that 31.8% patients showed improvement in consciousness (6), and the above findings suggest that SCS can effectively promote the recovery of consciousness. The overall effective rate of SCS ranges from 20 to 40% (13).…”

Section: Introductionsupporting

confidence: 62%

“…To verify the effectiveness of st-SCS and exclude the interference of natural recovery as much as possible, the study chose the same time of enrollment (3 months after onset brain injury) as conventional SCS (6,15). And, we adopted a selfcontrolled design.…”

Section: Discussionmentioning

confidence: 99%

“…The uppermost contact of the st-SCS was used for the stimulation contact cathode (0-1+2+). The stimulation pulse width was set to 120 us, the stimulation intensity ranged from 1.0 to 3.0 V, and the individualization stimulation intensity was set according to the Previous clinical study of SCS in the treatment of pDOC: 5 Hz stimulation induces bilateral upper limb tremors (13), and 70 Hz stimulation just did not induce significant limb movements (6).…”

Section: Stimulation Protocolmentioning

confidence: 99%

“…The principle of treatment of the non-invasive neuromodulation determines its scope of effect to modulate only the cortico-cortical connections. Deep Brain Stimulation (DBS) (5), spinal cord stimulation (SCS) (6), and vagus nerve stimulation (VNS) (7), can directly modulate the neural circuit and are expected to be an effective means to solve "disorders of consciousness (DOC)." DBS has been found to be an modulation for the thalamocortical and thalamostriate loops (8-10), but indications of DBS for DOC includes no significant lesions of thalamus and displacement of deep nuclear cluster to ensure accurate implantation of electrodes.…”

Section: Introductionmentioning

confidence: 99%

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

Zhuang

Yang

et al. 2022

Front. Neurol.

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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.

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Section: Introductionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Stimulation Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Zhuang

Yang

et al. 2022

Front. Neurol.

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“…As for surgical procedures, a C5 vertebra laminotomy is made and the electrode array is delivered up to the target zone at the midline of the C2–C5 level ( 12 ), and the electrode position may affect prognosis and patient tolerance. We preliminary reported stimulation parameters that could affect the therapeutic effects of SCS, such as inter-stimulus interval and frequency ( 5 , 13 ), and summarized clinical characteristics on patients' outcomes ( 14 ). Considering that the mechanism of SCS to treat disturbance of consciousness possibly underlying in the direct stimulation of the dorsal column, and since we observed that patients with electrodes closer to the midline seem to have a better prognosis, we proposed that surgical factors such as electrode deviation may affect the outcomes of patients.…”

Section: Introductionmentioning

confidence: 99%

Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness

Han²,

Xia³

et al. 2022

Front. Neurol.

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Background and PurposeSpinal cord stimulation (SCS) has been reported to be a promising neuromodulation method for patients with disorders of consciousness (DOC). Our previous studies found that clinical characteristics of patients and SCS stimulation parameters could affect the therapeutic effects of SCS, while surgical-related factors remain unknown. Through the improvement of surgical procedures, most of the SCS electrodes are implanted in the middle, while a small number of electrodes have still deviated.MethodsA total of 137 patients received SCS treatment in our institutions from 1 January 2010 to 31 December 2020. Among them, 27 patients were found with electrode deviation and met the inclusion criteria. Patients were grouped according to whether the electrode deviation angle (EDA) is >30°, respectively. Clinical characteristics of patients and SCS stimulation parameters were compared. Potential related factors and outcomes were evaluated by Chi-square test or two-way repeated measures analysis.ResultsTwenty seven patients receiving cervical SCS treatment were found to have electrode deviation postoperatively. Among them, 12 patients were classified into the more deviation group. No significant difference was found among age, sex, pathogeny, course of DOC, C2–C5 distance, spinal cord to spinal canal ratio at C2 level, and preoperative JFK Coma Recovery Scale-Revised (CRS-R) scores. We found that the electrode direction significantly deviated to the contralateral side in the lateral decubitus position (P = 0.025). The maximum tolerant stimulation intensity in the less deviation group (1.70 ± 0.41) was significantly higher than that in the more deviation group (1.25 ± 0.34) (P = 0.006). Under the strongest stimulation, less unilateral limb tremor (P = 0.049) and paroxysmal sympathetic hyperactivity (PSH) episodes (P = 0.030) were found. EDA had a significant effect on postoperative CRS-R in patients, and patients in the less deviation group had significantly higher postoperative CRS-R (P < 0.01). There was also an interaction effect between EDA and postoperative time. With the prolonged postoperative time, the CRS-R improvement rate of patients with different EDA was different, and the CRS-R improved faster in patients with less EDA (P < 0.05).ConclusionsElectrode deviation will affect the outcome of patients receiving cervical SCS treatment. The intraoperative surgical position is associated with postoperative electrode deviation direction. The reduction of EDA under 30° can increase maximum tolerant stimulation intensity, reduce complications, and further improve patients' outcomes.

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Emerging Treatment for Patients with Disorders of Consciousness: The Field of Neuromodulation

Hopkins,

Vitello,

Thibaut

et al. 2023

Coma and Disorders of Consciousness

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Long‐term functional prognosis and related factors of spinal cord stimulation in patients with disorders of consciousness

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 18 publications

References 45 publications

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

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

Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness

Emerging Treatment for Patients with Disorders of Consciousness: The Field of Neuromodulation

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