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Liu XW, Zhao NN, Pang T, Wen Q, Xiao P, Zeng KX, Wang DN, Chen JM, Wang YL, Yu HB. Effects of high-frequency repetitive transcranial magnetic stimulation on the nutritional status of patients in a persistent vegetative state: A pilot study. Front Nutr 2023; 10:924260. [PMID: 37032764 PMCID: PMC10076736 DOI: 10.3389/fnut.2023.924260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 02/15/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose This paper presents a preliminary study on whether repetitive transcranial magnetic stimulation (rTMS) can modulate the nutritional status of persistent vegetative state (PVS) patients (the primary endpoint) by regulating the intestinal flora and the metabolites, with the correlation between them also investigated. Methods Seventy-six patients with PVS were selected and divided into the observation group (n = 38) and the control group (n = 38) by random numerical grouping. All subjects' stool samples were examined for metabolites and analyzed regarding the short-chain fatty acids (SCFAs) content. All subjects' serum albumin, prealbumin, and hemoglobin levels were measured before and after the treatment. Nutrition risk screening 2002 was performed on all the subjects before and after the treatment and on the 30th and 90th days of the follow-up. Results (1) Intestinal flora structure: the Chao index, Ace index, and Shannon index of the observation group and the control group were significantly higher (p < 0.05), while the Simpson index was significantly lower (p < 0.05) following the treatment. (2) Metabolites of the intestinal flora: the observation group had significantly higher levels of acetic acid, butyric acid, and valeric acid (p < 0.05), as well as lower levels of propionic acid (p < 0.05) following the treatment. (3) Nutritional status (the primary endpoint): following the treatment, the above serum nutritional indices were significantly higher in both groups (p < 0.05), while the indices of the observation group were significantly higher than those of the control group (p < 0.05). Conclusion The rTMS method may improve the nutritional status of patients with PVS by regulating the structure of the intestinal flora and affecting the level of SCFAs through the microbiota-gut-brain axis. The possible mechanism involves how high-frequency rTMS can cause increased excitation in the frontal lobe of the right side of the brain, thus regulating the 5-hydroxytryptamine and norepinephrine levels.
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Affiliation(s)
- Xuan-Wei Liu
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People's Hospital, Shenzhen, China
| | - Na-Na Zhao
- Department of Acupuncture and Massage, Shenzhen Luohu District Hospital of Chinese Medicine, Shenzhen, China
| | - Tao Pang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People's Hospital, Shenzhen, China
| | - Qiong Wen
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People's Hospital, Shenzhen, China
| | - Peng Xiao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People's Hospital, Shenzhen, China
| | - Ke-Xue Zeng
- Department of Rehabilitation, Guangdong Province Second Hospital of Chinese Medicine, Guangzhou, China
| | - Dan-Ning Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jia-Min Chen
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People's Hospital, Shenzhen, China
| | - Yu-Long Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen, China
- *Correspondence: Yu-Long Wang, ; Hai-Bo Yu,
| | - Hai-Bo Yu
- Department of Acupuncture and Massage, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
- *Correspondence: Yu-Long Wang, ; Hai-Bo Yu,
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He Q, Li T, Xiong Y, Xia X, Dang Y, Chen X, Geng X, He J, Yang Y, Zhao J. Elevated cerebrospinal fluid protein levels associated with poor short-term outcomes after spinal cord stimulation in patients with disorders of consciousness. Front Aging Neurosci 2022; 14:1032740. [DOI: 10.3389/fnagi.2022.1032740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundSpinal cord stimulation (SCS) is a promising treatment for patients with disorders of consciousness (DoC); however, the laboratory examinations and different electrodes (permanent #39286 vs. temporary percutaneous #3777, Medtronic, USA) that are associated with postoperative outcomes are unclear. The study aims to study the association between the change in postoperative cerebrospinal fluid (CSF) protein level and improvement in consciousness after SCS in DoC patients and to explore whether different electrodes were associated with elevated CSF protein levels.Materials and methodsA total of 66 DoC patients who received SCS treatment from December 2019 to December 2021 were retrospectively analyzed. Patients were grouped according to their elevated CSF protein level. The clinical characteristics of the patients and SCS stimulation parameters were compared. The preoperative sagittal diameter of the spinal canal is the distance from the midpoint of the posterior border of the vertebral body to the midpoint of the