Effect of hyperbaric oxygen combined with repetitive transcranial magnetic stimulation in the treatment of coma following craniocerebral trauma

Abstract

Objective To study the therapeutic effect of hyperbaric oxygen (HBO) combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of coma following craniocerebral trauma. Methods One hundred and twenty coma patients caused by craniocerebral trauma were randomly selected for the study. Those patients without treatment or without rTMS were assigned as the control groups, and the group with Glasgow coma scale (GCS) scores of 6-8 was further assigned as the CA group, and the group with GCS scores of 3-5 was assigned as the CB group. In those patients who received HBO therapy, the ones with GCS scores of 6-8 were assigned as the HA group, and the ones with GCS scores of 3-5 were assigned as the HB group (conventional therapy group B). In those patients who received both HBO and rTMS therapy, the ones with GCS scores of 6-8 were assigned as the rTA group, while the ones with GCS scores of 3-5 were assigned as the rTB group. The patients of the 6 groups were given conventional therapy for the treatment of brain trauma, such as neural nutrition, anti-infection and maintenance of electrodes. The patients in the HA group and HB group were additionally treated with HBO, while the patients in the rTA and rTB groups were further treated with HBO and rTMS. The patients received HBO therapy at a pressure of 0.25 MPa, once a day, 10 days a treatment course, for a succession of 3 courses. The stimulation intensity of the rTMS treatment protocol was set at 0.72 T, with the frequency of the magnetic field being 0.5 HZ. The patients had 30 stimulations for every sequence, one sequence a day, 12 days a treatment course for a succession of 3 courses. Scores of Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) before and after treatment were assessed and statistically analyzed. Results After 3 successive treatment courses, the patients with GCS scores of 6-8 were further treated with HBO combined with rTMS in addition to conventional therapy. The GCS scores of the HBO+rTMS+conventional therapy group were as high as(11.15±4.17), which were higher than the scores of the HBO+conventional therapy group(9.05±3.12), which were also higher than the scores of the conventional therapy group(7.50±1.99). Statistical significance could be noted, when comparisons were made between the 3 groups(P<0.05). GOS scores of the HBO+rTMS+conventional therapy group(4.45±0.83)were higher than those of the conventional therapy group (3.90±0.55), with statistical significance (P<0.05). Conclusions The patients with GCS scores of 6-8 treated with HBO+rTMS+conventional therapy had better rehabilitation effect and prognosis, and therapeutic results were obviously superior to those of the patients treated with simple conventional therapy and HBO+conventional therapy. Key words: Craniocerebral trauma; Coma; Hyperbaric oxygen; Repetitive transcranial magnetic stimulation