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Wang Y, Dang Y, Bai Y, Xia X, Li X. Evaluating the effect of spinal cord stimulation on patient with disorders of consciousness: A TMS-EEG study. Comput Biol Med 2023; 166:107547. [PMID: 37806053 DOI: 10.1016/j.compbiomed.2023.107547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The application of spinal cord stimulation (SCS) in the treatment of disorders of consciousness (DOC) has attracted attention, but its effect on brain activity is still unknown. Transcranial magnetic stimulation combined with EEG (TMS-EEG) can measure cortical activity, which can evaluate the effect of SCS on DOC. METHODS We record 20 DOC patients' CRS-R values and TMS-EEG data before and after one-session SCS (Pre-SCS and Post-SCS). 20 DOC patients including 10 patients with unresponsive wakefulness syndrome (UWS) and 10 patients with minimally conscious states (MCS). TMS evoked potential (TEP) was used to measure the changes of cortical activity in DOC patients between Pre-SCS and Post-SCS. Firstly, we used the global mean field potential (GMFP) and fast perturbational complexity index (PCIst) to compare the temporal changes of patients' cortical activity. Then, we obtained the frequency feature (natural frequency, NF) based on the TEP time-frequency analysis, and compared the changes of natural frequency between Pre-SCS and Post-SCS. Finally, the study explored the relationship between the patient's baseline CRS-R values and changes of TMS evoked cortical activity in time and frequency domains. RESULTS After SCS, MCS and UWS groups almost have no changes of CRS-R values (MCS: 9.9 ± 1.52 at Pre-SCS, 10.2 ± 1.48 at Post-SCS; UWS: 5.6 ± 1.26 at Pre-SCS, 5.7 ± 1.34 at Post-SCS). MCS group showed significant increases of GMFP amplitude (around 100 ms and 300 ms) and PCIst values at Post-SCS (p < 0.05). UWS group had no significant changes (p > 0.05). Besides, SCS induced the significant increases of natural frequency for MCS group(p < 0.05), but not for UWS group. At last, the study found that all patient's baseline CRS-R values were significantly correlated with ΔPCIst (r = 0.67, p < 0.005), and ΔNF (r = 0.72, p < 0.001). CONCLUSIONS SCS can modulate cortical activity of DOC patient, including temporal complexity and natural frequency. The changes of cortical activity caused by SCS are related to patients' consciousness level. TMS-EEG can evaluate the effect of SCS on DOC patients.
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Affiliation(s)
- Yong Wang
- Zhuhai UM Science & Technology Research Institute, Zhuhai, 519031, China
| | - Yuanyuan Dang
- Medical School of Chinese PLA, Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China; Department of Neurosurgery, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China; Rehabilitation Medicine Clinical Research Center of Jiangxi Province, Nanchang, 330006, China
| | - Xiaoyu Xia
- Medical School of Chinese PLA, Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China; 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, 100875, China.
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Izzo A, D'Ercole M, Rapisarda A, Polli FM, Fuggetta F, Olivi A, Visocchi M, Montano N. Spinal Cord High-Frequency Stimulation. The Current Experience and Future Directions. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:203-207. [PMID: 38153470 DOI: 10.1007/978-3-031-36084-8_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Spinal cord stimulation (SCS) is a neuromodulation technology that has emerged as a valid treatment for chronic intractable neuropathic pain. After conventional tonic SCS, new waveforms of stimulation, like high frequency (HF), have proved that they can provide safe and effective pain relief. In addition, SCS is now being utilized more broadly as a potential treatment for a range of indications, including motor disorders and spasticity. Our study presents a retrospective analysis of 20 patients with heterogenous aetiologies of neuropathic pain treated with HF stimulation, after a standardized protocol in a temporary trial. We observed a significant improvement in pain relief according to comparisons of numerical rating scale (NRS) scores before the procedure, after the clinical trial and at latest follow-up. Two unusual clinical cases were also reported, and the pertinent literature was discussed.
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Affiliation(s)
- Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filomena Fuggetta
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
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Slavin KV, Vannemreddy P. Neuromodulation for Post-SAH Cerebral Vasospasm. Neuromodulation 2022; 25:1444-1445. [PMID: 36470597 DOI: 10.1016/j.neurom.2022.08.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/24/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; Neurology Service, Jesse Brown Veterans Administration Hospital, Chicago, IL, USA.
