Advertisement

Regaining consciousness for prolonged comatose patients with right median nerve stimulation

  • Jung-Tung Liu
  • C. H. Wang
  • I. C. Chou
  • S. S. Sun
  • C. H. Koa
  • E. Cooper
Conference paper
Part of the Acta Neurochirurgica Supplements book series (NEUROCHIRURGICA, volume 87)

Summary

During the past half year, we have utilized right median nerve stimulation (produced by Empi. Co. USA) to awaken consciousness of patients on 6 cases, 2 with brain trauma, one with aneurysm rupture, one with hemorrhagic stroke and two with hypoxic encephalopathy. The comatose duration ranged from 6 to 17 weeks. All patients underwent SPECT scan for cerebral perfusion evaluation and neurotransmitter quantification before and after the stimulation. The stimulation time lasted from 8 to 10 hours on daytime.

The stimulation persisted for 3 months in all patients. Four patients recovered from the consciousness within 35 days. There was no obvious clinical improvement in two patients. Brain perfusion increased in all cases through the SPECT study after stimulation. The elevation of neurotransmitter in CSF was found in 5 out of the 6 cases.

Median nerve stimulation elevates the cerebral blood flow and may influence the patient’s consciousness. Young patients (<40 years old) had better results than old patients. The stimulation could be initiated if the patient’s acute stage was over. In our series, although increase in cerebral blood flow was found in all cases, some patients did not regain consciousness.

Keyword

Median nerve stimulation prolonged comatose patient cerebral blood flow SPECT scan 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bouma G, Muizelaar J (1993) Evaluation of regional cerebral blood flow in acute head injury by stable xenon-enhanced computerized tomography. Acta Neurochir (Wien) [Suppl] 59: 34–40Google Scholar
  2. 2.
    Cooper JB, Jane JA, Cooper EB et al (1999) Right median nerve electrical stimulation to hasten awakening from coma. Brain Injury 13:261–267PubMedCrossRefGoogle Scholar
  3. 3.
    Glanz M, Klawansky S, Stason W et al (1996) Functional electrostimulation in poststroke rehabilitation: a meta-analysis of the randomized controlled trials. Arch Phys Med Rehab 77: 549–553CrossRefGoogle Scholar
  4. 4.
    Grady M, Jane J, Steward O (1989) Synaptic reorganization within the human central nervous system following injury. J Neurosurg 71: 534–537PubMedCrossRefGoogle Scholar
  5. 5.
    Hirata Y, Ushio U (2000) A case of successful treatment by median nerve stimulation for prolonged moderate consciousness disturbance in the chronic phase following subarachnoid hemorrhage. The Society for the Treatment of Coma 9: 85–89Google Scholar
  6. 6.
    Hosobuchi Y (1985) Electrical stimulation of cervical spinal cord increases cerebral blood flow in humans. Appl Neurophysiol 48: 372–276PubMedGoogle Scholar
  7. 7.
    Kanno T, Kamel Y, Yokoyama T et al (1989) Effects of dorsal column stimulation (DCS) on reversibility of neuronal function — Experience of treatment for vegetative states. PACE 12: 733–738PubMedCrossRefGoogle Scholar
  8. 8.
    Lawrence F, Eisenberg H, Jane J et al (1991) The outcome of severe closed head injury. Journal of Neurosurgery 75: s28–s36Google Scholar
  9. 9.
    Marion D, Darby J, Yonas H (1991) Acute regional cerebral blood flow changes caused by severe head injuries. J Neurosurg 74: 407–414PubMedCrossRefGoogle Scholar
  10. 10.
    Meglio M, Cioni B, Visocchi F et al (1991) Spinal Cord Stimulation and Cerebral haemodynamics. Acta Neurochir (Wien) 111:43–48PubMedCrossRefGoogle Scholar
  11. 11.
    Obrist WD, Langfitt TW, Jaggi JL et al (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. J Neurosurg 61: 241–253PubMedCrossRefGoogle Scholar
  12. 12.
    Peri CV, Shafery ME, Cooper ED et al (2001) Pilot study of electrical stimulation on median nerve in comatose severe brain injured patients: 3-month outcome. BRAIN INJURY 15: 903–910PubMedCrossRefGoogle Scholar
  13. 13.
    Scherder E, Bouma A, Steen L (1992) Influence of transcutaneous electrical nerve stimulation on memory in patients with demential of the Alzheimer’s type. Journal of Clinical and Experimental Neuropsychology 14: 951–960PubMedCrossRefGoogle Scholar
  14. 14.
    Yamamoto K, Sugita S, Ishikawa K et al (1997) A case of persistent vegetative state treated with median nerve stimulation. The Society for the Treatment of Coma 5: 117–125Google Scholar
  15. 15.
    Yokoyama T, Kamei T, Kanno T (1996) Right median nerve stimulation for comatose patients. The Society for the Treatment of Coma 5: 117–125Google Scholar

Copyright information

© Springer-Verlag Wien 2003

Authors and Affiliations

  • Jung-Tung Liu
    • 1
  • C. H. Wang
    • 1
  • I. C. Chou
    • 1
  • S. S. Sun
    • 2
  • C. H. Koa
    • 2
  • E. Cooper
    • 3
  1. 1.Department of NeurosurgeryChina Medical College HospitalTaichungTaiwan ROC
  2. 2.Department of NucleomedicineChina Medical College HospitalTaichungTaiwan ROC
  3. 3.Department of Physical Medicine and RehabilitationEast Carolina UniversityGreenvilleUSA

Personalised recommendations