Clinical study on treatment of chronic disorders of consciousness by deep brain stimulation: A report of 24 cases

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-10-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.10.006

Yi Yang, Yuan-yuan Dang, Xiaoyu Xia, Xueling Chen, Ruijing Huang, Jie Wu, Xiyu Lin, R. Xu

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引用次数: 1

Abstract

Objective To investigate the therapeutic effect of deep brain stimulation (DBS) in patients with chronic consciousness disorder (DOC) and its influencing factors. Methods Twenty-four DOC patients admitted to Department of Neurosurgery, the Seventh Medical Center of PLA General Hospital from July 2011 to December 2018 were retrospectively enrolled into this study. All patients were treated with DBS targeting unilateral central nucleus-parafascicular nucleus complex. CT or MRI was performed post operation to determine the electrode position. All patients were clinically followed up post operation. The follow-up included physical examination of the nervous system, assessment of modified coma recovery scale (CRS-R) score and extended Glasgow outcome score (GOS-E). According to the clinical symptoms and assessment scores of the patients, the therapeutic effects were evaluated and categorized into effective and ineffective. Furthermore, univariate and multivariate logistic regression analyses were used to explore the risk factors affecting the efficacy of patients. Results All 24 operations were successful. After reexamination of CT or MRI, the electrodes of all patients were implanted into the preset target position. DBS was turned on at 7 days post surgery in the 24 patients who received unipolar electrical stimulation with the voltage of (3.3±1.2)V (1.0-4.0 V), frequency of 100 Hz and pulse width of 120 μs. At 1-year follow-up, the outcomes of 24 patients were effective in 10 patients, improved in 13 and death in 1. The overall effective rate was 41.7% (10/24). Univariate analysis showed that the age, CRS-R score and recommendation criteria for surgery were influencing factors of the patient′s outcome (all P<0.05). Further multivariate logistic regression analysis showed that recommendation criteria for surgery was the independent risk factor affecting the outcome of patients(OR=4.333, 95%CI: 1.207-519.697, P=0.037). Conclusions DBS seems effective in the treatment of DOC and could be used as one of the feasible schemes for DOC treatment. recommendation criteria for surgery is the independent risk factor affecting the outcome of DOC patients. Key words: Consciousness disorders; Deep brain stimulation; Treatment outcome; Factor analysis, statistical

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脑深部电刺激治疗慢性意识障碍24例临床研究

目的探讨脑深部刺激（DBS）治疗慢性意识障碍（DOC）的疗效及其影响因素。方法对2011年7月至2018年12月在解放军总医院第七医学中心神经外科住院的24例DOC患者进行回顾性研究。所有患者均接受DBS靶向单侧中央核-束旁核复合体的治疗。术后进行CT或MRI检查以确定电极位置。所有患者术后均进行了临床随访。随访包括神经系统体检、改良昏迷恢复量表（CRS-R）评分和扩展格拉斯哥结果评分（GOS-E）评估。根据患者的临床症状和评估得分，对疗效进行评估，并将其分为有效和无效。此外，还采用单变量和多变量逻辑回归分析来探讨影响患者疗效的危险因素。结果24例手术全部成功。所有患者在复查CT或MRI后，将电极植入预设的目标位置。24例接受单极电刺激的患者术后7天开启DBS，电压为（3.3±1.2）V（1.0-4.0V），频率为100Hz，脉冲宽度为120μs。在一年的随访中，24名患者的结果有10名患者有效，13名患者改善，1名患者死亡。总有效率为41.7%（10/24）。单因素分析表明，CRS-R评分和手术推荐标准是影响患者预后的因素（均P＜0.05）。进一步的多元logistic回归分析表明，手术推荐标准为影响预后的独立危险因素（OR=4.33，95%CI:1.207-519.697，P=0.037）作为DOC处理的可行方案之一。手术推荐标准是影响DOC患者预后的独立风险因素。关键词：意识障碍；脑深部刺激；治疗结果；因素分析，统计学

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.