脊髄後索電気刺激療法による遷延性意識障害の治療：10例の経験

Recovery of Consciousness by Electrical Dorsal Column Stimulation in Brain Injury Patients

Ⅰ．はじめに

　脊髄後索電気刺激療法はこれまで難治性疼痛に対して用いられてきたが，疼痛のみならず遷延性意識障害に対しても有効な治療法であることが，近年わかってきた^{3,4,5,8,9,14,15,17)}．われわれは過去11年間に10例の遷延性意識障害患者に対し脊髄後索電気刺激療法による治療を行い，うち4例は明らかな意識の回復を認めたので報告する．

　Treatment with electrical dorsal column stimulation was performed in 7 cases of diffuse axonal injury,2 cases of brain contusion and 1 case of hypoxic diffuse brain damage. After inadequate response to various treatment modalities,each patient was implanted with a spinal cord stimulation system. The effectiveness was assessed using a standard scoring system which consisted of state scale and reaction scale (the society for treatment of coma).

　Both state scale and reaction scale were considered to improve in 4 patients after dorsal column stimulation. In 5 patients, the effectiveness of dorsal column stimulation could not be distinguished from natural improvement. One patient of hypoxic brain damage showed slight deterioration after the dorsal column stimulation. Among the state scale, significant improvement was found in spontaneous movement of the oral cavity and pharynx, spontaneous changes of expression muscles, concern about circumstances, voluntary purposeful movement, and coherent verbalization 2 weeks after the operation.

　As dorsal column stimulation can cause consciousness recovery from the semicomatose state,it should be considered as the treatment choice for the consciousness disturbance.