Reviving consciousness: The impact of short-term spinal cord stimulation on patients with early-onset prolonged disorders of consciousness

Introduction

Managing prolonged disorders of consciousness (pDoC) presents a significant clinical challenge despite numerous available therapies. While short-term spinal cord stimulation (st-SCS) for over 3 months has been recognized as an effective treatment for pDoC, its efficacy within the first 3 months remains unclear. This study explores st-SCS's impact on patients with pDoC for less than 3 months.

Material and methods

We enrolled 141 pDoC patients within 3 months of onset; 104 received st-SCS, and 37 underwent conservative treatment. Consciousness levels were assessed using the Coma Recovery Scale-Revised (CRS-R) before treatment, 2 weeks after, and at 3-month follow-up.

Results

Comparing the data from the 3-month follow-up, we found that, the st-SCS group showed significantly greater improvement in CRS-R scores compared to the control group (p < 0.01), with more patients showing symptom amelioration (51/104 (49%)). Further analysis of the st-SCS treatment group showed significant improvement in CRS-R scores after 2 weeks (T1) and at the 3-month follow-up (T2) compared to baseline (T0). Both consciousness levels and specific CRS-R items improved notably post-treatment. Younger patients (<40 years) with traumatic brain injury and higher initial CRS-R scores were more likely to experience positive outcomes. Additionally, multivariate logistic regression identified etiology, time since injury, and initial CRS-R score as significant predictors of the 3-month outcome (p < 0.05).

Conclusions

st-SCS is an effective treatment for pDoC within 3 months of onset, particularly for younger patients and those with trauma-induced conditions, significantly improving consciousness and outcomes.