Yamamoto T, Katayama Y, Kobayashi K, Kasai M, Oshima H, Fukaya C
Department of Neurological Surgery and Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan.
Acta Neurochir Suppl. 2003;87:15-8. doi: 10.1007/978-3-7091-6081-7_4.
Twenty-one cases of a persistent vegetative state (PVS) caused by various kinds of brain damage were evaluated neurologically and electrophysiologically at 3 months after the brain injury. The 21 cases were treated by deep brain stimulation (DBS) therapy, and followed up for over 10 years. The stimulation sites were the mesencephalic reticular formation (2 cases) and CM-pf complex (19 cases). Eight of the patients emerged from the PVS, and became able to obey verbal commands. However, they remained in a bedridden state. These 8 cases revealed a desynchronization on continuous EEG frequency analysis. The Vth wave of the ABR and N20 of the SEP could be recorded even with a prolonged latency, and the pain-related P250 was recorded with an amplitude of over 7 microV. The mean survival time of these 8 cases was 6.1 years, as compared to 3.1 years for the other 13 cases. Overall, 4 cases are alive after more than 10 years. DBS therapy may be useful for allowing patients to emerge from a PVS, if the candidates are selected according to neurophysiological criteria. The fact that 19% (4/21) of the PVS cases treated with DBS survived for over 10 years should be stressed in comparison with the usual survival period for the untreated PVS.
对21例因各种脑损伤导致的持续性植物状态（PVS）患者在脑损伤后3个月进行了神经学和电生理学评估。这21例患者接受了脑深部电刺激（DBS）治疗，并随访了10年以上。刺激部位为中脑网状结构（2例）和丘脑中央中核-束旁核复合体（CM-pf复合体，19例）。其中8例患者从PVS中苏醒，能够听从言语指令。然而，他们仍卧床不起。这8例患者在连续脑电图频率分析中显示出失同步。即使潜伏期延长，听觉脑干反应（ABR）的V波和体感诱发电位（SEP）的N20仍可记录到，且记录到与疼痛相关的P250，其波幅超过7微伏。这8例患者的平均生存时间为6.1年，而其他13例患者为3.1年。总体而言，有4例患者在10年以上仍存活。如果根据神经生理学标准选择合适的患者，DBS治疗可能有助于使患者从PVS中苏醒。与未经治疗的PVS通常的生存期相比，应强调接受DBS治疗的PVS病例中有19%（4/21）存活超过10年这一事实。