| | - Prasad Vannemreddy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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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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Slavin KV, Vannemreddy P. Cervical spinal cord stimulation for prevention and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: clinical and radiographic outcomes of a prospective single-center clinical pilot study. Acta Neurochir (Wien) 2022; 164:2927-2937. [PMID: 35920945 DOI: 10.1007/s00701-022-05325-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of high morbidity and mortality, for which there is no consistently effective treatment. Cervical spinal cord stimulation (cSCS) has been shown to induce vasodilatation and improve peripheral and cerebral blood flow in both animal and human studies. This pilot study was performed to assess the clinical effect and long-term results of cSCS treatment in aSAH patients. METHODS This was the first IRB- and US FDA-approved prospective non-randomized non-controlled study comprising of 12 aSAH patients (8 women, 4 men, age range 34-62 years) treated between May and November 2008. All patients underwent up to 2 weeks of cSCS with a single percutaneously implanted 8-contact electrode. Neurological outcomes at discharge and follow-up of up to 13 years and mortality/complications rates were analyzed. RESULTS All 12 aSAH patients underwent cSCS electrode implantation immediately after securing the aneurysm. Patients were stimulated for 10-14 consecutive days starting within 3 days of aneurysm rupture. Angiographic vasospasm occurred in six patients; two patients developed new vasospasm-related neurological symptoms; both recovered completely by discharge time. One patient died from unrelated multi-system failure; the rest were followed up clinically (average, 7.5 years; range, 12-151 months) and angiographically (average, 6.5 years; range, 36-125 months). No delayed ischemic neurological deficits/strokes and no cSCS-related adverse effects were observed. CONCLUSIONS Our short- and long-term data suggest that cSCS is feasible and safe for patients in the acute aSAH settings. Small size of the patient cohort and lack of control do not allow us to conclude whether cSCS is able to prevent cerebral vasospasm, decrease its severity, and improve clinical outcomes in aSAH patients. However, our findings support further clinical trials and development of cSCS as a new concept to prevent and treat cerebral vasospasm. TRIAL REGISTRATION CLINICALTRIALS gov NCT00766844, posted on 10/06/2008.
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Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA. .,Neurology Service, Jesse Brown Veterans Administration Hospital, Chicago, IL, USA.
| | - Prasad Vannemreddy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Yang Y, He Q, He J. Short-term spinal cord stimulation in treating disorders of consciousness monitored by resting-state fMRI and qEEG: The first case report. Front Neurol 2022; 13:968932. [PMID: 36388222 PMCID: PMC9640422 DOI: 10.3389/fneur.2022.968932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/20/2022] [Indexed: 10/28/2023] Open
Abstract
Disorders of consciousness (DOC) are one of the most frequent complications in patients after severe brain injury, mainly caused by trauma, stroke, and anoxia. With the development of neuromodulation techniques, novel therapies including deep brain stimulation (DBS) and spinal cord stimulation (SCS) have been employed to treat DOC. Here, we report the case of a DOC patient receiving short-term SCS (st-SCS) treatment and showing improvement monitored by resting-state fMRI (rs-fMRI) and quantitative EEG (qEEG). A 35-year-old male with severe traumatic brain injury remained comatose for 3 months. The patient was evaluated using JFK coma recovery scale-revised (CRS-R) and showed no improvement within 1 month. He received st-SCS surgery 93 days after the injury and the stimulation was applied the day after surgery. He regained communication according to instructions on day 21 after surgery and improved from a vegetative state/unwakefulness syndrome to an emergence from a minimally conscious state. To our knowledge, this report is the first published case of st-SCS in a patient with DOC. These results shed light that st-SCS may be effective in treating certain patients with DOC, which may reduce patients' suffering during treatment and lessen financial burden.
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Affiliation(s)
- Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Joint Laboratory, Chinese Institute for Brain Research, Beijing, China
- Center of Stroke, Beijing Institute of Brain Disorders, Beijing, China
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China
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Zhao S, Sufianova G, Shapkin A, Mashkin A, Meshcheryakova S, Han D. Improvement of brain perfusion in patients with chronic brain ischemia at epidural spinal cord electrical stimulation. Front Surg 2022; 9:1026079. [PMID: 36211284 PMCID: PMC9539408 DOI: 10.3389/fsurg.2022.1026079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Increasing life expectancy and aging of the population is accompanied by a steady increase in the number of elderly patients with chronic cerebral ischemia and age-related cognitive impairment associated with cerebral hypoperfusion and microangiopathy. The aim of this study was to identify long-term changes in cerebral blood flow (CBF) in patients with chronic cerebral ischemia at the epidural electrical stimulation of the spinal cord (SCS). Materials and methods Changes in cerebral blood flow were studied according to CT perfusion in 59 patients (aged 55–78 years) with vertebrogenic pain syndromes and chronic cerebral ischemia during epidural electrical stimulation of the spinal cord at the cervical (C3–C5) and lower thoracic (Th9–Th10) levels. Results In all patients, on the 5th day of trial SCS, an increase in cerebral blood flow by from 58.6 ± 1.13 ml/100 ml/min to 64.8 ± 1.21 ml/100 ml/min (p < 0.01) with stimulation at the Th9-Th10 level and from 58.8 ± 1.12 ml/100 ml/min to 68.2 ± 1.42 ml/100 ml/min (p < 0, 01) with stimulation at the C3-C5 level. These changes in brain perfusion were preserved during the follow-up examination 1 year after the implantation of chronic SCS system. The greatest increase in CBF was registered in the frontotemporal regions, subcortical structures and white matter of the brain. Changes in cerebral perfusion did not correlate with the degree of reduction in the severity of the accompanying pain syndrome. The change in CBF in the control group (32 patients) in all periods was not statistically significant. Conclusion Our results show that SCS is accompanied by a persistent improvement in brain perfusion, which may be potentially useful for developing methods for reducing age-related vascular disorders in the elderly.
