Spinal cord stimulation for concurrent improvement of consciousness and spasticity following severe traumatic brain...

Spasticity frequently complicates disorders of consciousness (DoC) after severe brain injury, yet effective treatments addressing both conditions remain limited. Spinal cord stimulation (SCS) has shown promise in treating each condition independently, but its application in patients with concurrent DoC and spasticity has rarely been systematically investigated.

We report a 30-year-old man with prolonged DoC and severe limb spasticity following traumatic brain injury who underwent dual-level percutaneous SCS lead implantation. Frequency screening was performed to identify optimal stimulation parameters, followed by 21 days of continuous stimulation. Assessments included the Coma Recovery Scale-Revised (CRS-R), Modified Ashworth Scale (MAS), Hip Adductor Tone Scale (HATS), surface electromyography (sEMG), electroencephalography (EEG), and transcranial magnetic stimulation (TMS).

Frequency screening identified 80 Hz as the optimal parameter for spasticity reduction. After 21 days of stimulation, the CRS-R score increased from 5 to 10, MAS improved from 3-4 to 1-1+ , and HATS decreased from 3 to 1. sEMG showed reduced muscle activity and spectral shifts consistent with decreased spasticity. EEG demonstrated enhanced frontotemporal functional connectivity and increased spectral power. TMS motor evoked potential latency was significantly shortened. Clinical improvements were sustained at the 6-month follow-up.

This case suggests that 80 Hz SCS may be associated with concurrent improvement in consciousness and spasticity in patients with DoC following severe brain injury, accompanied by electrophysiological correlates of altered neural connectivity and corticospinal function.