Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Chinese Institute for Brain Research, Beijing, China.
CNS Neurosci Ther. 2022 Aug;28(8):1249-1258. doi: 10.1111/cns.13870. Epub 2022 May 20.
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.
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.
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 (χ = 3.846, p = 0.871).
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.
意识障碍（DOC）患者的治疗仍然是一个具有挑战性的问题，一些研究报道脊髓刺激（SCS）对 DOC 有治疗作用。
本研究探讨 SCS 对不同意识水平的 DOC 患者的治疗效果，包括植物状态/无反应觉醒综合征（VS/UWS）和最小意识状态（MCS），并总结和分析 SCS 对 DOC 患者的长期效果及相关因素。
110 例患者中整体预后良好 35 例（31.8%）。预后良好患者中 MCS 组比 VS/UWS 组改善程度高 45.53%，差异有统计学意义。按推荐标准，高度推荐组中预后良好患者 33 例（94.3%），低度推荐组中预后良好患者 2 例（5.7%）（p < 0.001）。调整潜在协变量后，年轻（年龄≤19 岁）（p=0.045）和 MCS（p < 0.001）与预后良好显著相关。基于年龄、意识状态和病因的列线图显示出良好的预测性能，C 指数为 0.794。Hosmer-Lemeshow 拟合优度检验表明模型拟合良好（χ ²=3.846，p=0.871）。
SCS 是治疗 DOC 患者的最可行方法之一，尤其是 MCS 患者。年龄越小，预后越好，因此可作为术前筛选的依据。然而，还需要更多基于证据的随机对照试验来验证该治疗的疗效。
