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Therapeutic Value of Semiconductor Laser Irradiation in Nasal Cavity to
Persistent Vegetative State: one case report
Xiao Xuechang, Chu Xiaofan, Guo Yidong Jiazheng, Su Xiaolin,Zhou Cixiong,, Suo Ping,
Department of neurology Shenzhen People’s Hospital (Shenzhen 518020)
[Abstract] Objective To explore the therapeutic value of low power semiconductor laser
irradiation in nasal cavity to persistent vegetative state (PVS). Method One severely brain
injured patient being in persistent coma for 260 days had been undertaken low power
semiconductor laser irradiation in nasal cavity. With the laser wavelength was 650nm, the
power 4.0mW, 60 minutes every time. 1 or 2 times a day. The irradiation has been given 50
times to this patient. Before and after the 50 times procedure, brain SPECT blood infusion
images were taken and the remission of consciousness has been observed. Results Before the
procedure, brain SPECT revealed severe ischemia in right frontal lobe, parental lobe,
temporal cortex and thalamus and basal ganglions, with seriously damaged cerebral function
disorder. After the procedure, the ischemia had been alleviated in some areas mentioned
above. And the patient became conscious on the 380th day after the injury, with GCS being
improved from 7 to 12. Conclusion Low power laser irradiation in nasal cavity may improve
brain blood infusion, activate cerebral function and this may arouse the patients with
persistent vegetative state.
[Key words] Low power lasers; Vegetative state; Single photon emission computer
tomography
Treatment on Persistent Vegetative State (PVS) is presently a hard problem in neurological
rehabilitation field. There are many trial treatment for PVS, but due to complicated
mechanism change of PVS, no exact and effective method has been found up to now.
Recently, we tried Low Power Semiconductor Laser Irradiation in nasal cavity. (LINC) to
treat a severe brain injured patient being in PVS, and unexpected effect achieved, the report is
as follows:
1.
Case and Method
1.1 Clinical literature A 22-year-old girl named Zhan, a student of Southwest Politics & Law
College. Charge No.263974, CT No. 58933. In Aug 23rd , 2001, she was suffered from brain
trauma and unconsciousness due to traffic accident, upon which she was sent to Shenzhen
People’s Hospital. CT examination demonstrated hematoma below hard membrane of right
forehead temporal. 2 days after hematoma clearance, hematoma below hard membrane appear
again in the former hematoma part. After 2nd operation, brain CT exam showed
hydrocephalus, then conducted operation of hydrocephalus ventricule-abdominal cavity
separation, following hemostat, anti-inflammation and brain protection treatment. On Oct
25th, 2001, referred to brain surgery of Shenzhen People’s Hospital with following state:
persistent coma, operation cut in right forehead temporal, no voluntary movement, stable life
sign, active limbs sinew reflex. Coma GCS remark 6, and carry out hyperbaric oxygenation
treatment. Conduct mending on damaged skull of right forehead temporal on Dec 19th , 2001.
On April 25th, 2002, the patient was transferred to Neurology for rehabilitation treatment. It
can be seen as follows: obnubilation with coma, cornea reflex, eyelash sign (+), circle, focus
reflex, double upper extremities is of IIII grade and double lower extremities of II grade.
Muscular tension increased, sinew reflex hyperfunction, right lower extremity Babinski sign
(±), electroencephalogram demonstrated that two sides is not symmetrical, left side is
99.5c/s1030mVα, low amplitudeβand occasionally θwave act,; for right side,
10c/s35mVα,more θwave and more 1530c/s510mVβact; visual response and over aeration is
of no use. All means abnormal electroencephalogram.