posterior wall of the spinal canal at the level of the superior border of C3. The postoperative sagittal diameter of the spinal canal is the distance from the midpoint of the posterior edge of the vertebral body to the anterior edge of the stimulation electrode. Patients with improved postoperative CRS-R scores greater than 3 or who progressed to the MCS + /eMCS were classified as the improved group and otherwise regarded as poor outcome.ResultsWe found that more DoC patients had elevated CSF protein levels among those receiving SCS treatment with permanent electrodes than temporary percutaneous electrodes (P = 0.001), and elevated CSF protein levels were significantly associated with a reduced sagittal diameter (P = 0.044). In DoC patients receiving SCS treatment, we found that elevated CSF protein levels (P = 0.022) and preoperative diagnosis (P = 0.003) were significantly associated with poor outcomes at 3 months. Logistic regression analysis showed that elevated CSF protein levels were significantly associated with poor outcomes (OR 1.008, 95% CI 1.001–1.016, P = 0.032).ConclusionThe results suggest that reducing the effect of electrode pads on anatomical changes may help improve the outcomes of DoC patients receiving SCS treatment. CSF protein levels are associated with poor postoperative outcomes and whether they are potential biomarkers in DoC patients receiving SCS treatment remain further exploration.
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Zhang XH, Han P, Zeng YY, Wang YL, Lv HL. The Clinical Effect of Repetitive Transcranial Magnetic Stimulation on the Disturbance of Consciousness in Patients in a Vegetative State. Front Neurosci 2021; 15:647517. [PMID: 33994925 PMCID: PMC8119637 DOI: 10.3389/fnins.2021.647517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To explore the effect of combining repetitive transcranial magnetic stimulation (rTMS) and conventional rehabilitation on the recovery of consciousness in patients in a persistent vegetative state (PVS). Methods A total of 48 patients in a PVS were randomly divided into a treatment and control group. Patients in the treatment group were treated with rTMS to stimulate the dorsolateral prefrontal cortex, and patients in the control group were treated with false stimulation. All patients were evaluated using scales and neuroelectrophysiological assessment before treatment, after 30 days of treatment, and following 60 days of treatment. Results Based on the Coma Recovery Scale-Revised (CRS-R) and electroencephalogram (EEG) grading indexes, the treatment group was significantly higher than those of the control group after 30 and 60 days of treatment. The average difference in the three measurements between the two groups before treatment, at 30 days, and 60 days was 0.04, 1.54, and 2.09 for CRS-R and 0.08, −0.83, and −0.62 for EEG indexes, respectively. The latency periods of each wave of the brainstem auditory evoked potentials (BAEPs) in the treatment group were shorter than those in the control group after 30 and 60 days of treatment. In both groups, the BAEP scores after 30 days of treatment were significantly higher than the scores before treatment, and the scores after 60 days of treatment were higher than the scores after 30 days. Conclusion In patients in a PVS, rTMS assists in the recovery of consciousness function.
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Affiliation(s)
- Xiao-Hua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
| | - Ping Han
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
| | - Yuan-Yuan Zeng
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
| | - Yu-Long Wang
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Hui-Lan Lv
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
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Kanarskii M, Nekrasova J, Vitkovskaya S, Pradhan P, Peshkov S, Borisova E, Borisov I, Panasenkova O, Petrova MV, Pryanikov I. Effect of Retinohypothalamic Tract Dysfunction on Melatonin Level in Patients with Chronic Disorders of Consciousness. Brain Sci 2021; 11:brainsci11050559. [PMID: 33925097 PMCID: PMC8145260 DOI: 10.3390/brainsci11050559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study is to compare the secretion level of nocturnal melatonin and the characteristics of the peripheral part of the visual analyzer in patients with chronic disorders of consciousness (DOC). MATERIALS AND METHODS We studied the level of melatonin in 22 patients with chronic DOC and in 11 healthy volunteers. The fundus condition was assessed using the ophthalmoscopic method. RESULTS The average level of nocturnal melatonin in patients with DOC differed by 80% from the level of indole in healthy volunteers. This reveals a direct relationship between etiology, the level of consciousness, gaze fixation, coma recovery scale-revised score and the level of melatonin secretion. Examination by an ophthalmologist revealed a decrease in the macular reflex in a significant number of DOC patients, which in turn correlates negatively with the time from brain injury and positively with low values of nocturnal melatonin.