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Affiliation(s)
- Shu Zhao
- Emergency Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Galina Sufianova
- Department of Pharmacology, Tyumen State Medical University, Tyumen, Russia
| | - Andrey Shapkin
- Department of Functional Neurosurgery, Federal Center of Neurosurgery, Tyumen, Russia
| | - Andrey Mashkin
- Educational and Scientific Institute of Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian
| | | | - Dayong Han
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
- Correspondence: Dayong Han
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He Q, Han B, Xia X, Dang Y, Chen X, He J, Yang Y. Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness. Front Neurol 2022; 13:947464. [PMID: 35860489 PMCID: PMC9289267 DOI: 10.3389/fneur.2022.947464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Spinal 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. Methods A 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. Results Twenty 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). Conclusions Electrode 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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Affiliation(s)
- Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bin Han
- Department of Neurosurgery, Zhongshan Hospital of Traditional Chinese Medicine, Guangdong, China
| | - Xiaoyu Xia
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Yuanyuan Dang
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Xueling Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China
- Jianghong He
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurosurgery, Chinese Institute for Brain Research, Beijing, China
- Department of Neurosurgery, Beijing Institute of Brain Disorders, Beijing, China
- *Correspondence: Yi Yang
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Yang Y, He Q, Xia X, Dang Y, Chen X, He J, Zhao J. Long-term functional prognosis and related factors of spinal cord stimulation in patients with disorders of consciousness. CNS Neurosci Ther 2022; 28:1249-1258. [PMID: 35619213 PMCID: PMC9253730 DOI: 10.1111/cns.13870] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The treatment of patients with disorders of consciousness (DoC) remains a challenging issue, and spinal cord stimulation (SCS) has been reported to be a promising treatment for DoC in some studies. AIMS This study explores the efficiency of SCS in treating patients with DoC at different consciousness levels, including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) and the minimally conscious state (MCS) and summarizes and analyzes the long-term effect and related factors of SCS in patients with DoC. RESULTS An overall positive outcome was reached in 35 of 110 patients (31.8%). Among patients with positive outcomes, the MCS group improved 45.53% more than VS/UWS group, and this difference was statistically significant. In terms of the recommendation standard, positive outcomes occurred in 33 patients (94.3%) in the highly recommended group and 2 patients (5.7%) in the weakly recommended group (p < 0.001). After adjustment for potential covariables, young age (age ≤ 19 years old) (p = 0.045) and MCS (p < 0.001) were significantly correlated with positive outcome. A nomogram based on age, state of consciousness, and pathogeny showed good predictive performance, with a c-index of 0.794. The Hosmer-Lemeshow goodness-of-fit test showed that the model was well calibrated (χ2 = 3.846, p = 0.871). CONCLUSIONS SCS is one of the most feasible treatments for patients with DoC, especially for patients with MCS. Younger age is significantly associated with better outcomes and could therefore serve as a basis for preoperative screening. However, more evidence-based randomized controlled trials are needed to confirm the efficacy of the treatment.
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Affiliation(s)
- Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China.,Beijing Institute of Brain Disorders, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaoyu Xia
- Department of Neurosurgery, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yuanyuan Dang
- Department of Neurosurgery, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Xueling Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Liu X, Zhang Y, Wang Y, Qian T. Inflammatory Response to Spinal Cord Injury and Its Treatment. World Neurosurg 2021; 155:19-31. [PMID: 34375779 DOI: 10.1016/j.wneu.2021.07.148] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 01/14/2023]
Abstract
Spinal cord injury (SCI), as one of the intractable diseases in clinical medicine, affects thousands of human beings, and the pathologic changes after injury have been a hot spot for exploration in clinical medicine. With the development of new treatments, the survival of patients has shown an increasing trend; however, the inflammatory response after injury has not yet been effectively controlled. SCI is divided into primary injury and secondary injury according to the time of injury and pathophysiologic changes. Primary injury occurs immediately and the damage to the injury site is irreversible; however, secondary injury occurs after primary injury and involves pathologic changes at the cellular and molecular levels, which are reversible. Thus, the inflammatory response from secondary injuries has become the main direction of research. In recent years, a complex pathophysiologic mechanism has gradually been unveiled, which has been followed by an upgrade of treatment methods. This article describes the mechanisms of the inflammatory response after SCI and the mainstream treatment modalities. Also, neuroprotective agents and nerve regeneration agent agents are commonly used in the treatment of SCI; the therapeutic mechanism and classification of these agents are reviewed.
