What is the key to treating prolonged coma after craniocerebral injury

  After a cranial injury, most patients can recover and return to normal work and life, but there are a significant number of patients with serious injuries who will fall into a long-term coma, which is commonly referred to as a “vegetative state”. This state of prolonged coma indicates that brain function is severely impaired and requires long-term medical care and attention. The incidence of long-term coma after craniocerebral injury is not low, with about 10-25,000 adults and 0.4-10,000 children in the United States and a rough estimate of 50,000-70,000 in China. These patients only have basic physiological functions and sleep cycles, and communication with society and relatives is in a state of isolation. Behind each patient in a vegetative state, there is a family’s sorrow and sadness.  Brain resuscitation of vegetative patients is difficult. However, a large number of clinical observations prove that a significant proportion of patients in a vegetative state regain consciousness within one to two years after the onset of the disease. The recovery of vegetative patients is not only restricted by medical conditions, but also by the socio-cultural background and health and economic conditions. While European and American countries have a relatively conservative attitude toward the treatment of patients in long-term coma, relatives of patients in Asian countries with Eastern culture often have a more urgent and positive desire for treatment. At present, it is believed that within one year of traumatic brain injury and three months of ischemic-hypoxic encephalopathy there is a possibility of reawakening and there is a value of active treatment.  The key to the treatment of long-term coma after craniocerebral injury lies in the early interventional treatment of patients with severe injuries that may fall into long-term coma, just like the timely watering and irrigation of crops in a dry field, in order to bring them back to green and avoid the end of withering. However, these patients are mostly injured after receiving cranial surgery, early are in intensive care treatment stage, now the common application of domestic hyperbaric oxygen, Chinese medicine and other means of application is limited. Exploring simple and effective means to promote waking up from coma has become a hot spot for research at home and abroad. The Department of Neurosurgery of Renji Hospital, which is the supporting unit of Shanghai Institute of Craniocerebral Trauma, has introduced and implemented the right median nerve electrical stimulation for wakefulness treatment since 2005. It uses the principle of body surface electrical stimulation to apply weak low-frequency current stimulation to the distribution area of the median nerve on the right side of the patient’s wrist, and the electrical stimulation signal is transmitted to the spinal cord, brainstem and cortex through the neural pathway, which can stimulate the spontaneous secretion of neurotrophic substances and neurotransmitters in the brain, increase cerebral blood flow and promote the integration of the injured neural structures. The integration of the injured neural structures can achieve coma-rousing.  The results of several years of early coma intervention practice in the Department of Neurosurgery at Renji Hospital show that it is technically feasible to implement right median nerve electrical stimulation treatment for patients in coma early after injury (2 weeks), and this beeper-sized treatment device does not affect ICU treatment and operation in any way, and the operation is safe without causing other complications. The most gratifying thing is that the statistical analysis of a large number of cases shows that the percentage of patients who received right median nerve stimulation for wakefulness was much higher than that of patients who did not receive this treatment, while the percentage of patients who fell into a vegetative state was lower, which obviously proves the efficacy of this technology for the treatment of patients in coma with craniocerebral trauma.  At the International Neurotrauma Congress held in Budapest, Hungary in March this year, Prof. Jiang Jiyao and Associate Prof. Gao Guoyi of Shanghai Institute of Craniocerebral Trauma introduced the diagnosis of craniocerebral trauma coma and the clinical effect of right median nerve electrical stimulation treatment to the participants, which aroused wide interest of the participants. The applause on the beautiful Danube was the hope and blessing for the coma patients to regain consciousness soon. With the gradual promotion of this technology, it is believed that more patients in coma with cranio-cerebral injuries will benefit and wake up from the sleep of long-term coma to welcome the bright and brilliant new dawn of life.