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To observe whether maintaining the appropriate depth of anesthesia with Bispectral Index (BIS) can improve the prognosis of Spinal Cord stimulation (SCS) implantation in patients with chronic Disorders of consciousness (DoC). Methods: 103 patients with DoC undergoing SCS implantation were reviewed, and 83 patients with DoC were included according to the standard of inclusion and exclusion Criteria. Patients were divided into a BIS group (n =45) and a non-BIS group (n =38) according to whether BIS monitoring was used during the operation. The depth of anesthesia in the BIS group was maintained between 40– 60. The anesthesiologist adjusted the depth of anesthesia in the non-BIS group according to clinical experience. Relevant information such as disease course, cause, anesthesia time, and operation time were collected. Preoperative CRS-R(preoperative) score, postoperative CRS-R(24h), and postoperative CRS-R(3m) changes were collected. Results: The CRS-R(3m) score in the BIS group was higher than that in the non-BIS group (preoperative), and the difference was statistically significant (P < 0.05). In CRS-R (24h), the BIS group was higher than the non-BIS group, and the difference was statistically significant (X2=8.787, P =0.004). The improvement of consciousness was included in the multivariate Logistic regression analysis model, and it was found that the thalamus was an independent factor affecting the improvement of consciousness (P < 0.05). During follow-up, 1 patient in the BIS group had a decrease in consciousness from MCS− to VS/ UWS and 2 patients in the non-BIS group died during follow-up. Conclusion: Patients can be benefit in hearing in CRS-R (24h). We recommend the use of BIS to monitor the depth of anesthesia in patients with DoC to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Objective To study the changes of pituitary-related hormones in patients with prolonged disorders of consciousness (pDOC) and its influence on the prognosis of patient in order to explore the risk factor of hormone levels with consciousness level and prognosis of patients. Methods The clinical data of 87 pDOC patients admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University and the Department of Neurosurgery of the Seventh Medical Center of Chinese PLA General Hospital from January 2018 to December 2020 were analyzed retrospectively. According to the improvement of patients' consciousness, they were divided into consciousness recovery group (n=39) and consciousness non-recovery group (n=48). The secretion levels of pituitary related hormones were measured in the 2 groups, including free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), growth hormone (GH) and cortisol and prolactin (PRL). According to Coma Recovery Scale-Revised (CSR-R) score, the patients were assigned into vegetative state VS group (n=61) and minimal consciousness state MCS group (n=26). The relationship between the changes of pituitary hormones and consciousness of pDOC patients was analyzed. According to the normal standard of hormone level, the patients were divided into normal hormone level group (n=25) and abnormal hormone level group (n=62). Univariate analysis and logistic regression model were used to explore the influencing factors (age, sex, cause of injury, course of disease, preoperative CRS-R score and injured location, etc.) of pDOC patients. Results Among the 87 pDOC patients, 62 (71.3%) had abnormal pituitary hormones, including 42 cases of single hormone abnormality (67.7%), and 20 cases of more than 2 changes (32.3%). The types and proportions of abnormal pituitary hormones were: GH 18 cases (29.0%), TSH and FT3/FT4 19 cases (30.6%), PRL 11 cases (17.7%), ACTH 8 cases (12.9%), and COR6 cases (9.7%). In the comparison of the differences of pituitary hormone levels between the VS group and MCS group, there were significant differences in GH, TSH, PRL and ACTH between the 2 groups (P < 0.01). Compared with the normal hormone level group, the abnormal hormone level group has an older onset age (P=0.001), a lower proportion of MCS patients (P=0.001), a lower CRS-R score (P < 0.001), a longer ICU stay (P < 0.001), and a higher proportion of paroxysmal sympathetic hyperexcitability syndrome (PSH). Multivariate analysis indicated that age (OR=1.316, P=0.006), CRS-R score (OR=0.200, P=0.037), ICU stay time (OR=3.991, P=0.040) and PSH symptoms (OR=11.874, P=0.040) were major influencing factors for abnormal hormone levels. Conclusion The pDOC patients have a high proportion of abnormal pituitary hormones, which is positively correlated with CRS-R score of patients' consciousness level. ICU stay time and PSH symptoms are risk factors of abnormal pituitary hormones.

Objective To assess the efficacy of long-lasting repeated high-definition transcranial direct current stimulation (HD-tDCS) over the precuneus on consciousness recovery in patients with minimally conscious state (MCS). Methods A prospective case-control study was carried out on 40 MCS patients admitted in the Fifth Affiliated Hospital of Zhengzhou University from June 2018 to January 2021. They were randomly divided into HD-tDCS group (n=20) and control group (n=20). The patients in the control group received routine treatment, while those in the HD-tDCS group were treated with HD-tDCS protocol over the precuneus (at 2 mA, for 20 min per time, twice per day for 14 d, with totally 28 sessions) on the basis of routine treatment. Gender, age, duration of consciousness, Coma Recovery Scale-Revised (CRS-R) scores before (T0), and at a single session (T1), 7 d (T2), and 14 d (T3) were recorded and analyzed. Results The CRS-R score at T3 was significantly higher in the HD-tDCS group than the control group (P < 0.05). In the control group, 2 MCS patients demonstrated a new sign of consciousness at T3, and the CRS-R scores at T1, T2 and T3 were not significantly changed than those at T0. While in the HD-tDCS group, 17 patients showed a new sign of consciousness, and the CRS-R scores at T1, T2, and T3 were obviously increased when compared with those at T0 (P < 0.05). And the scores of visual, auditory and motor subscales at T3 were also statistically elevated than the scores at baseline (P < 0.01). Conclusion Long-lasting repeated HD-tDCS over the precuneus improves the recovery of consciousness in MCS patients at the 14th day of neuromodulation, especially in the visual, auditory and motor aspects of conscious behaviors.

