The use of epidural spinal cord stimulation in patients with chronic disorders of consciousness - neuroimaging and clinical results

OBJECTIVE: Chronic disorders of consciousness are considered as a serious unresolved problem complicated by significant medical, social, and economic burden. There-fore, improving the conditions and facilitating the rehabilitation management of these patients is of particular interest. In recent years, interest-ing results of the use of spinal cord stimulation in patients with chronic disorders of conscious-ness appeared in the world literature, which makes the use of this technique promising in this category of patients. PATIENTS AND METHODS: We analyzed the results of high cervical spinal cord stimulation, both, in tonic and "Burst" modes, in 21 patients with chronic disorders of consciousness and severe spasticity managed in the last two years in FRCC ICMR. In 9 of them pre-and post -stimu-lation fMRI before and right after the stimulation was also performed for brain functional connec-tivity assessment. RESULTS: Improvement of the conscious-ness level was observed in 38.1% (n = 8) and a decrease in spasticity was obtained in 52.4% (n=11) of the patients. The difference in CRS-R score before and after spinal cord stimulation was statistically significant (p=0.028). The fMRI results revealed an increase in functional con-nectivity of the right anterior insula with several areas that are part of the Dorsal Attention, Visu-al and Default Mode networks after spinal cord stimulation.CONCLUSIONS: Epidural spinal stimulation at the upper cervical spine level demonstrated its effectiveness in patients with chronic diseas-es of consciousness of various etiology. Evalu-ation of the effect of specific stimulation modes requires further controlled study in larger group of patients.