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Affiliation(s)
- Mikhail Kanarskii
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Julia Nekrasova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Svetlana Vitkovskaya
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Pranil Pradhan
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
- Correspondence:
| | - Sergey Peshkov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Elena Borisova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Ilya Borisov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Olga Panasenkova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
| | - Marina V. Petrova
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
- Department of Anestesiology-Reanimatology, People’s Friendship University of Russia, 117198 Moscow, Russia
| | - Igor Pryanikov
- Department for the Study of Chronic Disorder of Consciousness, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 117647 Moscow, Russia; (M.K.); (J.N.); (S.V.); (S.P.); (E.B.); (I.B.); (O.P.); (M.V.P.); (I.P.)
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Sattin D, Leonardi M, Picozzi M. The autonomic nervous system and the brainstem: A fundamental role or the background actors for consciousness generation? Hypothesis, evidence, and future directions for rehabilitation and theoretical approaches. Brain Behav 2020; 10:e01474. [PMID: 31782916 PMCID: PMC6955833 DOI: 10.1002/brb3.1474] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION One of the hardest challenges of the third century is to develop theories that could joint different results for a global explanation of human consciousness. Some important theories have been proposed, trying to explain the emergence of consciousness as the result of different progressive changes in the elaboration of information during brain processing, giving particular attention to the thalamocortical system. METHODS In this article, a summary review of results that highlighted as cerebral cortex could not be so fundamental for consciousness generation is proposed. In detail, three topics were analyzed: (a) studies using experimental approach (manipulating stimuli or brain areas), such as decorticated animals or subliminal presentation of stimuli; (b) studies using anatomo-clinical method (conscious inferenced from observed behaviors); and (c) data from neurostimulation of subcortical areas or of the autonomic nervous system. RESULTS We sketch two speculative hypothesis relative, firstly, to the possible independence from cortical areas of the on/off mechanism for consciousness generation and, secondly, to the possible role of information variability generated by the bottom-up exchange of information among neural systems as a switch for consciousness. CONCLUSIONS A broad range of evidence regarding the functional role of the brainstem and autonomic nervous system is reviewed for its bearing on a future hypothesis regarding the generation of consciousness experience.
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Affiliation(s)
- Davide Sattin
- Neurology, Public Health, Disability Unit and Coma Research CentreFondazione IRCCS Istituto Neurologico C.BestaMilanItaly
- Experimental Medicine and Medical Humanities‐PhD ProgramBiotechnology and Life Sciences Department and Center for Clinical EthicsInsubria UniversityVareseItaly
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit and Coma Research CentreFondazione IRCCS Istituto Neurologico C.BestaMilanItaly
| | - Mario Picozzi
- Biotechnology and Life Sciences Department and Center for Clinical EthicsInsubria UniversityVareseItaly
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Wang Y, Bai Y, Xia X, Yang Y, He J, Li X. Spinal cord stimulation modulates complexity of neural activities in patients with disorders of consciousness. Int J Neurosci 2019; 130:662-670. [PMID: 31847650 DOI: 10.1080/00207454.2019.1702543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Yong Wang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Yang Bai
- Department of Basic Medical Science, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Xiaoyu Xia
- Department of Neurosurgery, The Seventh Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Yi Yang
- Department of Neurosurgery, The Seventh Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, The Seventh Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing, Normal University, Beijing, China
