Application of spinal cord electrical stimulation in coma facilitation

Coma as a state in which the patient has a complete loss of consciousness, no spontaneous eye opening, and cannot be awakened by any verbal or painful stimuli, is a serious emergency of consciousness disorder. In China, according to incomplete statistics, there are more than 100,000 patients in coma every year due to various reasons, and the annual incidence of patients in persistent vegetative state is 25/100,000, so the overall situation is not optimistic. Due to the special nature of coma, it brings huge economic pressure and heavy psychological burden to families and society. The early awakening of comatose patients has become a medical problem that needs to be solved, and the medical community is moving forward in the field of research. Research has confirmed that spinal cord stimulation (SpinalCordStimulation, or SCS) is a procedure in which an electrode is attached to the patient’s cervical epidural and a stimulator is buried under the skin for 12 hours a day to stimulate the patient with microcurrent. Spinal cord nerve stimulation can improve the clinical symptoms of the “vegetative state”, and the combination of spinal cord electrical stimulation with hyperbaric oxygen, acupuncture, and physical therapy has brought hope for some coma patients to wake up. What is spinal cord neurostimulator placement? Spinal cord electrical stimulation is a new technique in which electrodes are implanted in the patient’s spinal cord outside the dura mater to provide continuous electrical stimulation to the spinal cord nerves at a certain frequency and voltage. The electrodes are placed above the spinal cord through minimally invasive surgery to stimulate the spinal nerves with pulsed current to increase cerebral blood flow and cerebral metabolism, and also activate the brainstem reticular upstream system, which can improve cerebral circulation, narrow the ischemic foci, excite the cerebral cortex, and promote the patient’s mental clarity. Spinal cord electrical stimulation is performed by implanting electrodes in the epidural space of the high cervical medullary segment and distributing continuous electrical stimulation pulses to increase cerebral blood flow, regulate the levels of various neurotransmitters, activate the superior reticular activating system, regulate sympathetic parasympathetic nerves, increase the rate of glucose metabolism in brain tissue, improve neurophysiological indexes and other possible mechanisms to promote recovery of consciousness. The nerve impulses generated by SCS pass through all levels of conduction bundles, through the brainstem upward reticular activation system to the thalamus and the cerebral cortex. With the participation of sympathetic/parasympathetic nerves, it regulates the release of neurotransmitters, increases cerebral blood flow and intracerebral glucose metabolic rate through the synergistic effect of humoral regulation and self-regulation, improves the energy metabolism of hypoxic and ischemic brain tissues, and thus promotes the increase of consciousness level and the recovery of consciousness content. Patients suitable for spinal nerve stimulation placement are: 1. after severe craniocerebral trauma; 2. after massive cerebral infarction or cerebral hemorrhage; 3. ischemic-hypoxic encephalopathy; 4. carbon monoxide poisoning; 5. other causes of coma.