Clinical Evaluation for transferring state: Coma GCS Table grades 7; Rancho Los Amigos,
RLA) [1] Evaluate as II grade; Brain SPECT revealed (on Apr 29) severe ischemia in right
frontal lobe, parental lobe, temporal cortex and thalamus and basal ganglions, with seriously
damaged cerebral function disorder. Semiconductor laser irradiation in nasal cavity, power
4.0mW, instant effect (examine after 30mins): blood supply recovered in right frontal lobe,
parental lobe, temporal cortex and thalamus and basal ganglions; Induced potential
evaluation: NCV examination revealed severe damage in double side calf nerves and left shin
nervous movement transmission function; Left calf intestines nerves transmission function;
BAEP exam showed lightly damage in hearing transmission left side to brain stem, abnormal
right side function; Diagnosis: Persistent Vegetative State after operation on severe brain
trauma.
1.2 Rehabilitation Therapy Drug: cytidine diphosphate choline，cerebral polypeptide
etc.
Physiotherapy: hyperbaric oxygenation therapy for 5 courses (total 50 times) during
hospitalization. After Low Power Laser Intra-vascular Irradiation 3.0mW×60mins×10times,
and change to Nasal Cavity Irradiation 4.0mW×60mins×40times. Needle: Si Shencong.
Motion Therapy: Anti-spasm, dredge nerves.
2.
Result
After above therapy for 55 days, the ill state improved, coma GCS remark 9, the patient left
hospital for hard economy on June 20th , 2002, with still low coma, SPECT demonstrated:
compared with that of Apr 29, above severe ischemia in brain is partly improved. After
hospitalization, conduct semiconductor laser nasal cavity irradiation, power 4.0mW, 60mins
each time, 1~2 times a day. Following information by phone on Sep 20th, 2002 is that the
patient has become conscious with recognition. On Oct 4th , we visited the patient, the
neurological examination showed: consciousness, understanding, unclear phonation,
emotional reaction(recognize family member, show nervous when many people is around,
require relative accompany) , still urinary incontinence.; upper extremities is IV grade of near
tip and III grade of far tip, part separate movement, lower extremities is III grade of near tip
and I grads of far tip, part separate movement, but muscular tension enhanced, hyperfunction
of double knees reflex, right lower extremity ankle clonus is positive, right lower extremity
Babinsk Sign (±). GCS grades 12, RLA recognition grades IV-V.
3. Discussion
This case of severe injured brain following persistent moderate coma has lasted over 6
months, no voluntary movement, life sign is stable, urinary incontinence, GCS remark 7,
which comply with National Relative PVS Diagnose Standard [1]. Treatment on Persistent
Vegetative State is a presently a hard problem in rehabilitation field. Present treatment
includes drug, hyperbaric oxygenation and stimulation of voice, light and electronics. Drug
includes DA such as TRH. The drug mainly act to strengthen conscious system. PVS
hyperbaric oxygenation is a valid and recognized method, but accumulative treatment of 100
even 200 times is needed. In 1993, it is reported in Guangdong Police Hospital that a patient
with coma caused by brain trauma for 130 days, become conscious after Low Power He-Ne
Laser Intra-vascular Irradiation. In recent 10 years, Basic study on Low Power Laser Therapy
mechanism has developed greatly. Study showed: Low Power Laser can adjust inequilibrium
state of Nerve-Endocrine-Immune Net[2], enhanceβ-EP level of migraine patient[3], adjust
CCK8 level of Parkinson’s disease patient [4] , adjust L-ENK level, adjust Single Amine
neurotransmitter level in brain tissue of mouse, improve brain blood perfusion of cerebral
infarction patient, activate brain cells function [5] , low power He-Ne Laser irradiation in nasal
cavity can affect electroencephalogram activity of rabbit. It is inferred from the above
mechanism that it probably has the function of consciousness. 4 operations has been carried
out on the PVS patients. During hospitalization, in first 8 months, 50 times hyperbaric
oxygenation therapy on the basis of drug and stop drug due to hard economy, with only 100
times LINC therapy, become conscious after 380-day persistent coma due to severe injured
brain, LINC is considered to activate for consciousness. Because ILNC is of no any cut,
safety and without any side effect, as well as simple operation, it is repeatable, especially for
long-term use for patient with vegetative state.
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