Research Reports - Deep brain stimulation for the early treatment of the minimally conscious state and vegetative state

J Neurosurg. 2017 Jun 16:1-10. doi: 10.3171/2016.10.JNS161071. [Epub ahead of
print]

Chudy D(1)(2), Deletis V(3)(4), Almahariq F(1), Marčinković P(1), Škrlin J(5),
Paradžik V(6).

OBJECTIVE An effective treatment of patients in a minimally conscious state (MCS)
or vegetative state (VS) caused by hypoxic encephalopathy or traumatic brain
injury (TBI) is not yet available. Deep brain stimulation (DBS) of the thalamic
reticular nuclei has been attempted as a therapeutic procedure mainly in patients
with TBI. The purpose of this study was to investigate the therapeutic use of DBS
for patients in VS or MCS. METHODS Fourteen of 49 patients in VS or MCS qualified
for inclusion in this study and underwent DBS. Of these 14 patients, 4 were in
MCS and 10 were in VS. The etiology of VS or MCS was TBI in 4 cases and hypoxic
encephalopathy due to cardiac arrest in 10. The selection criteria for DBS,
evaluating the status of the cerebral cortex and thalamocortical reticular
formation, included: neurological evaluation, electrophysiological evaluation,
and the results of positron emission tomography (PET) and MRI examinations. The
target for DBS was the centromedian-parafascicular (CM-pf) complex. The duration
of follow-up ranged from 38 to 60 months. RESULTS Two MCS patients regained
consciousness and regained their ability to walk, speak fluently, and live
independently. One MCS patient reached the level of consciousness, but was still
in a wheelchair at the time the article was written. One VS patient (who had
suffered a cerebral ischemic lesion) improved to the level of consciousness and
currently responds to simple commands. Three VS patients died of respiratory
infection, sepsis, or cerebrovascular insult (1 of each). The other 7 patients
remained without substantial improvement of consciousness. CONCLUSIONS
Spontaneous recovery from MCS/VS to the level of consciousness with no or minimal
need for assistance in everyday life is very rare. Therefore, if a patient in VS
or MCS fulfills the selection criteria (presence of somatosensory evoked
potentials from upper extremities, motor and brainstem auditory evoked
potentials, with cerebral glucose metabolism affected not more than the level of
hypometabolism, which is judged using PET), DBS could be a treatment option. 

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