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Li S, Dong X, Sun W, Zhao N, Yu G, Shuai L. Effects of transcranial direct current stimulation on patients with disorders of consciousness after traumatic brain injury: study protocol for a randomized, double-blind controlled trial. Trials 2019; 20:596. [PMID: 31623656 PMCID: PMC6796458 DOI: 10.1186/s13063-019-3680-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background Disorders of consciousness (DOC) after traumatic brain injury (TBI) raise the mortality of patients, restrict the rehabilitation of patients with TBI, and increase the physical and economic burden that TBI imposes on patients and their families. Thus, treatment to promote early awakening in DOC after TBI is of vital importance. Various treatments have been reported, but there is no advanced evidence base to support them. Transcranial direct current stimulation (tDCS) has shown great potential in promoting neuroelectrochemical effects. This protocol is for a double-blind, randomized, controlled, clinical trial aiming to research the effects and safety of conventional rehabilitation combined with tDCS therapy in patients with DOC after TBI. Methods/design Eighty patients with DOC after TBI will be randomized into one of two groups receiving conventional rehabilitation combined with sham tDCS or conventional rehabilitation combined with active tDCS. The intervention period in each of the two groups will last 4 weeks (20 min per day, 6 days per week). Primary outcomes (Glasgow Outcome Scale (GOS)) will be measured at baseline and the end of every week from the first to the fourth week. Secondary outcomes will be measured at baseline and the end of the fourth week. Adverse events and untoward effects will be measured during each treatment. Discussion Patients with central nervous system lesions have received tDCS as a painless, non-invasive, easily applied and effective therapy for several decades, and there has been some evidence in recent years showing partial improvement on the level of consciousness of partial patients with DOC. However, reports mainly focus on the patients in a minimally conscious state (MCS), and there is a lack of large-sample clinical trials. This protocol presents an objective design for a randomized controlled trial that aims to study the effectiveness of conventional rehabilitation combined with tDCS therapy for DOC after TBI, to evaluate its safety, and to explore effective and economical therapeutic methods. Trial registration Chinese Clinical Trial Registry, ChiCTR1800014808. Registered on 7 February 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3680-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shilin Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China.,First Clinical Medical School, Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Xiangli Dong
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Weiming Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China. .,First Clinical Medical School, Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China.
| | - Na Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China.,First Clinical Medical School, Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Guohua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China.,First Clinical Medical School, Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Lang Shuai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China.,First Clinical Medical School, Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
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Cinamon U, Albukrek D, Dvir D, Marom T. Reversible conductive hearing impediments among patients with severe brain injury. Disabil Rehabil 2019; 42:3199-3202. [PMID: 30950659 DOI: 10.1080/09638288.2019.1588923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Rehabilitation of patients with severe traumatic brain injury may include auditory stimuli. Hampering the function of the external, middle ear or Eustachian tube generates a conductive auditory deficit up to 35 dB that may potentially hinder auditory rehabilitation. The objective was to evaluate the incidence of conductive hearing impediments among patients with severe brain injury.Methods: The cross-section study included adults with severe brain injury hospitalized in a rehabilitation center. The patients presented with a prolonged vegetative state, were dependent on mechanical ventilation and gastrostomy tube feeding. Assessment of external, middle ear and Eustachian tube included otoscopy, tympanometry, nasopharyngoscopy, gag reflex and soft palate evaluations.Results: Nineteen patients (38 ears) were evaluated: 14 males and 5 females, aged 18-93 years (average 59). All patients had a normal nasopharynx, lacked a gag reflex, palatal movements or supraglottic sensation. Eighteen ears (47%) had middle ear effusion, 26 (68%) ears had cerumen impaction, and 14 (37%) had both.Conclusions: Many patients with severe brain injury have reversible and treatable impairments that cause potential conductive hearing loss. Routine otoscopic examination and treatment if required, that is, removal of impacted cerumen or middle ear drainage, have rehabilitating and general health benefits.Implications for rehabilitationAuditory stimulation was suggested for rehabilitation in patients with severe traumatic brain injury.Many patients have cerumen and/or otitis media with effusion causing conductive hearing impairment as well as general health issues.Both aural impediments are diagnosed by routine otoscopy, are easily treated, and may affect rehabilitation.
