Effects of the Cervical Spinal Cord Stimulation on Persistent Vegetative Syndrome: Experimental and clinical study Toshikazu Kuwata 1 1Department of Neurological Surgery, Wakayama Medical College Keyword: Spinal cord stimulation , Vegetative syndrome , Acetylcholine , EEG , CT scan pp.325-331
Published Date 1993/4/10
DOI https://doi.org/10.11477/mf.1436900629
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Influence of spinal cord stimulation (SCS) on elec-troencephalograms (EEGs) and intracerebral neuro-transmitters were studied in cats, and clinical usefulness of the stimulation was reviewed in patients with vegetative syndrome.

Cat spinal cords were transdurally stimulated at the second cervical spine for two hours with a pulse width of 1.0 milliseconds, a frequency of 200 Hz and an am-plitude ranging from 10 to 15 volts. EEGs were re-corded at the frontal epidural space and neurotransmit-ters in the frontal cortex, such as acetylcholine (ACh), 5-hydroxyindoleacetic acid (5- HIAA), aspartate, gluta-mate and y-aminobutyric acid (GABA), were mea-sured by an in vivo microdialysis method. The back-ground activities of the EEGs were increased by 2 Hz after the SCS. The ACh content increased to 320% three hours after initiation of the SCS, although the other four neurotransmitters did not show any change. Epidural SCS at the upper cervical level was applied to 15 vegetative patients for the amelioration of their vegetative state. Eleven of the 15 patients were treated later than three months after the onset of vegetative state and the other four within three months. Three of the 11 patients treated late and one of the four treated early escaped from the vegetative state (good group). Some clinical improvements were observed in four cases (fair group), two of whom were treated late and the other treated early. The other seven patients showed no improvement (no change group). Most cases of the “good” and “fair” group had relatively small and localized lesions on CT scans or MR images, and showed bilateral fifth wave of auditory brain stem re-sponse and/or N20 of short latency SEP irrespective of the prolongation of their latency. On the other hand, the “no change” group had large lesions or diffuse cor-tical atrophy and did not show fifth wave and/or N20. Patients treated within three months got better results than those in cases treated later than 3 months. This study suggests that SCS is able to improve con-sciousness in vegetative patients with desynchroniza-tion of EEG and an increase in intracerebral ACh, both of which seem to he induced by activation of the ascending cholinergic reticular activating system.

Copyright © 1993, Igaku-Shoin Ltd. All rights reserved.


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