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Affiliation(s)
- Xiangyu Liu
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China
| | - Yiwen Zhang
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China
| | - Yitong Wang
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China
| | - Taibao Qian
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China.
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Zibly Z, Abofani H, Rennert N. Neuromodulation for Refractory Angina, Heart Failure and Peripheral Vascular Disease. Neurol India 2020; 68:S297-S301. [PMID: 33318365 DOI: 10.4103/0028-3886.302461] [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: 11/04/2022]
Abstract
Use of spinal cord stimulation (SCS) has expanded beyond pain control. There are increasing indications in which SCS is being used. The understanding of central and peripheral neural pathways and their controlling influences on peripheral organs is better understood now. The concept of stimulating the spinal cord and modulating central pathways with SCS is already established. Different studies have shown the benefit with SCS on visceral pain control, improving quality of live in severe peripheral vascular disease and even assist in controlling the vago-sympathetic balance. We will discuss the art of implantation. Patient selection and stimulation with respect to current clinical data.
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Affiliation(s)
- Zion Zibly
- Department of Neurosurgery, Functional Neurosurgery Unit, Focused Ultrasound Institute and Sackler School of Medicine, Tel Aviv University, Israel
| | - Hannan Abofani
- Department of Neurosurgery and Sackler School of Medicine, Tel Aviv University, Israel
| | - Noa Rennert
- Department of Neurosurgery and Sackler School of Medicine, Tel Aviv University, Israel
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12
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Kaijankoski H, Nissen M, Ikäheimo TM, von Und Zu Fraunberg M, Airaksinen O, Huttunen J. Effect of Spinal Cord Stimulation on Early Disability Pension in 198 Failed Back Surgery Syndrome Patients: Case-Control Study. Neurosurgery 2020; 84:1225-1232. [PMID: 30476235 PMCID: PMC6520102 DOI: 10.1093/neuros/nyy530] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/09/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Spinal cord stimulation (SCS) has proven to be a cost-effective treatment for failed back surgery syndrome (FBSS). However, the effect on patients’ working capability remains unclear. OBJECTIVE To evaluate the impact of SCS on working capability and to identify the factors behind permanent disability in FBSS patients. METHODS The study group consisted of 198 working-age patients with SCS trialed or implanted for FBSS in a single center between 1996 and 2014. For each patient, 3 living controls, matched by age, gender, and birthplace, were otherwise randomly selected by the Population Register Center. The data on working ability were obtained from the Social Insurance Institution. Patients were divided into 3 groups: SCS trial only, SCS implanted permanently, and SCS implanted but later explanted. RESULTS A rehabilitation subsidy was given to 68 patients and 8 controls for a mean of 5.2 (95% confidence interval [CI] 2.4-8.2) and 0.2 (95% CI 0.05-0.6) days per month (P < .05). At the end of follow-up, 16 (37%), 13 (33%), 25 (22%), and 27 (5%) subjects were on disability pension (DP) in the SCS trial, SCS explanted, SCS permanent, and control groups. Patients in the SCS trial-only group were significantly more often on DP than were patients with permanent SCS (odds ratio 2.6; 95% CI 1.2-5.9; P = .02) CONCLUSION Permanent SCS usage was associated with reduced sick leave and DP. Prospective study will be required to assess possible predictive value.
