Nutrition as Modulator of Oxidative Stress in Cancer Prevention and Treatment.

Disorders of consciousness (DoC) are characterized by impaired arousal and awareness following severe brain injury (). Spasticity is a frequent complication in DoC, affecting approximately 59%–89% of patients (; ; ). It mainly results from an exaggerated stretch reflex driven by a fundamental imbalance between spinal excitability and its supraspinal regulation (). Owing to severe and widespread brain damage, patients with DoC exhibit atypical clinical patterns and generally develop more severe spasticity than individuals with isolated stroke or spinal cord injury (). Moreover, the inability of DoC patients to perceive or communicate spasticity-related pain further aggravates muscle hypertonia, creating a self-perpetuating vicious cycle (). Spinal cord stimulation (SCS) has shown partial efficacy in treating DoC and spasticity independently (; ; ; ; ; ; ). However, the technical implementation of SCS differs between these two indications. In patients with DoC, high cervical stimulation has been used to engage arousal related ascending pathways, and short term SCS protocols have increasingly adopted percutaneous multi-contact cylindrical leads to reduce procedural invasiveness in this medically fragile population (; ). By contrast, spasticity oriented SCS places greater emphasis on stable, segment specific recruitment of spinal sensorimotor circuits, because stimulation effects are strongly influenced by electrode location, contact configuration, and targeted spinal roots (; ). Nevertheless, systematic investigations into SCS for patients with DoC complicated by spasticity remained limited and are largely confined to the work of Mayorova and colleagues, which focused predominantly on hypothesizing the therapeutic mechanisms of SCS in this clinical context (, ; ; ). These studies were methodologically constrained, characterized by insufficient clinical description and reproducible protocols. We conducted a series of observations and investigations in a patient with severe traumatic brain injury (TBI) who presented with DoC complicated with limb spasticity and underwent implantation of SCS. We reported detailed procedures encompassing electrode implantation, stimulation frequency screening, quantitative assessments, and longitudinal follow-up. The aim was to characterize the coupled changes in spasticity and arousal-related measures following SCS and provide novel insights into the clinical management of this patient population. This case report has been reported in line with the SCARE checklist ().