Effect Of Electrical Stimulation Of Auricular Vagus Nerve On Chronic Consciousness Disorder In Patients With Traumatic Brain Injury

Objective(s):1.To prospectively study the awakening-promoting effect of auricular vagus nerve electrical stimulation(taVNS)on patients with chronic consciousness disorder after traumatic brain injury(TBI);2.The modified Coma Recovery Scale(CRS-R)and Total Non-responsiveness(FOUR)scale were used to evaluate the efficacy of taVNS in the treatment of chronic consciousness disorder after TBI,combined with diffusion tensor imaging(DTI)and magnetic resonance spectroscopy(MRS)in neuroimaging,so as to provide imaging basis for its clinical application.Methods:Sixty-four patients with chronic consciousness disorder after TBI who met the criteria were randomly assigned to taVNS intervention group(group T)and control group(group C),with 32 cases in each group.Subjects in both groups were given unified standard conventional wakefulness stimulating treatment,and group T was additionally given taVNS treatment on the basis of conventional wakefulness stimulating treatment for 4 weeks.The treatment parameters of taVNS were stimulation intensity of 6m A,stimulation time of 30min/ time,twice/day,each course of treatment for 10 days,four consecutive courses of treatment.The subjects in the two groups were scored on the modified Coma Recovery Scale(CRS-R),Glasgow Coma Scale(GCS)and Total non-responsiveness Scale(FOUR)before and after treatment,respectively.The CRS-R,GCS and FOUR scores were scored again after 2 and 4 weeks of taVNS intervention and 2 weeks after the intervention ended.DTI and MRS Were improved before intervention and 4 weeks after intervention.Imaging data were collected to analyze and compare the changes of white matter and the values of brain metabolites N-acetylaspartic acid(NAA)and creatine(Cr)in the two groups.FA value,NAA,Cr and NAA/Cr ratio were used as comparison indexes.Neuroimaging evidence was used to support the effectiveness of taVNS in the treatment of chronic disorders of consciousness.Using SPSS23.0 software is analyzed,the measurement data accord with normal distribution,with mean±standard deviation((?)±S)said,than using t test between groups;For those that do not conform to normal distribution,non-parametric test is adopted.Pearson correlation analysis was used to analyze the correlation among factors,and P < 0.05 indicated that the difference was statistically significant.Results:1.A total of 60 qualified subjects were enrolled,including 32 in group T and 28 in group C.There were no statistically significant differences in age,gender,age,whether there was surgical intervention,and GCS score before intervention between the two groups(P > 0.05).2.The CRS-R score,FOUR score and GCS score of the two groups had no statistical significance before treatment(P > 0.05),but the CRS-R score,FOUR score and GCS score of the two groups were significantly increased after treatment,with statistical significance(P < 0.05).3.In terms of neuroimaging,FA value in T group was significantly increased after intervention,and brain metabolites NAA,Cr and NAA/Cr ratio were significantly increased,with statistical significance(P <0.05).4.Pearson correlation analysis was conducted between functional brain FA values and CRS-R scores in the two groups,and the results showed that FA values in the prefrontal cortex,the knee of the corpus callosum and the posterior limb of the right internal capsule were significantly correlated with CRS-R scores.Conclusion(s):1.Conventional wake-promoting therapy and taVNS combined with conventional wake-promoting therapy can both improve the degree of disturbance of consciousness in TBI patients,but the degree of improvement is different.2.taVNS combined with conventional wake-up therapy can better improve the consciousness level and accelerate the awakening process of patients with chronic disorders of consciousness after TBI than conventional wake-up therapy.3.The mechanism of taVNS in the treatment of disturbance of consciousness in patients with traumatic brain injury may be achieved by improving the metabolism of brain functional areas such as prefrontal cortex,corpus callosum,and right posterior limb of the internal capsule.