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Affiliation(s)
- Hanna Kaijankoski
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mette Nissen
- Department of Neurosurgery, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tiina-Mari Ikäheimo
- Department of Neurosurgery, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Department of Neurosurgery, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Olavi Airaksinen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Department of Neurosurgery, Kuopio University Hospital (KUH), and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Visocchi M. Commentary: Effect of Spinal Cord Stimulation on Early Disability Pension in 198 Failed Back Surgery Syndrome Patients: Case-Control Study. Neurosurgery 2019; 84:E291-E293. [PMID: 30541134 DOI: 10.1093/neuros/nyy575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Indexed: 11/14/2022] Open
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14
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Si J, Dang Y, Zhang Y, Li Y, Zhang W, Yang Y, Cui Y, Lou X, He J, Jiang T. Spinal Cord Stimulation Frequency Influences the Hemodynamic Response in Patients with Disorders of Consciousness. Neurosci Bull 2018; 34:659-667. [PMID: 29995275 PMCID: PMC6060214 DOI: 10.1007/s12264-018-0252-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/27/2018] [Indexed: 02/05/2023] Open
Abstract
Spinal cord stimulation (SCS) is a promising technique for treating disorders of consciousness (DOCs). However, differences in the spatio-temporal responsiveness of the brain under varied SCS parameters remain unclear. In this pilot study, functional near-infrared spectroscopy was used to measure the hemodynamic responses of 10 DOC patients to different SCS frequencies (5 Hz, 10 Hz, 50 Hz, 70 Hz, and 100 Hz). In the prefrontal cortex, a key area in consciousness circuits, we found significantly increased hemodynamic responses at 70 Hz and 100 Hz, and significantly different hemodynamic responses between 50 Hz and 70 Hz/100 Hz. In addition, the functional connectivity between prefrontal and occipital areas was significantly improved with SCS at 70 Hz. These results demonstrated that SCS modulates the hemodynamic responses and long-range connectivity in a frequency-specific manner (with 70 Hz apparently better), perhaps by improving the cerebral blood volume and information transmission through the reticular formation-thalamus-cortex pathway.
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Affiliation(s)
- Juanning Si
- School of Instrumentation Science and Opto-electronics Engineering, Beijing Information Science and Technology University, Beijing, 100192, China
| | - Yuanyuan Dang
- Department of Neurosurgery, People's Liberation Army General Hospital, Beijing, 100700, China
| | - Yujin Zhang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Yaxin Li
- School of Instrumentation Science and Opto-electronics Engineering, Beijing Information Science and Technology University, Beijing, 100192, China
| | - Wenyue Zhang
- School of Instrumentation Science and Opto-electronics Engineering, Beijing Information Science and Technology University, Beijing, 100192, China
| | - Yi Yang
- Department of Neurosurgery, People's Liberation Army General Hospital, Beijing, 100700, China
| | - Yue Cui
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Xiaoping Lou
- School of Instrumentation Science and Opto-electronics Engineering, Beijing Information Science and Technology University, Beijing, 100192, China
| | - Jianghong He
- Department of Neurosurgery, People's Liberation Army General Hospital, Beijing, 100700, China.
| | - Tianzi Jiang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 625014, China.
- Chinese Academy of Sciences Center for Excellence in Brain Science, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
- Queensland Brain Institute, University of Queensland, St. Lucia, QL, 4072, Australia.
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Rupawala M, Dehghani H, Lucas SJE, Tino P, Cruse D. Shining a Light on Awareness: A Review of Functional Near-Infrared Spectroscopy for Prolonged Disorders of Consciousness. Front Neurol 2018; 9:350. [PMID: 29872420 PMCID: PMC5972220 DOI: 10.3389/fneur.2018.00350] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/30/2018] [Indexed: 12/19/2022] Open
Abstract
Qualitative clinical assessments of the recovery of awareness after severe brain injury require an assessor to differentiate purposeful behavior from spontaneous behavior. As many such behaviors are minimal and inconsistent, behavioral assessments are susceptible to diagnostic errors. Advanced neuroimaging tools can bypass behavioral responsiveness and reveal evidence of covert awareness and cognition within the brains of some patients, thus providing a means for more accurate diagnoses, more accurate prognoses, and, in some instances, facilitated communication. The majority of reports to date have employed the neuroimaging methods of functional magnetic resonance imaging, positron emission tomography, and electroencephalography (EEG). However, each neuroimaging method has its own advantages and disadvantages (e.g., signal resolution, accessibility, etc.). Here, we describe a burgeoning technique of non-invasive optical neuroimaging—functional near-infrared spectroscopy (fNIRS)—and review its potential to address the clinical challenges of prolonged disorders of consciousness. We also outline the potential for simultaneous EEG to complement the fNIRS signal and suggest the future directions of research that are required in order to realize its clinical potential.
