Neurostimulation for Patients in Vegetative Status

Kanno, Tetsuo; Kamei, Yoshifumi; Yokoyama, Tetsuya; Jain, V. K.

doi:10.1111/j.1540-8159.1987.tb05949.x

Cited by 23 publications

(13 citation statements)

References 1 publication

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“…Brain perfusion increased due to RMNS in all six cases and the elevation of neurotransmitters in CSF was found in five out of six patients. A number of well-documented prospective single case studies, mainly in Asia (Japan), have confirmed on class 3 evidence the previous clinical results [39,90,146,172,173]. [7, 12, 22-30, 32-38, 40-51, 55-58, 68, 69, 72, 78, 91, 100-102, 104, 105, 118-122, 127, 128, 132, 137, 139, 143, 144, 150-157, 162, 163, 165, 166, 169, 175, 178, 182-186] The main demand is to provide every AS patient, independent of his/her functional stage, with the medical treatment and rehabilitative measures needed over time (during early, postacute and long-term rehabilitation and activating nursing).…”

Section: Functional Electrical Right Median Nerve Stimulation (Rmns)supporting

confidence: 59%

“…If any, a consistent program of specific stimulation should be used by all staff members and relatives to prevent over-stimulation. Reports of functional electrical stimulation (FES) to enhance awareness and consciousness are promising for some selected cases [39,42,44,86,88,90,93,98,100,122,143,143,145,152,160,161,168,172].…”

Section: Stimulation Techniquesmentioning

confidence: 99%

“…Candidates have to be carefully selected. Laboratory electro-neurophysiological examination includes SSEP's and event-related potentials, trans-cranial magnetic stimulation (TCMS), and metabolic CBF studies [(CBF à 30 ml/g/min), fSPECT scans (e.g., HMPAO Tc-99m single photon emission computed tomography) and 18 Fluor-Glucose-PETscan studies (positron emission tomography) of brain metabolism] [88][89][90][91]146].…”

Section: Functional Electrical Stimulation (Class 2 and 3 Evidence)mentioning

confidence: 99%

“…Following Kanno's criteria [39,88,90,146] that are based on class II and III evidence, dorsal column stimulation (DCS) might be an option for treatment especially for (1) relatively young patients (< 40 years), (2) patients with traumatic etiology, (3) patients without severe destruction of the thalamus and without marked cerebral atrophy on CT or MRI, (4) patients with CBF à 20 ml/100 g per minute. Examination of regional blood flow (rCBF) during DCS with the aid of three-dimensional stereotactic region of interest template (3DSRT) was pre and postoperatively performed on 30 AS cases (8 after vascular, 13 TBI, 9 after anoxic brain damage).…”

Section: Dorsal Column Stimulationmentioning

confidence: 99%

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Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Wild

Gerstenbrand²,

Dolce

et al. 2007

Eur J Trauma Emerg Surg

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Management of AS aims at the social reintegration of patients or has to guarantee humanistic active nursing if treatment fails. Outcome depends on the cause and duration of AS/VS as well as patient's age. There is no single AS/VS specific laboratory investigation, no specific regimen or stimulating intervention to be recommended for improving higher cerebral functioning. Quality management requires at least 3 years of advanced training and permanent education to gain approval of qualification for AS/VS treatment and expertise. Sine qua non areas covering AS/VS institutions for early and long-term rehabilitation are required on a population base (prevalence of 2/100.000/year) to quicken functional restoration and to prevent or treat complications. Caring homes are needed for respectful humane nursing including basal sensor-motor stimulating techniques. Passive euthanasia is considered an act of mercy by physicians in terms of withholding treatment; however, ethical and legal issues with regard to withdrawal of nutrition and hydration and end of life discussions raise deep concerns. The aim of the guideline is to provide management guidance (on the best medical evidence class II and III or task force expertise) for neurologists, neurosurgeons, other physicians working with AS/VS patients, neurorehabilitation personnel, patients, next-of-kin, and health authorities.

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Section: Functional Electrical Right Median Nerve Stimulation (Rmns)supporting

confidence: 59%

Section: Stimulation Techniquesmentioning

confidence: 99%

Section: Functional Electrical Stimulation (Class 2 and 3 Evidence)mentioning

confidence: 99%

Section: Dorsal Column Stimulationmentioning

confidence: 99%

See 2 more Smart Citations

Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Wild

Gerstenbrand²,

Dolce

et al. 2007

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

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“…Therefore, the promising results of SCSinduced CBF augmentation have led some clinicians to use this procedure to treat various cerebral vascular disorders. These cerebral diseases and/or pathological conditions include cerebral ischemia (Broseta et al, 1994;De Andres et al, 2007;Hosobuchi, 1991), ischemic spastic hemiparesis (Visocchi et al, 1994), focal cerebral ischemia (Meglio et al, 1991a, b;Ebel et al, 2001;Sagher et al, 2003;Sagher and Huang 2006;Robaina et al, 2004), cerebral vasospasm Karadag et al, 2005;Visocchi et al, 2001), stroke (Hosobuchi, 1991;Matsui and Hosobuchi, 1989;Visocchi et al, 1994Visocchi et al, , 2001, ischemic cerebral oedema (Gonzalez-Darder and Canadas-Rodriguez, 1991), postapoplectic spastic hemiplegia (Nakamura and Tsubokawa, 1985), prolonged coma (Fujii et al, 1998), persistent vegetative state (Funahashi et al 1989;Kanno et al, 1987;Kuwata, 1993), as well as migraine and posttraumatic cervicogenic headache (Dario et al, 2005). However, the underlying mechanisms of blood flow improvement are not well understood ).…”

