Spinal cord stimulation and deep brain stimulation for disorders of consciousness: a systematic review and individual patient data analysis of 608 cases

Wu, Yang; Xu, Yangyang; Deng, Hao; Zhang, Wei; Zhang, Shuxin; Li, Jiaming; Xiong, Botao; Xiao, Linglong; Li, Denghui; Ren, Zhang-Qing; Qin, Yifan; Yang, Runze; Wang, Wei

doi:10.1007/s10143-023-02105-1

Cited by 4 publications

(3 citation statements)

References 48 publications

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“…Among invasive therapies, DBS requires surgically implanting electrodes into specific brain regions to deliver controlled electrical impulses, showing promise in improving consciousness among individuals with DoC. Stimulation of various thalamic nuclei has demonstrated significant success rates, with sustained improvements observed in numerous patients [10–14]. VNS therapy, involving stimulation of the vagus nerve, offers a less invasive alternative, potentially modulating consciousness by influencing corticothalamic networks and the reticular activation system via connections with the brainstem [15].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the potential of these brain stimulation methods, their adoption as reliable therapies for DoC faces challenges due to the considerable variability in treatment outcomes, attributed to factors like the patient’s condition, the extent of brain damage, and individual biological characteristics [8, 14]. In turn, this leads to a large variability in the patients’ need in stimulation, from the most appropriate technique (e.g., transcranial, or more invasive DBS), to stimulation parameters in terms of e.g., location, frequency and duration.…”

Section: Introductionmentioning

confidence: 99%

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Personalized stimulation therapies for disorders of consciousness: a computational approach to inducing healthy-like brain activity based on neural field theory

Polyakov,

Robinson,

Müller

et al. 2024

Preprint

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Disorders of consciousness (DoC) pose significant challenges in neurology. Conventional neuromodulation therapies for DoC have exhibited limited success, with varying effectiveness among patients. In this study, we introduce a computational approach for constructing personalized stimulus signals capable of inducing healthy-like neural activity patterns in DoC patients. Leveraging a simplified brain model based on neural field theory, we fit this model to the power spectrum of a patient with DoC and derive a personalized stimulus time series to induce a healthy-like power spectrum. By applying this stimulus to brain regions typically targeted by stimulation therapies such as deep brain stimulation and repetitive transcranial magnetic stimulation, we demonstrate in silico, the ability of our method to elicit EEG power spectra resembling those of healthy individuals. We speculate that in the course of a long-term treatment, when the brain produces healthy-like activity, it may trigger intrinsic plasticity mechanisms, potentially leading to sustained improvements in the patient's condition. While further clinical adjustments and validation are needed, this novel approach offers promise in tailoring brain stimulation therapies for DoC patients. Moreover, it presents potential extensions to other conditions that could also benefit from brain stimulation therapies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Personalized stimulation therapies for disorders of consciousness: a computational approach to inducing healthy-like brain activity based on neural field theory

Polyakov,

Robinson,

Müller

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Thus, clinicians are seeking alternative therapeutic avenues to promote the recovery of patients with disorders of consciousness. Among these, neuromodulation techniques offer a novel approach to facilitating changes in the patients’ brain activity patterns in hopes of restoring consciousness ( Vanhoecke and Hariz, 2017 ; Wu et al, 2023 ). This method represents an emerging frontier in the treatment of disorders of consciousness, attempting to bridge the gap between the damaged neuronal pathways and the complex network that governs wakefulness and awareness ( Raguz et al, 2021 ; Cao et al, 2023 ).…”

Section: Introductionmentioning

confidence: 99%

Anatomical-related factors and outcome of percutaneous short-term spinal cord stimulation electrode shift in patients with disorders of consciousness: a retrospective study

He,

Yang,

et al. 2024

Front. Aging Neurosci.

