Clinical Outcome After Epidural Spinal Cord Stimulation in Patients With Severe Traumatic Brain Injury

Cureus, 2024 · DOI: 10.7759/cureus.65753 · Published: July 30, 2024

Simple Explanation

This study explores the use of epidural spinal cord stimulation (ESCS) to help patients with severe traumatic brain injuries (sTBI) who experience spasticity and altered consciousness. The procedure involves implanting an electrode in the spinal cord to deliver electrical stimulation, which can potentially reduce muscle stiffness and improve brain activity. The researchers found that ESCS reduced spasticity in many patients and improved movement and consciousness in some, suggesting it could be a useful rehabilitation tool.

Study Duration

Between 2021 and 2023

Participants

34 patients with central paresis, severe hypertonia, and chronically altered consciousness following sTBI

Evidence Level

Not specified

Key Findings

1
Epidural spinal cord stimulation was administered for an average of 4 ± 1.5 days.
2
A reduction in spasticity with clinical improvement was observed in 21 patients (61.8%).
3
Active movements in paretic limbs increased or appeared in 12 patients (35.3%), while a heightened level of consciousness was observed in six patients (17.6%).

Research Summary

This study evaluated epidural spinal cord stimulation (ESCS) in 34 patients with severe traumatic brain injury (sTBI) experiencing spasticity and chronic disorders of consciousness. The results showed a significant reduction in spasticity in over half of the patients, with improvements noted in both upper and lower extremities. Additionally, some patients experienced increased active movements and heightened levels of consciousness, suggesting ESCS as a promising rehabilitation method.

Practical Implications

Rehabilitation Strategy

ESCS can be considered as a potential rehabilitation method for patients with sTBI sequelae to reduce spastic syndrome and increase active movements.

Upper Extremity Focus

Neuromodulation at the cervical level may have pronounced effects on the upper extremities, making it a valuable approach for improving motor function in these limbs.

Further Research

The promising findings regarding consciousness level improvement warrant further validation through randomized trials to confirm the effects and understand the mechanisms.

Study Limitations

1
The study included a relatively small cohort of 34 patients, which limits the generalizability of the findings.
2
Longer follow-up periods are essential to assess the long-term efficacy and safety of epidural spinal cord stimulation in these patients.
3
The study design did not include randomized controlled trials (RCTs), which are considered the gold standard for determining the efficacy of a treatment.

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