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Affiliation(s)
- Mohammed Rupawala
- Centre for Doctoral Training in Physical Sciences for Health, University of Birmingham, Birmingham, United Kingdom
| | - Hamid Dehghani
- Centre for Doctoral Training in Physical Sciences for Health, University of Birmingham, Birmingham, United Kingdom.,School of Computer Science, University of Birmingham, Birmingham, United Kingdom
| | - Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Peter Tino
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
| | - Damian Cruse
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Abstract
Objectives: Paresthesia-free stimulation such as high frequency and burst have been demonstrated as effective therapies for neuropathic pain. The aim of this meta-analysis was to evaluate the efficacy and safety of conventional spinal cord stimulation (SCS) in the treatment of refractory angina pectoris (RAP). Materials and Methods: Relevant randomized controlled trials that investigated SCS for patients with RAP were comprehensively searched in Medline, Pubmed, Embase, and Cochrane Library. Five meta-analyses were performed examining the changes in Canadian Cardiovascular Society classes, exercise time, Visual Analog Scale (VAS) scores of pain, Seattle Angina Questionnaire, and nitroglycerin use in RAP patients after SCS therapy. We analyzed standardized mean differences (MD) and 95% confidence intervals (CIs) for each outcome by Review Manager 5.0 and STATA 12.0. Results: A total of 12 randomized controlled trials involving 476 RAP patients were identified. A trend of reduction in the angina frequency (MD=−9.03, 95% CI, −15.70 to −2.36) and nitroglycerin consumption (MD=−0.64, 95% CI, −0.84 to −0.45) could be observed in the SCS group. Compared with the control group, SCS showed benefit on increasing exercise time (MD=0.49, 95% CI, 0.13-0.85) and treatment satisfaction (MD=6.87, 95% CI, 2.07-11.66) with decreased VAS scores of pain (MD=−0.50, 95% CI, −0.81 to −0.20) and disease perception (MD=−8.34, 95% CI, −14.45 to −2.23). However, the result did not reach the significance level in terms of physical limitation (95% CI, −8.75 to 3.38; P=0.39) or angina stability (95% CI, −7.55 to 3.67; P=0.50). Discussion: The current meta-analysis suggested that SCS was a potential alternative in the treatment of PAP patients. Further investigation for finding the appropriate intensity of stimulation is required before this treatment should be widely recommended and applied.
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Zhang Y, Yang Y, Si J, Xia X, He J, Jiang T. Influence of inter-stimulus interval of spinal cord stimulation in patients with disorders of consciousness: A preliminary functional near-infrared spectroscopy study. NEUROIMAGE-CLINICAL 2017; 17:1-9. [PMID: 29619317 PMCID: PMC5883216 DOI: 10.1016/j.nicl.2017.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/12/2017] [Accepted: 09/23/2017] [Indexed: 11/30/2022]
Abstract
Spinal cord stimulation (SCS) is a promising treatment for disorders of consciousness (DOC), but the underlying mechanism and most effective procedures remain uncertain. To optimize the protocol, previous studies evaluated the frequency-specific effects of SCS on neurophysiological activities. However, whether and how the inter-stimulus interval (ISI) parameter affects the SCS neuromodulation in DOC remains unknown. We enrolled nine DOC patients who had implanted SCS devices and conducted three different durations of ISIs. Using functional near-infrared spectroscopy (fNIRS), we monitored the blood volume fluctuations in the prefrontal and occipital cortices during the SCS. The results showed that short stimuli (30 s) induced significant cerebral blood volume changes, especially in the prefrontal cortex, an important area in the consciousness system. By comparing the mean value of the responses from the first and the last block in each session, a shorter ISI was found to improve the blood volume in the prefrontal cortex. This phenomenon was more significant for the subgroup of patients with a favorable prognosis. These preliminary results imply that the ISI may be an important factor for SCS. The research paradigm proposed here also provides insights for further quantitative evaluations of the therapeutic effects of neuromodulation. Spinal cord stimulation rapidly evokes activity in consciousness-related brain areas. Inter-stimulus interval of neuromodulation is important for treating disorders of consciousness. Shorter inter-stimulus interval can better improve the blood volume in frontal area. Near-infrared spectroscopy is feasible for evaluating neuromodulation effects.
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Key Words
- ARAS, ascending reticular activating system
- CBF, cerebral blood flow
- DBS, deep brain stimulation
- DOC, disorders of consciousness
- Disorders of consciousness
- EEG, electroencephalography
- FWHM, full-width-at-half-maximum
- Functional near-infrared spectroscopy
- GOS, Glasgow Outcome Scale
- HbO, oxygenated hemoglobin
- HbR, deoxygenated hemoglobin
- HbT, total hemoglobin
- ISI, inter-stimulus interval
- Inter-stimulus interval
- JFKCRS-R, JFK Coma Recovery Scale
- LTP, long-term potentiation
- MBLL, modified Beer-Lambert law
- MCS, minimally conscious state
- MSN, medium spiny neuron
- Prefrontal cortex
- SCS, spinal cord stimulation
- Spinal cord stimulation
- TMS, transcranial magnetic stimulation
- VS, vegetative state
- fMRI, functional magnetic resonance imaging
- fNIRS, functional near-infrared spectroscopy
- rCBV, regional cerebral blood volume
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Affiliation(s)
- Yujin Zhang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Yi Yang
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, China
| | - Juanning Si
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Xiaoyu Xia
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, China
| | - Jianghong He
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, China.
| | - Tianzi Jiang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 625014, China; CAS Center for Excellence in Brain Science, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; Queensland Brain Institute, University of Queensland, St. Lucia, Queensland 4072, Australia.