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BackgroundDisorders of consciousness (DoC) represent a spectrum of neurological conditions that pose significant treatment challenges. Percutaneous short-term spinal cord stimulation (SCS) has emerged as a promising experimental diagnostic treatment to assess and potentially improve consciousness levels. However, the effectiveness of this intervention is frequently compromised by the shift of electrodes, particularly in the cervical region, which can negatively affect therapeutic outcomes.MethodsThis retrospective study aimed to study if electrodes shift in percutaneous short-term SCS in patients with DoC would affect the outcome. We analyzed the relationship between electrode shift length and patient outcome, as well as the correlation with various anatomical parameters, including the actual length of the cervical spine, linear length, spinal canal transverse diameter, spinal canal diameter, and C2 cone height, in a cohort of patients undergoing the procedure.ResultsOur findings revealed that in patients with better outcome, there are significant less patient with electrode shift (p = 0.019). Further, a linear correlation was found between the length of electrode shift and patients’ outcome (Rho = 0.583, p = 0.002), with longer shift lengths associated with poorer outcomes. Contrary to our expectations, there was no significant association between the measured anatomical parameters and the extent of electrode shift. However, a trend was found between the actual length of the cervical spine and the shift of the electrode (p = 0.098). Notably, the shorter spinal canal transverse diameter was found to be significantly associated with better outcome in patients with DoC receiving percutaneous short-term SCS (p = 0.033).ConclusionThese results highlight the clinical importance of electrode stability in the cervical region during SCS treatment for patients with DoC. Ensuring secure placement of electrodes may play a crucial role in enhancing patients’ outcome and minimize postoperative complications. Given the lack of association with expected anatomical parameters, future research should investigate other factors that could impact electrode stability to optimize this therapeutic intervention.

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Assessing brain activity in patients with disorder of consciousness using the amplitude of low-frequency fluctuations and regional homogeneity derived from resting-state functional magnetic resonance images

Qin,

Chen,

Yao

et al. 2024

Preprint

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Objective Disorder of consciousness (DoC) is an impaired state of consciousness. This study used the amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) measures obtained from resting-state functional magnetic resonance imaging (rs-fMRI) to observe neuronal activity changes in patients with DoC from various injuries for prognostic predictions. Methods This study included six patients with traumatic brain injury (TBI)-induced DoC and six patients with cerebrovascular disease (CVD)-induced DoC. Images were processed using Data Processing Assistant for rs-fMRI software to obtain the ALFF and ReHo values. Results The ALFF values were lower in the TBI group than in the CVD (i.e., control) group for the Precuneus_R, Superior frontal gyrus_R, Middle frontal gyrus, Middle occipital gyrus, and Hippocampus_R but higher for the bilateral insula, Postcentral gyrus_L, right moment gyrus, Superior parietal gyrus_L, and Inferior temporal gyrus_L. The ReHo values were higher in the TBI group than in the CVD group for the Precental gyrus_L and Postcentral gyrus_L, Middle temporal gyrus_R, right superior temporal gyrus, Superior temporal gyrus_R, Superior parietal gyrus_L, Superior frontal gyrus_R, and Inferior frontal gyrus)_L but lower for the Insula_R, Postcentral gyrus_R, Inferior frontal gyrus, Orbital part_L, straight gyrus, and Anterior cingulate_L. Consciousness improved in three patients with CVD DoC and one with TBI DoC. Conclusion ALFF and ReHo enhancements in the precuneus and frontal lobes on rs-fMRI might suggest improved consciousness for patients with CVD and TBI DoC.

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Spinal cord stimulation and deep brain stimulation for disorders of consciousness: a systematic review and individual patient data analysis of 608 cases

Cited by 4 publications

References 48 publications

Personalized stimulation therapies for disorders of consciousness: a computational approach to inducing healthy-like brain activity based on neural field theory

Personalized stimulation therapies for disorders of consciousness: a computational approach to inducing healthy-like brain activity based on neural field theory

Anatomical-related factors and outcome of percutaneous short-term spinal cord stimulation electrode shift in patients with disorders of consciousness: a retrospective study

Assessing brain activity in patients with disorder of consciousness using the amplitude of low-frequency fluctuations and regional homogeneity derived from resting-state functional magnetic resonance images

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