Chronic conscious disturbance generally includes vegetative state (VS) and minimal conscious state (MCS), which are mostly caused by brain trauma, ischemia and hypoxia and cerebrovascular diseases. VS refers to unconscious activities, inability to execute instructions, loss of cognitive function, periodic awakening-sleep cycle, aimless eye tracking, ability to open eyes automatically or under stimulation, inability to understand and express language, maintenance of autonomic blood pressure and breathing, and basic preservation of brain stem and hypothalamus functions. VS lasting more than 1 month is called persistent vegetative state (PVS).
How to treat chronic disturbance of consciousness? Traditional treatment methods include drugs, hyperbaric oxygen, rehabilitation physiotherapy, sensory and environmental stimulation, and noninvasive external electrical stimulation (transcranial magnetic stimulation, transcranial direct current stimulation, median nerve electrical stimulation, etc.). ), acupuncture and the like, but the effect is not good. As a result, the patient has been in a vegetative state or a slightly conscious state, which cannot be further improved and will only increase the burden on the patient's family.
So, is there a better way to help patients wake up? Yes, in recent years, many studies have found that high cervical spinal cord electrical stimulation of SCS may be an effective means to treat chronic consciousness disorder. Many medical institutions at home and abroad have successively developed this technology, and the total effective rate of awakening can reach 5 1.6%.
What is spinal cord electrical stimulation surgery (SCS)? Spinal cord electrical stimulation surgery is to place stimulation electrodes outside the dura mater at C2-C4 level of cervical spinal cord, and pulse stimulation is transmitted to cerebral cortex through ascending reticular activation system, so as to increase local glucose metabolism rate and cerebral blood flow, promote the release of excitatory transmitters, enhance conscious impulse and EEG activity, and thus promote patients' awakening.
Who is suitable for spinal cord electrical stimulation surgery (SCS)? 1, the patient has intermittent but definite conscious behavior (mild disturbance of consciousness);
2. There is a good potential for consciousness recovery, but some patients have been stagnant in this state for a long time;
3. Traditional treatment has been unable to further improve their consciousness.
Who is not suitable for spinal cord electrical stimulation surgery (SCS)? 1, neurodegenerative diseases, malignant brain tumors caused by surgery;
2. Patients with coma or short life expectancy caused by deterioration of systemic diseases;
3. Patients whose consciousness level has reached a level beyond the diagnosis of micro-consciousness, that is, patients who can use articles or communicate effectively with the outside world;
4. The illness time is less than 3 months, or there is progressive improvement or deterioration of consciousness within 4 weeks.
Besides arousing vegetative state, what diseases can SCS treat? SCS operation can not only help vegetative patients to wake up, but also treat other chronic pain diseases.
Diabetic foot pain;
Peripheral ischemic pain;
Neuralgia after herpes zoster;
Spinal surgery failure syndrome (FBSS);
Nerve root pain syndrome/nerve root disease;
Phantom limb pain/stump pain …
In addition to calling for chronic pain, it also includes:
Arachnitis/lumbar adhesion arachnoiditis;
Dural fibrosis;
Burning pain of peripheral nerve;
Reflex sympathetic dystrophy (RSD) or neuralgia;
Chronic intractable angina pectoris …
These chronic pains are often treated with drugs with poor effect, large dosage and great side effects, which are seriously harmful to human body. Therefore, when the analgesic effect of drugs is not good, SCS operation is feasible to relieve pain.
Mechanism of spinal cord electrical stimulation surgery in the treatment of chronic pain Spinal cord electrical stimulation surgery is a treatment method to control pain and relieve symptoms by stimulating spinal nerves with weak current. It generates weak current stimulation through nerve stimulator implanted under abdominal skin, and it is conducted to the dorsal column of spinal cord through electrodes placed in epidural space, thus affecting the peripheral nerve-dominated areas of different segments. Studies have shown that spinal cord electrical stimulation can direct micro-current to specific nerves needed to activate muscles, and continuous stimulation can induce the recovery of nerve function and inhibit the transmission of pain signals to the brain.
SCS can widely inhibit the excessive excitation of spinal dorsal horn neurons with wide dynamic range, promote the release of inhibitory neurotransmitters such as GABA, and inhibit the release of excitatory neurotransmitters such as glutamic acid and aspartic acid.
Generally, SCS surgery for chronic pain needs to be carried out in two steps. The first step is to implant electrodes and connect external stimulators to observe the pain relief of patients and the side effects after parameter adjustment. After several days of observation, if the analgesic effect is good, the pulse generator can be implanted in the body in the second stage. If the analgesic effect is not good, the electrode can be removed and the treatment scheme can be changed, such as morphine pump implantation.
The patient has been unable to wake up, and the long-term treatment expenditure and complicated nursing burden have brought economic and psychological pressure to the family. At present, awakening in the vegetative state is still a worldwide medical problem. In order to better help this patient group, our hospital has set up a consciousness disorder awakening center and adopted an advanced awakening method-spinal cord electrical stimulation surgery (SCS), hoping that more patients with consciousness disorder will benefit from it!
Dong Lei Brain Hospital Consciousness Disorder Awakening Center Multidisciplinary Expert Team Diagnosis and Treatment
The hospital consciousness disorder awakening center is composed of multidisciplinary teams such as neurosurgery, neurology, critical care, rehabilitation and radiology, providing professional and personalized diagnosis and treatment services for patients.
Multi-means, comprehensive and meticulous evaluation system to guide treatment.
In the aspect of conscious state evaluation, in addition to CRS-R scale, the team also used fMRI, DTI, CTP, EEG and brain-computer interface to evaluate the patients in the whole process, so as to clarify the changes of patients' conscious state and provide reference and guidance for our whole treatment process.
Early intervention and standardized wake-up treatment process
The whole treatment process of coma patients includes severe treatment, complication treatment, consciousness evaluation, drug awakening, rehabilitation awakening and operation awakening. The team will treat coma patients from the early stage, form a set of standardized wake-up procedures, and improve the effect of wake-up treatment.
* Note: The above drugs are only for patients diagnosed by clinical treatment, and the doctor will prescribe the treatment. Patients are not allowed to buy drugs for treatment.
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