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Ragazzoni A, Cincotta M, Giovannelli F, Cruse D, Young GB, Miniussi C, Rossi S. Clinical neurophysiology of prolonged disorders of consciousness: From diagnostic stimulation to therapeutic neuromodulation. Clin Neurophysiol 2017; 128:1629-1646. [DOI: 10.1016/j.clinph.2017.06.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/17/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
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Alterations in autonomic cerebrovascular control after spinal cord injury. Auton Neurosci 2017; 209:43-50. [PMID: 28416148 PMCID: PMC6432623 DOI: 10.1016/j.autneu.2017.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 04/02/2017] [Accepted: 04/03/2017] [Indexed: 11/24/2022]
Abstract
Among chronic cardiovascular and metabolic sequelae of spinal cord injury (SCI) is an up-to four-fold increase in the risk of ischemic and hemorrhagic stroke, suggesting that individuals with SCI cannot maintain stable cerebral perfusion. In able-bodied individuals, the cerebral vasculature is able to regulate cerebral perfusion in response to swings in arterial pressure (cerebral autoregulation), blood gases (cerebral vasoreactivity), and neural metabolic demand (neurovascular coupling). This ability depends, at least partly, on intact autonomic function, but high thoracic and cervical spinal cord injuries result in disruption of sympathetic and parasympathetic cerebrovascular control. In addition, alterations in autonomic and/or vascular function secondary to paralysis and physical inactivity can impact cerebrovascular function independent of the disruption of autonomic control due to injury. Thus, it is conceivable that SCI results in cerebrovascular dysfunction that may underlie an elevated risk of stroke in this population, and that rehabilitation strategies targeting this dysfunction may alleviate the long-term risk of adverse cerebrovascular events. However, despite this potential direct link between SCI and the risk of stroke, studies exploring this relationship are surprisingly scarce, and the few available studies provide equivocal results. The focus of this review is to provide an integrated overview of the available data on alterations in cerebral vascular function after SCI in humans, and to provide suggestions for future research.
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Mattogno PP, Barbagallo G, Iacopino G, Pappalardo G, LA Rocca G, Signorelli F, Zhong J, Visocchi M. Recovery from Chronic Diseases of Consciousness: State of the Art in Neuromodulation for Persistent Vegetative State and Minimally Conscious State. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017; 124:19-25. [PMID: 28120048 DOI: 10.1007/978-3-319-39546-3_4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic diseases of consciousness (CDC) can still be considered a challenging frontier for modern medicine, probably because of their not completely understood physiopathological mechanisms. Following encouraging evidence on cerebral hemodynamics, some authors have hypothesized a role for neuromodulation in the treatment of CDC patients. In the past 40 years, spinal cord stimulation (SCS) and deep brain stimulation (DBS) have been used experimentally for the treatment of patients in a severe altered state of consciousness, with some interesting but not conclusive results. The present review summarizes the data currently available in the literature on this particular and debated topic. On these grounds, further clinical studies are needed to better understand the altered dynamics of neuronal network circuits in CDC patients as a step towards novel therapeutic strategies.
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Affiliation(s)
- Pier Paolo Mattogno
- Neurosurgery, Catholic University Medical School, Rome, Italy. .,Neurosurgery - A, Gemelli Hospital, Largo A. Gemelli, 8, Rome, 00168, Italy.
| | - Giuseppe Barbagallo
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy
| | - Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy
| | | | | | | | - Jun Zhong
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200092, China
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Clavo B, Robaina F, Jorge IJ, Cabrera R, Ruiz-Egea E, Szolna A, Otermin E, Llontop P, Carames MA, Santana-Rodríguez N, Sminia P. Spinal cord stimulation as adjuvant during chemotherapy and reirradiation treatment of recurrent high-grade gliomas. Integr Cancer Ther 2014; 13:513-9. [PMID: 25228535 DOI: 10.1177/1534735414550037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS Relapsed high-grade gliomas (HGGs) have poor prognoses and there is no standard treatment. HGGs have ischemia/hypoxia associated and, as such, drugs and oxygen have low access, with increased resistance to chemotherapy and radiotherapy. Tumor hypoxia modification can improve outcomes and overall survival in some patients with these tumors. In previous works, we have described that cervical spinal cord stimulation can modify tumor microenvironment in HGG by increasing tumor blood flow, oxygenation, and metabolism. The aim of this current, preliminary, nonrandomized, study was to assess the clinical effect of spinal cord stimulation during brain reirradiation and chemotherapy deployed for the treatment of recurrent HGG; the hypothesis being that an improvement in oxygenated blood supply would facilitate enhanced delivery of the scheduled therapy. MATERIALS AND METHODS Seven patients had spinal cord stimulation applied during the scheduled reirradiation and chemotherapy for the treatment of recurrent HGG (6 anaplastic gliomas and 1 glioblastoma). Median dose of previous irradiation was 60 Gy (range = 56-72 Gy) and median dose of reirradiation was 46 Gy (range = 40-46 Gy). Primary end point of the study was overall survival (OS) following confirmation of HGG relapse. RESULTS From the time of diagnosis of last tumor relapse before reirradiation, median OS was 39 months (95% CI = 0-93) for the overall study group: 39 months (95% CI = 9-69) for those with anaplastic gliomas and 16 months for the patient with glioblastoma. Posttreatment, doses of corticosteroids was significantly decreased (P = .026) and performance status significantly improved (P = .046). CONCLUSIONS Spinal cord stimulation during reirradiation and chemotherapy is feasible and well tolerated. In our study, spinal cord stimulation was associated with clinical improvement and longer survival than previously reported in recurrent anaplastic gliomas. Spinal cord stimulation as adjuvant during chemotherapy and reirradiation in relapsed HGGs merits further research.