Section: Introductionmentioning

confidence: 99%

Roles of dorsal column pathway and transient receptor potential vanilloid type 1 in augmentation of cerebral blood flow by upper cervical spinal cord stimulation in rats

Yang

Farber

et al. 2008

Neuroscience

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Clinical and basic studies have indicated that upper cervical spinal cord stimulation (cSCS) significant increases cerebral blood flow (CBF), but the mechanisms are incompletely understood. This investigation was conducted to differentiate between stimulation of dorsal column fibers and upper cervical spinal cord cell bodies in cSCS-induced increases in CBF and decreases in cerebral vascular resistance (CVR). cSCS (50 Hz, 0.2 ms, 1 min) was applied on the left C1-C2 dorsal column n pentobarbital anesthetized, ventilated and paralyzed male rats. Laser Doppler flowmetry probes were placed bilaterally over the parietal cortex, and arterial pressure was monitored. cSCS at 30%, 60%, and 90% of motor threshold (MT) produced vasodilation bilaterally in cerebral cortices. Subsequently, cSCS was applied at 90% MT, and ipsilateral responses were recorded. Ibotenic acid (0.3mg/ml, 0.1ml) placed on dorsal surface of C1-C2 (n=7) to suppress cell body activity, did not affect cSCS-induced %□CBF (42.5±8.1% vs 36.8±7.1%, P>0.05□and %□CVR (−19.4±4.2% vs −15.2±5.6%, P>0.05). However, bilateral transection of the dorsal column at rostral C1 (n=8) abolished cSCS-induced changes in CBF and CVR. Also, rostral C1 transection (n=7) abolished cSCS-induced changes in CBF and CVR. Resinferatoxin (RTX), an ultra potent TRPV1 agonist, was used to inactivate TRPV1 containing nerve fibers / cell bodies. RTX (2 µg/ml□0.1ml) placed on the C1-C2 spinal cord (n=7) did not affect cSCS-induced %ΔCBF (60.2±8.1% vs 46.3±7.7%, P>0.05) and %ΔCVR (−25.5±3.5% vs −21.4±8.9%, P>0.05). However, intravenous RTX (2 µg/kg, n=9) decreased cSCS-induced %ΔCBF from 65.0±9.5% to 27.4±7.2% (P<0.05) and %ΔCVR from −28.0 ±7.6% to −14.8±4.2% (P<0.05). These results indicated that cSCS-increases in CBF and decreases in CVR occurred via rostral spinal dorsal column fibers and did not depend upon C1-C2 cell bodies. Also, our results suggested that cerebral but not spinal TRPV1 was involved in cSCS-induced cerebral vasodilation.

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Disentangling disorders of consciousness: Insights from diffusion tensor imaging and machine learning

Zheng

Reggente

Lutkenhoff

et al. 2016

Human Brain Mapping

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Previous studies have suggested that disorders of consciousness (DOC) after severe brain injury may result from disconnections of the thalamo-cortical system. However, thalamo-cortical connectivity differences between vegetative state (VS), minimally conscious state minus (MCS-, i.e., low-level behavior such as visual pursuit), and minimally conscious state plus (MCS+, i.e., high-level behavior such as language processing) remain unclear. Probabilistic tractography in a sample of 25 DOC patients was employed to assess whether structural connectivity in various thalamo-cortical circuits could differentiate between VS, MCS-, and MCS+ patients. First, the thalamus was individually segmented into seven clusters based on patterns of cortical connectivity and tested for univariate differences across groups. Second, reconstructed whole-brain thalamic tracks were used as features in a multivariate searchlight analysis to identify regions along the tracks that were most informative in distinguishing among groups. At the univariate level, it was found that VS patients displayed reduced connectivity in most thalamo-cortical circuits of interest, including frontal, temporal, and sensorimotor connections, as compared with MCS+, but showed more pulvinar-occipital connections when compared with MCS-. Moreover, MCS- exhibited significantly less thalamo-premotor and thalamo-temporal connectivity than MCS+. At the multivariate level, it was found that thalamic tracks reaching frontal, parietal, and sensorimotor regions, could discriminate, up to 100% accuracy, across each pairwise group comparison. Together, these findings highlight the role of thalamo-cortical connections in patients' behavioral profile and level of consciousness. Diffusion tensor imaging combined with machine learning algorithms could thus potentially facilitate diagnostic distinctions in DOC and shed light on the neural correlates of consciousness. Hum Brain Mapp 38:431-443, 2017. © 2016 Wiley Periodicals, Inc.

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Neurostimulation for Patients in Vegetative Status

Cited by 23 publications

References 1 publication

Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Roles of dorsal column pathway and transient receptor potential vanilloid type 1 in augmentation of cerebral blood flow by upper cervical spinal cord stimulation in rats

Disentangling disorders of consciousness: Insights from diffusion tensor imaging and machine learning

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