This study is a prospective multicenter randomized controlled trial from Asian countries to compare the effect and safety of right median nerve stimulation versus traditional treatment for comatose patients at the early stage following traumatic brain injury.
Traumatic brain injury (TBI) is a leading cause of mortality and morbidity and one of the greatest unmet needs in public health. The most severe injury can lead to a poor outcome and prolonged coma of the victims. It is estimated that ten to fifteen percent of the severe TBI patients are discharged in a prolonged coma or a vegetative state. However, no treatment measure to data has been proven robustly to alter the pace of recovery or improve neurological outcome of the comatose patients following TBI. Although right median nerve electrical stimulation (RMNS) has been used clinically for more than two decades, no strong evidence of efficacy was generated because of the limitations in the past trials including a small sample size or the inappropriate study design. In the present study, a multicenter research network with inclusion of neurotrauma centers from China, India, Nepal and Kazakhstan was established with the aim to validate the efficacy and safety of a promising intervention strategy for traumatic coma at early stage. Since RMNS is a simple, inexpensive, noninvasive technique with a good safety profile, our study will probably add more evidence to the treatment of traumatic coma in Asian countries.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
360
Right median nerve electrical stimulation (RMNS) is administered via a pair of lubricated one-inch square rubber surface electrodes pasted on the volar aspect of the right distal forearm over the median nerve. An electrical neuromuscular stimulator supplied trains of asymmetric biphasic pluses at an amplitude of 20 milliamps with a pulse width of 300 microseconds at 40 Hz for 20 sec/min. The RMNS treatment continues 8 hours per day for two weeks.
Proportion of patients returning consciousness
The term "consciousness" is defined when the patient shows objective ability to respond to verbal commands.
Time frame: Within six months after injury
Duration of unconsciousness
This outcome is defined as the time between trauma and objective recovery of the ability to respond to verbal commands
Time frame: Within six months after injury
Adverse events
The potential adverse events include but not limited to seizures, intracranial bleeding, increased sympathetic activity and so on.
Time frame: Within six months post injury
Glasgow Coma Scale (GCS)
Time frame: 28 days post injury
Coma Recovery Scale-Revised (CRS-R)
Time frame: six months post injury
Disability Rating Scale (DRS)
Time frame: six months post injury
Full Outline of UnResponsiveness scale(FOUR)
Time frame: 28 days post injury
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