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Affiliation(s)
- Udi Cinamon
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Holon, Israel
| | - Dov Albukrek
- Reuth Rehabilitation Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Dvir
- Reuth Rehabilitation Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Sackler School of Medicine, Tel Aviv University, Assuta Ashdod University Hospital, Ashdod, Israel
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Liang Z, Li J, Xia X, Wang Y, Li X, He J, Bai Y. Long-Range Temporal Correlations of Patients in Minimally Conscious State Modulated by Spinal Cord Stimulation. Front Physiol 2018; 9:1511. [PMID: 30420813 PMCID: PMC6215825 DOI: 10.3389/fphys.2018.01511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/08/2018] [Indexed: 01/08/2023] Open
Abstract
Spinal cord stimulation (SCS) has been shown to improve the consciousness levels of patients with disorder of consciousness (DOC). However, the underlying mechanisms of SCS remain poorly understood. This study recorded resting-state electroencephalograms (EEG) from 16 patients with minimally conscious state (MCS), before and after SCS, and investigated the mechanisms of SCS on the neuronal dynamics in MCS patients. Detrended fluctuation analysis (DFA), combined with surrogate data method, was employed to measure the long-range temporal correlations (LRTCs) of the EEG signals. A surrogate data method was utilized to acquire the genuine DFA exponents (GDFAE) reflecting the genuine LRTCs of brain activity. We analyzed the GDFAE in four brain regions (frontal, central, posterior, and occipital) at five EEG frequency bands [delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), beta (13-30 Hz), and gamma (30-45 Hz)]. The GDFAE values ranged from 0.5 to 1, and showed temporal and spatial variation between the pre-SCS and the post-SCS states. We found that the channels with GDFAE spread wider after SCS. This phenomenon may indicate that more cortical areas were engaged in the information integration after SCS. In addition, the GDFAE values increased significantly in the frontal area at delta, theta, and alpha bands after SCS. At the theta band, a significant increase in GDFAE was observed in the occipital area. No significant change was found at beta or gamma bands in any brain region. These findings show that the enhanced LRTCs after SCS occurred primarily at low-frequency bands in the frontal and occipital regions. As the LRTCs reflect the long-range temporal integration of EEG signals, our results indicate that information integration became more "complex" after SCS. We concluded that the brain activities at low-frequency oscillations, particularly in the frontal and occipital regions, were improved by SCS.
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Affiliation(s)
- Zhenhu Liang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Jiani Li
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Xiaoyu Xia
- Department of Neurosurgery, PLA Army General Hospital, Beijing, China
| | - Yong Wang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, PLA Army General Hospital, Beijing, China
| | - Yang Bai
- Department of Basic Medical Science, School of Medicine, Hangzhou Normal University, Hangzhou, China
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Naro A, Bramanti A, Leo A, Bramanti P, Calabrò RS. Metaplasticity: A Promising Tool to Disentangle Chronic Disorders of Consciousness Differential Diagnosis. Int J Neural Syst 2017; 28:1750059. [PMID: 29370729 DOI: 10.1142/s0129065717500599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The extent of cortical reorganization after brain injury in patients with Vegetative State/Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS) depends on the residual capability of modulating synaptic plasticity. Neuroplasticity is largely abnormal in patients with UWS, although the fragments of cortical activity may exist, while patients MCS show a better cortical organization. The aim of this study was to evaluate cortical excitability in patients with disorders of consciousness (DoC) using a transcranial direct current stimulation (TDCS) metaplasticity protocol. To this end, we tested motor-evoked potential (MEP) amplitude, short intracortical inhibition (SICI), and intracortical facilitation (ICF). These measures were correlated with the level of consciousness (by the Coma Recovery Scale-Revised, CRS-R). MEP amplitude, SICI, and ICF strength were significantly modulated following different metaplasticity TDCS protocols only in the patients with MCS. SICI modulations showed a significant correlation with the CRS-R score. Our findings demonstrate, for the first time, a partial preservation of metaplasticity properties in some patients with DoC, which correlates with the level of awareness. Thus, metaplasticity assessment may help the clinician in differentiating the patients with DoC, besides the clinical evaluation. Moreover, the responsiveness to metaplasticity protocols may identify the subjects who could benefit from neuromodulation protocols.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
