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Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness

BACKGROUND AND PURPOSE: Spinal cord stimulation (SCS) has been reported to be a promising neuromodulation method for patients with disorders of consciousness (DOC). Our previous studies found that clinical characteristics of patients and SCS stimulation parameters could affect the therapeutic effect...

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Autores principales: He, Qiheng, Han, Bin, Xia, Xiaoyu, Dang, Yuanyuan, Chen, Xueling, He, Jianghong, Yang, Yi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289267/
https://www.ncbi.nlm.nih.gov/pubmed/35860489
http://dx.doi.org/10.3389/fneur.2022.947464
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author He, Qiheng
Han, Bin
Xia, Xiaoyu
Dang, Yuanyuan
Chen, Xueling
He, Jianghong
Yang, Yi
author_facet He, Qiheng
Han, Bin
Xia, Xiaoyu
Dang, Yuanyuan
Chen, Xueling
He, Jianghong
Yang, Yi
author_sort He, Qiheng
collection PubMed
description BACKGROUND AND PURPOSE: Spinal cord stimulation (SCS) has been reported to be a promising neuromodulation method for patients with disorders of consciousness (DOC). Our previous studies found that clinical characteristics of patients and SCS stimulation parameters could affect the therapeutic effects of SCS, while surgical-related factors remain unknown. Through the improvement of surgical procedures, most of the SCS electrodes are implanted in the middle, while a small number of electrodes have still deviated. METHODS: A total of 137 patients received SCS treatment in our institutions from 1 January 2010 to 31 December 2020. Among them, 27 patients were found with electrode deviation and met the inclusion criteria. Patients were grouped according to whether the electrode deviation angle (EDA) is >30°, respectively. Clinical characteristics of patients and SCS stimulation parameters were compared. Potential related factors and outcomes were evaluated by Chi-square test or two-way repeated measures analysis. RESULTS: Twenty seven patients receiving cervical SCS treatment were found to have electrode deviation postoperatively. Among them, 12 patients were classified into the more deviation group. No significant difference was found among age, sex, pathogeny, course of DOC, C2–C5 distance, spinal cord to spinal canal ratio at C2 level, and preoperative JFK Coma Recovery Scale-Revised (CRS-R) scores. We found that the electrode direction significantly deviated to the contralateral side in the lateral decubitus position (P = 0.025). The maximum tolerant stimulation intensity in the less deviation group (1.70 ± 0.41) was significantly higher than that in the more deviation group (1.25 ± 0.34) (P = 0.006). Under the strongest stimulation, less unilateral limb tremor (P = 0.049) and paroxysmal sympathetic hyperactivity (PSH) episodes (P = 0.030) were found. EDA had a significant effect on postoperative CRS-R in patients, and patients in the less deviation group had significantly higher postoperative CRS-R (P < 0.01). There was also an interaction effect between EDA and postoperative time. With the prolonged postoperative time, the CRS-R improvement rate of patients with different EDA was different, and the CRS-R improved faster in patients with less EDA (P < 0.05). CONCLUSIONS: Electrode deviation will affect the outcome of patients receiving cervical SCS treatment. The intraoperative surgical position is associated with postoperative electrode deviation direction. The reduction of EDA under 30° can increase maximum tolerant stimulation intensity, reduce complications, and further improve patients' outcomes.
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spelling pubmed-92892672022-07-19 Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness He, Qiheng Han, Bin Xia, Xiaoyu Dang, Yuanyuan Chen, Xueling He, Jianghong Yang, Yi Front Neurol Neurology BACKGROUND AND PURPOSE: Spinal cord stimulation (SCS) has been reported to be a promising neuromodulation method for patients with disorders of consciousness (DOC). Our previous studies found that clinical characteristics of patients and SCS stimulation parameters could affect the therapeutic effects of SCS, while surgical-related factors remain unknown. Through the improvement of surgical procedures, most of the SCS electrodes are implanted in the middle, while a small number of electrodes have still deviated. METHODS: A total of 137 patients received SCS treatment in our institutions from 1 January 2010 to 31 December 2020. Among them, 27 patients were found with electrode deviation and met the inclusion criteria. Patients were grouped according to whether the electrode deviation angle (EDA) is >30°, respectively. Clinical characteristics of patients and SCS stimulation parameters were compared. Potential related factors and outcomes were evaluated by Chi-square test or two-way repeated measures analysis. RESULTS: Twenty seven patients receiving cervical SCS treatment were found to have electrode deviation postoperatively. Among them, 12 patients were classified into the more deviation group. No significant difference was found among age, sex, pathogeny, course of DOC, C2–C5 distance, spinal cord to spinal canal ratio at C2 level, and preoperative JFK Coma Recovery Scale-Revised (CRS-R) scores. We found that the electrode direction significantly deviated to the contralateral side in the lateral decubitus position (P = 0.025). The maximum tolerant stimulation intensity in the less deviation group (1.70 ± 0.41) was significantly higher than that in the more deviation group (1.25 ± 0.34) (P = 0.006). Under the strongest stimulation, less unilateral limb tremor (P = 0.049) and paroxysmal sympathetic hyperactivity (PSH) episodes (P = 0.030) were found. EDA had a significant effect on postoperative CRS-R in patients, and patients in the less deviation group had significantly higher postoperative CRS-R (P < 0.01). There was also an interaction effect between EDA and postoperative time. With the prolonged postoperative time, the CRS-R improvement rate of patients with different EDA was different, and the CRS-R improved faster in patients with less EDA (P < 0.05). CONCLUSIONS: Electrode deviation will affect the outcome of patients receiving cervical SCS treatment. The intraoperative surgical position is associated with postoperative electrode deviation direction. The reduction of EDA under 30° can increase maximum tolerant stimulation intensity, reduce complications, and further improve patients' outcomes. Frontiers Media S.A. 2022-07-04 /pmc/articles/PMC9289267/ /pubmed/35860489 http://dx.doi.org/10.3389/fneur.2022.947464 Text en Copyright © 2022 He, Han, Xia, Dang, Chen, He and Yang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
He, Qiheng
Han, Bin
Xia, Xiaoyu
Dang, Yuanyuan
Chen, Xueling
He, Jianghong
Yang, Yi
Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness
title Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness
title_full Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness
title_fullStr Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness
title_full_unstemmed Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness
title_short Related Factors and Outcome of Spinal Cord Stimulation Electrode Deviation in Disorders of Consciousness
title_sort related factors and outcome of spinal cord stimulation electrode deviation in disorders of consciousness
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289267/
https://www.ncbi.nlm.nih.gov/pubmed/35860489
http://dx.doi.org/10.3389/fneur.2022.947464
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