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Clinical Outcome After Epidural Spinal Cord Stimulation in Patients With Severe Traumatic Brain Injuryстатья
- Авторы: Vorobyev Alexey N., Burmistrova Aleksandra V., Puzin Kiril M., Varyukhina Maria D., Radutnaya Margarita L., Yakovlev Alexey A., Chmutin Gennady E., Musa Gerald, Chmutin Egor G., Grechko Andrey V., Reyes Soto Gervith, Catillo-Rangel Carlos, Nurmukhametov Renat, Ramirez Manuel de Jesus Encarnacion, Montemurro Nicola
- Журнал: Cureus
- Том: 16
- Номер: 7
- Год издания: 2024
- DOI: 10.7759/cureus.65753
- Аннотация: Introduction: Epidural spinal cord stimulation is a minimally invasive procedure with a growing list ofindications. It has a good safety profile and analgesic effect, reduces the severity of spasticity, and activatesvarious brain regions. The purpose of this study is to evaluate the clinical outcome of epidural spinal cordstimulation in patients with spastic syndrome and chronic disorders of consciousness resulting from severetraumatic brain injury (sTBI).Methods: Between 2021 and 2023, an epidural spinal cord stimulation test was performed in 34 patientswith central paresis, severe hypertonia, and chronically altered consciousness following sTBI. The severityof spastic syndrome was assessed using a modified Ashworth scale. All patients underwent implantation of acylindrical eight-contact test epidural electrode at C3-C5 cervical level, followed by neurostimulation andselection of individual modes. Tonic stimulation at a frequency of 60 Hz, "burst" mode, or a combination ofthe two was used.Results: Epidural spinal cord stimulation was administered for an average of 4 ± 1.5 days, with tonicstimulation mode applied in 15 (44.1%) patients, "burst" mode in 10 (29.4%), and a combination of two innine (26.5%) patients. A reduction in spasticity with clinical improvement was observed in 21 patients(61.8%). The Ashworth scale scores for distal and proximal upper extremities decreased from 3 points to 2.5points and from 3 points to 2 points, respectively. This was significant in the right upper limbs (p = 0.0152distally and p = 0.0164 proximally). Significant improvements were also seen in the lower extremities. Activemovements in paretic limbs increased or appeared in 12 patients (35.3%), while a heightened level ofconsciousness was observed in six patients (17.6%). Permanent neurostimulator implantation wasperformed in 12 patients (35.3%), with no reported surgical complications.Conclusion: Epidural spinal cord stimulation shows promise as an invasive rehabilitation method forpatients with sTBI sequelae. Its use reduced the severity of spastic syndrome in over half of patients andincreased active movements in paretic limbs in over a third. Notably, neuromodulation at the cervical levelyielded pronounced effects on the upper extremities, both proximally and distally. Findings regardingconsciousness level improvement are particularly intriguing but warrant further validation throughrandomized trials.
- Добавил в систему: Воробьев Алексей Николаевич