Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation.
Eur Rev Med Pharmacol Sci. 2023 Jan;27(2):681-686. doi: 10.26355/eurrev_202301_31070.
Chronic disorders of consciousness are considered as a serious unresolved problem complicated by significant medical, social, and economic burden. Therefore, improving the conditions and facilitating the rehabilitation management of these patients is of particular interest. In recent years, interesting results of the use of spinal cord stimulation in patients with chronic disorders of consciousness appeared in the world literature, which makes the use of this technique promising in this category of patients.
We analyzed the results of high cervical spinal cord stimulation, both, in tonic and "Burst" modes, in 21 patients with chronic disorders of consciousness and severe spasticity managed in the last two years in FRCC ICMR. In 9 of them pre- and post-stimulation fMRI before and right after the stimulation was also performed for brain functional connectivity assessment.
Improvement of the consciousness level was observed in 38.1% (n = 8) and a decrease in spasticity was obtained in 52.4% (n=11) of the patients. The difference in CRS-R score before and after spinal cord stimulation was statistically significant (p=0.028). The fMRI results revealed an increase in functional connectivity of the right anterior insula with several areas that are part of the Dorsal Attention, Visual and Default Mode networks after spinal cord stimulation.
Epidural spinal stimulation at the upper cervical spine level demonstrated its effectiveness in patients with chronic diseases of consciousness of various etiology. Evaluation of the effect of specific stimulation modes requires further controlled study in larger group of patients.
慢性意识障碍被认为是一个严重且未解决的问题，其复杂之处在于存在重大的医疗、社会和经济负担。因此，改善这些患者的状况并促进其康复管理具有特别的意义。近年来，世界文献中出现了关于脊髓刺激在慢性意识障碍患者中应用的有趣结果，这使得该技术在这一类患者中具有应用前景。
我们分析了在过去两年中，在 FRCC ICMR 中管理的 21 例慢性意识障碍和严重痉挛患者中，高颈段脊髓刺激（无论是在紧张模式还是“突发”模式下）的结果。其中 9 例患者在刺激前后进行了 fMRI 检查，以评估脑功能连接。
38.1%（n=8）的患者意识水平得到改善，52.4%（n=11）的患者痉挛程度降低。脊髓刺激前后 CRS-R 评分的差异具有统计学意义（p=0.028）。fMRI 结果显示，脊髓刺激后右侧前岛叶与背侧注意、视觉和默认模式网络的几个区域之间的功能连接增加。
在上颈段硬膜外脊髓刺激对各种病因的慢性意识障碍患者有效。需要进一步对更大组患者进行对照研究，以评估特定刺激模式的效果。
