A 38-year-old male patient with disorders of consciousness (DOC) successfully recovered consciousness and get obvious motor function improvements through three stages of cervical spinal cord stimulation (SCS) treatment (6 Hz, 40 Hz, and combined frequency stimulation). We used the Coma Recovery Scale-Revised (CRS-R), Fugl–Meyer Assessment Scale, activities of daily living, and Berg Balance Scale to detect changes in consciousness and motor function during the 7-month postoperative follow-up. Electroencephalography-based individual alpha frequency (IAF) and relative power spectral density (RP) were used to assess changes in cognitive function and brain network function before and after the combined stimulation. The results revealed a gradually increased patient's CRS-R score after stimulation at 6 Hz, and the patient recovered consciousness 12 weeks postoperatively. The patient's motor function score gradually increased after adjusting the stimulation frequency to 40 Hz. However, the patient regressed in motor function when the stimulation frequency was decreased to 2 Hz. The patient's fine motor control of both hands significantly improved, accompanied by an increased RP in the beta band but the IAF decreased, after combined stimulation (40 Hz and 6 Hz). Then, motor function continued to improve with an increased IAF and RP in the alpha band after switching the stimulation order to 6 Hz and 40 Hz. Our results demonstrated that different frequency stimulations of cervical SCS may improve consciousness and motor function in patients with DOC.
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Case Report
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Open Access
Review Article
Issue
Spasticity after brain injury is a neurological sequela caused by damage to upper motor neurons. The primary symptoms are involuntary muscle activity, decreased muscle strength, and joint contracture. Acupuncture as a therapeutic method to regulate central nervous system function has been studied widely in recent years. Many clinical experiments have proved that acupuncture has positive effects on spasticity after brain injury. In this review, we discuss recent research of acupuncture treatment and the need for large randomized controlled trials.
Open Access
Review Article
Issue
To investigate the clinical effects of time window on hyperbaric oxygen treatment (HBOT) in patients with disorders of consciousness (DOC).
All the clinical research literature regarding HBOT for DOC published between January 2000 and November 2020 were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Standards Database (WFSD) and VIP Database using Chinese key words disorders of consciousness, the vegetable state, minimally conscious state, or hyperbaric oxygen followed by a comprehensive meta-analysis.
The query gave rise to 348 results, in which 21 articles were eventually selected for meta-analysis. Among the selected 21 articles, 18 articles involved a time window comparison. All the patients were classified into < 60- (718 patients) and ≥ 60- (374 patients) day groups depending on the number of days from HBOT initiation. The Jadad scores for the included datasets were relatively low in general with 2 points as the highest score. Comparable baseline data were demonstrated in all of the articles. Datasets from different sources were pooled and analyzed, and the results suggested that the clinical curative effect rate in the treatment group was significantly higher compared with that in the control group (curative effect rate: 69.86% versus 42.30%; Z = 11.28, P = 0.000, odds ratio = 3.80, 95% CI = 3.02-4.80). Additionally, the adverse reaction rate of the < 60-day group was found to be significantly lower compared with that of the ≥ 60-day group (Z = 10.01, P = 0.000, odds ratio = 4.82, 95% CI = 3.54-6.56). The funnel diagram in articles related to curative effect analysis and time window evaluation is inverted and symmetrical, indicating that publication bias was not significant.
The clinical curative effect of the HBOT group is higher compared with that of the control group. However, the conclusions based on meta-analysis are limited because of the methodological problems of some studies. Therefore, the clinical efficacy needs to be further tested using carefully designed large sample trials (multicenter, randomized, controlled, and double-blind).
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