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Characterization and Modification of Brain Activity with Deep Brain Stimulation in Patients in a Persistent Vegetative State: Pain‐Related Late Positive Component of Cerebral Evoked Potential
Author(s) -
KATAYAMA YOICHI,
TSUBOKAWA TAKASHI,
YAMAMOTO TAKAMITSU,
HIRAYAMA TERUYASU,
MIYAZAKI SHUHEI,
KOYAMA SEIGOU
Publication year - 1991
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1991.tb04055.x
Subject(s) - reticular formation , medicine , stimulation , deep brain stimulation , reticular activating system , depression (economics) , chronic pain , anesthesia , thalamic stimulator , thalamus , central pain , neuroscience , physical therapy , psychology , disease , radiology , parkinson's disease , economics , macroeconomics
A series of eight patients in a persistent vegetative state (PVS) were subjected to chronic deep brain stimulation (DBS) for the purpose of promoting recovery from the PVS. The characteristics of the brain activity in these patients were evaluated from the late positive component of the cerebral evoked potential in response to painful stimuli (pain‐related P 250 ). While any neurological scoring system for the comatose state includes evaluations of motor reactions to painful stimuli, the pain‐related P 250 is unique in terms of its ability to assess the cortical responsiveness to painful stimuli directly and quantitatively without involving functions of the motor system. It was found that the pain‐related P 250 was more or less depressed in patients in a PVS. It was repeatedly demonstrated in four patients, however, that the pain‐related P 250 could be transiently increased by preceding stimulation of the mesencephalic reticular formation. Furthermore, a persistent increase in the pain‐related P 250 was produced in these four patients following chronic DBS of the mesencephalic reticular formation or nonspecific thalamic nuclei for more than 6 months, and this was correlated with the clinical improvements. These results imply that responsiveness at the cortical level to pain is depressed in the PVS. It also appears that some fraction of the depression may, however, be functionally produced and potentially reversible.