Neurochirurgia Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, University of Pavia-Fondazione IRCCS Policlinico S. Matteo, Pavia.
Neurorehabilitation Unit, Salvatore Maugeri Foundation IRCCS, Scientific Institute of Pavia.
J Neurosurg. 2016 Oct;125(4):972-981. doi: 10.3171/2015.7.JNS15700. Epub 2016 Jan 8.
OBJECTIVE Deep brain stimulation of the thalamus was introduced more than 40 years ago with the objective of improving the performance and attention of patients in a vegetative or minimally conscious state. Here, the authors report the results of the Cortical Activation by Thalamic Stimulation (CATS) study, a prospective multiinstitutional study on the effects of bilateral chronic stimulation of the anterior intralaminar thalamic nuclei and adjacent paralaminar regions in patients affected by a disorder of consciousness. METHODS The authors evaluated the clinical and radiological data of 29 patients in a vegetative state (unresponsive wakefulness syndrome) and 11 in a minimally conscious state that lasted for more than 6 months. Of these patients, 5 were selected for bilateral stereotactic implantation of deep brain stimulating electrodes into their thalamus. A definitive consensus for surgery was obtained for 3 of the selected patients. All 3 patients (2 in a vegetative state and 1 in a minimally conscious state) underwent implantation of bilateral thalamic electrodes and submitted to chronic stimulation for a minimum of 18 months and a maximum of 48 months. RESULTS In each case, there was an increase in desynchronization and the power spectrum of electroencephalograms, and improvement in the Coma Recovery Scale-Revised scores was found. Furthermore, the severity of limb spasticity and the number and severity of pathological movements were reduced. However, none of these patients returned to a fully conscious state. CONCLUSIONS Despite the limited number of patients studied, the authors confirmed that bilateral thalamic stimulation can improve the clinical status of patients affected by a disorder of consciousness, even though this stimulation did not induce persistent, clinically evident conscious behavior in the patients. Clinical trial registration no.: NCT01027572 ( ClinicalTrials.gov ).
目的
丘脑深部电刺激技术于 40 多年前问世，其目的是改善处于植物状态或最小意识状态患者的表现和注意力。在此，作者报告了皮层丘脑刺激（CATS）研究的结果，这是一项关于双侧慢性刺激前内丘脑核和邻近旁核区对意识障碍患者影响的前瞻性多机构研究。
方法
作者评估了 29 例处于植物状态（无反应觉醒综合征）和 11 例持续时间超过 6 个月的最小意识状态的患者的临床和影像学数据。在这些患者中，有 5 例被选择进行双侧立体定向丘脑深部电刺激电极植入。有 3 例患者最终确定进行了手术。所有 3 例患者（2 例处于植物状态，1 例处于最小意识状态）均接受了双侧丘脑电极植入，并接受了至少 18 个月、最长 48 个月的慢性刺激。
结果
在每种情况下，脑电图的去同步化和功率谱都有所增加，昏迷恢复量表修订版的评分也有所提高。此外，肢体痉挛的严重程度以及病理性运动的数量和严重程度均有所降低。然而，这些患者中没有任何一个恢复到完全有意识的状态。
结论
尽管研究的患者数量有限，但作者证实双侧丘脑刺激可以改善意识障碍患者的临床状况，尽管这种刺激并没有在患者中引起持续的、临床上明显的意识行为。临床试验注册号：NCT01027572（ClinicalTrials.gov）。
