Matsumoto-Miyazaki Jun, Nishibu Yumiko, Ikegame Yuka, Shinoda Jun, Yano Hirohito
Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Chubu Neurorehabilitation Hospital, Minokamo, JPN.
Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, JPN.
Cureus. 2024 Aug 8;16(8):e66439. doi: 10.7759/cureus.66439. eCollection 2024 Aug.
Spastic muscle overactivity (SMO) is a frequent retractable complication in patients with prolonged disorder of consciousness (DOC) after severe traumatic brain injury (sTBI). Here, we describe a patient with DOC and SMO after sTBI successfully treated with adjunctive acupuncture. A woman in her 70s with chronic DOC, corresponding to a minimally conscious state (MCS), and limb SMO after severe TBI due to a traffic accident was admitted to our hospital six months after the injury and received multiple care interventions including physiotherapy and nurse care. However, her SMO in the extremities with decorticated posture, in which bilateral elbow joints were flexed and bilateral knee joints were extended, remained. The passive range of motion (ROM) of bilateral elbow joints decreased. Her DOC also remained in MCS. Thus, acupuncture was implemented twice weekly for 20 weeks to improve SMO and promote arousal 30 months after injury. Modified Tardieu scale (MTS) during right elbow extension was measured before and after each acupuncture session. The maximum passive ROM (MTS-R2) gradually increased during the acupuncture period. The catch angle (MTS-R1), which indicates the influences of the hyper stretch reflex, also gradually reduced. The ROM limitation and the catch angle trended to decrease immediately after each acupuncture session. Ultrasound shear-wave elastography of the right brachial biceps muscle (BBM) at the 28th acupuncture session showed a reduction of shear-wave speeds immediately after the session, indicating that acupuncture reduced BBM stiffness. Her DOC state remained MCS. In the presented case, the adjunctive acupuncture therapy reduced SMO after severe TBI. Acupuncture may be beneficial for such patients. A large cohort study is warranted to confirm the effects of acupuncture on SMO in patients with DOC after sTBI.
痉挛性肌肉过度活动（SMO）是重度创伤性脑损伤（sTBI）后长期意识障碍（DOC）患者常见的可恢复性并发症。在此，我们描述了一名sTBI后出现DOC和SMO的患者，通过辅助针灸成功治疗。一名70多岁的女性，因交通事故导致重度TBI后处于慢性DOC状态，相当于最低意识状态（MCS），并伴有肢体SMO，受伤6个月后入住我院，接受了包括物理治疗和护理在内的多种护理干预。然而，她四肢呈去皮层姿势的SMO仍然存在，即双侧肘关节屈曲，双侧膝关节伸展。双侧肘关节的被动活动范围（ROM）减小。她的DOC状态也仍为MCS。因此，在受伤30个月后，每周进行两次针灸，共20周，以改善SMO并促进觉醒。在每次针灸前后测量右肘关节伸展时的改良Tardieu量表（MTS）。在针灸期间，最大被动ROM（MTS-R2）逐渐增加。表示牵张反射亢进影响的捕捉角（MTS-R1）也逐渐减小。每次针灸后，ROM限制和捕捉角都有立即减小的趋势。在第28次针灸时，对右肱二头肌（BBM）进行超声剪切波弹性成像显示，针灸后剪切波速度立即降低，表明针灸降低了BBM的硬度。她的DOC状态仍为MCS。在本病例中，辅助针灸疗法减轻了重度TBI后的SMO。针灸可能对此类患者有益。有必要进行一项大型队列研究，以证实针灸对sTBI后DOC患者SMO的影响。