| | | | - Antonino Leo
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
- S.S. 113, Contrada Casazza, 98124 Messina, Italy
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The value of midbrain morphology in predicting prognosis in chronic disorders of consciousness: A preliminary ultrasound study. J Neurol Sci 2017; 380:46-50. [PMID: 28870587 DOI: 10.1016/j.jns.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 11/20/2022]
Abstract
Transcranial sonography (TCS) of the brainstem is currently used to support the clinical diagnosis of movement disorders. The aim of the study was to assess the usefulness of midbrain TCS in assessing outcome in patients with Chronic Disorders of Consciousness (DOC). Eleven patients with Minimally Conscious State (MCS) and Unresponsive Wakefulness Syndrome (UWS) were included in the study. We measured the area and echogenicity of the midbrain by encoding and digitally analyzing the corresponding images from the orbitomeatal plane, the morphology of brain parenchyma from the thalamic and cella media plane, and the intracranial circulation. All the patients showed an increase of pulsatility index and numerous morphological alterations on all the scan planes. In particular, we found a loss of the characteristic butterfly-shape of the midbrain, which appeared hypoechoic in the UWS but not in the MCS patients. After six months, the patients were clinically assessed by using Glasgow Outcome Scale Extended (GOSE). We found that a higher increase in GOSE scoring at follow-up was correlated with larger area and higher echogenicity of the midbrain at baseline. The present study suggests that TCS data of the midbrain may support clinical assessment of patients with chronic DOC to estimate their outcome.
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Bai Y, Xia X, Liang Z, Wang Y, Yang Y, He J, Li X. Frontal Connectivity in EEG Gamma (30-45 Hz) Respond to Spinal Cord Stimulation in Minimally Conscious State Patients. Front Cell Neurosci 2017; 11:177. [PMID: 28701924 PMCID: PMC5487422 DOI: 10.3389/fncel.2017.00177] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/12/2017] [Indexed: 01/21/2023] Open
Abstract
Spinal cord stimulation (SCS) has become a valuable brain-intervention technique used to rehabilitate patients with disorders of consciousness (DOC). To explore how the SCS affects the cerebral cortex and what possible electrophysiological mechanism of SCS effects on the cortex, the present study investigated the functional connectivity and network properties during SCS in minimally conscious state (MCS) patients. MCS patients received both SCS and sham sessions. Functional connectivity of the phase lock value (PLV) in the gamma band (30-45 Hz) was investigated at the pre-, on- and post-SCS stages. In addition, to evaluate global network properties, complex network parameters, including average path length, cluster coefficient and small-world, were measured. When SCS was turned on, significantly decreased connectivity was noted in the local scale of the frontal-frontal region and in the large scales of the frontal-parietal and frontal-occipital regions. The global network showed fewer small-world properties, average path lengths increased and cluster coefficients decreased. When SCS was turned off, the large-scale connectivity and global network returned to its pre-SCS level, but the local scale of frontal-frontal connectivity remained significantly lower than its pre-SCS level. Sham sessions produced no significant changes in either functional connectivity or network. The findings directly showed that SCS could effectively intervene cortical gamma activity, and the intervention included immediate global effects (large scale connectivity and network alteration only occurred in stimulation period) and long-lasting local effects (local scale connectivity alteration persist beyond stimulation period). Moreover, considering the mechanism and propagation of gamma activity, it indicates that the frontal cortex plays a crucial role in the SCS effects on the cerebral cortex.
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Affiliation(s)
- Yang Bai
- Institute of Electrical Engineering, Yanshan UniversityQinhuangdao, China
| | - Xiaoyu Xia
- Department of Neurosurgery, PLA General HospitalBeijing, China
| | - Zhenhu Liang
- Institute of Electrical Engineering, Yanshan UniversityQinhuangdao, China
| | - Yong Wang
- Institute of Electrical Engineering, Yanshan UniversityQinhuangdao, China
| | - Yi Yang
- Department of Neurosurgery, PLA General HospitalBeijing, China
| | - Jianghong He
- Department of Neurosurgery, PLA General HospitalBeijing, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal UniversityBeijing, China.,IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
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