Spinal Cord Stimulation Therapy at an Early Stage for Unresponsive Patients with Hypoxic Encephalopathy Masami FUJII 1 , Daikai SADAMITSU 2 , Tsuyoshi MAEKAWA 2 , Seiji UESUGI 1 , Satoshi OZAKI 1 , Hiroyasu KOIZUMI 1 , Shinpei UETSUKA 1 , Kenichi SAKAMOTO 1 , Tetsuo YAMASHITA 3 , Haruhide ITO 1 1Departments of Neurosurgery, Yamaguchi University School of Medicine 2Departments of Critical Care Medicine, Yamaguchi University School of Medicine 3Department of Neurosurgery, Yamaguchi Prefectural Hospital Keyword: hypoxia , disturbance of consciousness , spinal cord stimulation pp.315-321
Published Date 1998/4/10
DOI https://doi.org/10.11477/mf.1436901553
  • Abstract
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Recently, spinal cord stimulation (SCS) has been used for the treatment of patients in prolonged coma.However, the results of SCS in unresponsive patients with hypoxic encephalopathy at the chronic stagehave not been satisfactory. Considering these circumstances, we began SCS from one month after theonset of hypoxic encephalopathy and evaluated its effect.

Twelve patients (5 males and 7 females) with hypoxic encephalopathy, ranging in age from 7 to 72years, were treated with SCS. The causes of hypoxia were acute cardiac failure in 4, automobile exhaustgas poisoning in 2, and asthma, pneumothorax, anaphylaxis, asphyxia, drowning and hypotension duringaortic surgery in one patient each. One month after the onset, an electrode for electrical stimulation wasimplanted in the epidural space at the C2 - C4 level under general anesthesia. The spinal cord was stimu-lated for 8 hours each day, starting on the clay after implantation, and was continued for 3 months. Magne-tic resonance imaging (MRI), cerebral blood flow (CBF) measurement using xenon-computed tomography(Xe-CT), and measurement of auditory evoked potential (AEP) and somatosensory evoked potential(SEP) were carried out 3 weeks after the onset for presurgical evaluation.

Among the 12 patients, 7 (58%) showed clinical improvement, beginning within two weeks after startingstimulation. They were able to communicate with others and to express their emotion. However, disturb-ance of writing, picture drawing and calculation were not improved by stimulation. From presurgical eva-luation, cases in which SCS therapy was effective had the following features : 1) No hemorrhagic infarc-tion in the basal ganglia was demonstrable by MRI. 2) Mean hemispheric CBF measured by the Xe-CTmethod exceeded 25 ml/100g per min. 3) The mean increase in hemispheric CBF 20 min after acetazola-mide administration exceeded 5 ml/100g per min. 4) An N20 peak was evident on the median nerve SEP.SCS appears to be an effective supplementary for unresponsive patients with hypoxic encephalopathy atthe subacute stage, in addition to rehabilitation and drug therapy.

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