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Affiliation(s)
- Bernardino Clavo
- Dr Negrín University Hospital, Las Palmas, Spain ICIC (Canary Islands Institute for Cancer Research), Las Palmas, Spain GICOR (Grupo de Investigación Clínica en Oncología Radioterápica), Madrid, Spain
| | - Francisco Robaina
- Dr Negrín University Hospital, Las Palmas, Spain ICIC (Canary Islands Institute for Cancer Research), Las Palmas, Spain
| | | | | | | | - Adam Szolna
- Dr Negrín University Hospital, Las Palmas, Spain
| | | | | | | | | | - Peter Sminia
- VU University Medical Center, Amsterdam, the Netherlands
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Functional and metabolic changes in the brain in neuropathic pain syndrome against the background of chronic epidural electrostimulation of the spinal cord. Bull Exp Biol Med 2014; 157:462-5. [PMID: 25113605 DOI: 10.1007/s10517-014-2591-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Indexed: 10/24/2022]
Abstract
Changes in functional and metabolic activities of the brain were evaluated by EEG and positron-emission/computer tomography with 18F-fluorodeoxyglucose in patients with neuropathic pain syndrome previous to and 3 months after implantation of a system for chronic epidural spinal cord stimulation. In most cases, the use of a nerve stimulator was followed by alleviation of neuropathic pain and partial normalization of functional and metabolic activities of brain structures responsible for pain perception, emotiogenic, behavioral, and autonomic responses.
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Kuck KH, Bordachar P, Borggrefe M, Boriani G, Burri H, Leyva F, Schauerte P, Theuns D, Thibault B, Kirchhof P, Hasenfuss G, Dickstein K, Leclercq C, Linde C, Tavazzi L, Ruschitzka F. New devices in heart failure: an European Heart Rhythm Association report: Developed by the European Heart Rhythm Association; Endorsed by the Heart Failure Association. Europace 2013; 16:109-28. [DOI: 10.1093/europace/eut311] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yamamoto T, Katayama Y, Obuchi T, Kobayashi K, Oshima H, Fukaya C. Deep brain stimulation and spinal cord stimulation for vegetative state and minimally conscious state. World Neurosurg 2012; 80:S30.e1-9. [PMID: 22543046 DOI: 10.1016/j.wneu.2012.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 03/13/2012] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE On the basis of the findings of the electrophysiological evaluation of vegetative state (VS) and minimally conscious state (MCS), the effect of deep brain stimulation (DBS) was examined according to long-term follow-up results. The results of spinal cord stimulation (SCS) on MCS was also examined and compared with that of DBS. METHODS One hundred seven patients in VS and 21 patients in MCS were evaluated neurologically and electrophysiologically over 3 months after the onset of brain injury. Among the 107 VS patients, 21 were treated by DBS. Among the 21 MCS patients, 5 were treated by DBS and 10 by SCS. RESULTS Eight of the 21 patients recovered from VS and were able to follow verbal instructions. These eight patients showed desynchronization on continuous electroencephalographic frequency analysis. The Vth wave of the auditory brainstem response and N20 of somatosensory evoked potential were recorded even with a prolonged latency, and pain-related P250 was recorded with an amplitude of more than 7 μV. In addition, DBS and SCS induced a marked functional recovery in MCS patients who satisfied the electrophysiological inclusion criteria. CONCLUSION DBS for VS and MCS patients and SCS for MCS patients may be useful, when the candidates are selected on the basis of the electrophysiological inclusion criteria. Only 16 (14.9%) of the 107 VS patients and 15 (71.4%) of the 21 MCS patients satisfied the electrophysiological inclusion criteria.
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Affiliation(s)
- Takamitsu Yamamoto
- Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan.
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