Advanced Treatment of Prolonged Coma: Selection of Candidates for Deep Brain Stimulation and Clinical Results
In an attempt to facilitate recovery from prolonged coma, deep brain stimulation has been applied to the pallidum, the ventroanterior thalamus, the midbrain reticular formation, and the thalamic intralaminar nucleus [1–4]. This approach is based on the anatomical and electrophysiological finding that brain arousal activity might be produced by stimulation of the ascending activating system [5,6]. Deep brain stimulation might also inhibit an active neural process within the brain stem that is involved in the production of coma . However clinical results of deep brain stimulation have been quite variable and long-term follow-up results have not yet been reported [1–4, 8].
KeywordsDeep Brain Stimulation Vegetative State Neurological Score Wave Versus Chronic Stimulation
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- 1.McLardy T, Ervin F, Sweet W (1968) Attempted inset-electrodes arousal from traumatic coma: Neuropathological findings. Trans Am Neurol Ass 93: 25–30Google Scholar
- 4.Katayama Y, Miyazaki S, Yamamoto T, Maejima S, Tsubokawa T (1987) Chronic stimulation of the midbrain reticular formation in patients with traumatic prolonged coma. Oriental Medicine and the Pain Clinic 17: 67–71Google Scholar
- 5.Moruzzi G, Magoun HW (1963) Brain stem reticular formation and activation of the EEG. Electroencephalogr Clin Neurophysiol 139: 343–344Google Scholar
- 8.Katayama Y, Tsubokawa T, Yamamoto T, Maejima S (1987) Chronic stimulation of the midbrain reticular formation and thalamus in patients suffering from prolonged coma caused by diffuse brain injury. Neurotraumatology 10: 32Google Scholar
- 9.Yamamoto T, Katayama Y, Tsubokawa T, Maejima S. Yoshino A, Hiratama T (1988) Clinical indication of deep brain stimulation for comatose patients: Electrophysiological classification and long-term prognosis of persistent vegetative patients. Functional Neurosurgery 27: 153–159Google Scholar
- 11.Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T (1985) Chronic stimulation of deep brain structures for treatment of chronic pain. In: Tasker RR (ed) Neurosurgery (State of arts review) vol 2, stereotaxic surgery. Henley and Belfus, Philadelphia, pp 235–255Google Scholar