Prolonged disorders of consciousness (pDOC) and its long rehabilitation process are difficult problems in clinical practice. This review mainly introduces the clinical characteristics of neurorehabilitation in patients with chronic disorders of consciousness, and summarizes the rehabilitation treatment techniques from the pathogenic pattern of pDOC, clinical manifestations, and particularity of consciousness recovery sequence, as well as common complications that may interfere with rehabilitation progress, and discusses the existing problems such as the formulation principles of rehabilitation programs, treatment intensity, and time arrangement

Background: The management of patients with disorders of consciousness (DOC) presents substantial challenges in clinical practice. Deep brain stimulation (DBS) has emerged as a potential therapeutic approach, but the lack of standardized regulatory parameters for DBS in DOC hinders definitive conclusions. Objective: This comprehensive review aims to provide a detailed summary of the current issues concerning patient selection, target setting, and modulation parameters in clinical studies investigating the application of DBS for DOC patients. Methods: A meticulous systematic analysis of the literatures was conducted, encompassing articles published from 1968 to April 2023, retrieved from reputable databases (PubMed, Embase, Medline, and Web of Science). Results: The systematic analysis of 21 eligible articles, involving 146 patients with DOC resulting from acquired brain injury or other disorders, revealed significant insights. The most frequently targeted regions were the Centromedian‐parafascicular complex (CM‐pf) nuclei and central thalamus (CT), both recognized for their role in regulating consciousness. However, other targets have also been explored in different studies. The stimulation frequency was predominantly set at 25 or 100 Hz, with pulse width of 120 μs, and voltages ranged from 0 to 4 V. These parameters were customized based on individual patient responses and evaluations. The overall clinical efficacy rate in all included studies was 39.7%, indicating a positive effect of DBS in a subset of DOC patients. Nonetheless, the assessment methods, follow‐up durations, and outcome measures varied across studies, potentially contributing to the variability in reported efficacy rates. Conclusion: Despite the challenges arising from the lack of standardized parameters, DBS shows promising potential as a therapeutic option for patients with DOC. However, there still remains the need for standardized protocols and assessment methods, which are crucial to deepen the understanding and optimizing the therapeutic potential of DBS in this specific patient population. [ABSTRACT FROM AUTHOR]

Background: Accurately diagnosing patients with the vegetative state (VS) and the minimally conscious state (MCS) reached a misdiagnosis of approximately 40%. Methods: A method combined microstate and dynamic functional connectivity (dFC) to study the spatiotemporal variability of the brain in disorders of consciousness (DOC) patients was proposed. Resting‐state EEG data were obtained from 16 patients with MCS and 16 patients with VS. Mutual information (MI) was used to assess the EEG connectivity in each microstate. MI‐based features with statistical differences were selected as the total feature subset (TFS), then the TFS was utilized to feature selection and fed into the classifier, obtaining the optimal feature subsets (OFS) in each microstate. Subsequently, an OFS‐based MI functional connectivity network (MIFCN) was constructed in the cortex. Results: The group‐average MI connectivity matrix focused on all channels revealed that all five microstates exhibited stronger information interaction in the MCS when comparing with the VS. While OFS‐based MIFCN, which only focused on a few channels, revealed greater MI flow in VS patients than in MCS patients under microstates A, B, C, and E, except for microstate D. Additionally, the average classification accuracy of OFS in the five microstates was 96.2%. Conclusion: Constructing features based on microstates to distinguish between two categories of DOC patients had effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the prognostic effect of electroencephalography (EEG) instant effects of single spinal cord stimulation (SCS) on clinical outcome in disorders of consciousness (DOC) and the time‐dependent brain response during the recovery of consciousness prompted by SCS. Methods: Twenty three patients with DOC underwent short‐term SCS (stSCS) implantation operation. Then, all patients received the postoperative EEG test including EEG record before (T1) and after (T2) single SCS session. Subsequently, 2 weeks stSCS treatment was performed and revised coma recovery scale (CRS‐R) and EEG data were collected. Finally, they were classified into effective and ineffective groups at 3‐month follow‐up (T6). Results: The parietal‐occipital (PO) connectivity and clustering coefficients (CC) in the beta band of the effective group at the 1 week after the treatment (T5) were found to be higher than preoperative assessment (T0). Correlation analysis showed that the change in beta CC at T1/T2 was correlated with the change in CRS‐R at T0/T6. In addition, the change in PO connectivity and CC in the beta at T0/T5 were also correlated with the change in CRS‐R at T0/T5. Conclusion: SCS may facilitate the recovery of consciousness by enhancing local information interaction in posterior brain regions. And the recovery can be predicted by beta CC in the EEG test. [ABSTRACT FROM AUTHOR]