Gender differences in adult traumatic brain injury according to the Glasgow coma scale:A multicenter descriptive study

Purpose:Patients’gender,which can be one of the most important determinants of traumatic brain injury(TBI)outcomes,is also likely to interact with many other outcome variables of TBI.This multicenter descriptive study investigated gender differences in epidemiological,clinical,treatment,mortality,and variable characteristics in adult TBI patients.Methods:The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1,2016 and December 31,2018.A total of 4468 adult TBI patients were enrolled at eight University Hospitals.Based on the list of enrolled patients,the medical records of the patients were reviewed and they were registered online at each hospital.The registered patients were classified into three groups according to the Glasgow coma scale(GCS)score:mild(13-15),moderate(9-12),and severe(3-8),and the differences between men and women in each group were investigated.The risk factors of moderated and severe TBI compared to mild TBI were also investigated.Results:The study included 3075 men and 1393 women and the proportion of total males was 68.8%.Among all the TBI patients,there were significant differences between men and women in age,past history,and GCS score.While the mild and severe TBI groups showed significant differences in age,past history,and clinical symptoms,the moderate TBI group showed significant differences in age,past history,cause of justice,and diagnosis.Conclusion:To the best of our knowledge,this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea.This study shows significant differences between men and women in many aspects of adult TBI.Therefore,gender differences should be strongly considered in TBI studies.

Long-term results of a simultaneous trial of deep brain and motor cortex stimulation in refractory neuropathic pain

Objective: Although deep brain stimulation(DBS) and motor cortex stimulation(MCS)are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods: To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis(Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results: Of the 11 patients implanted with both DBS and MCS electrodes, nine(81.8%)had successful trials. Seven of these nine patients(77.8%) responded to MCS, and two(18.2%) responded to Vc DBS. With long-term follow-up(56 ± 27.5 months), the mean numerical rating scale decreased significantly(P < 0.05). The degree of percentage pain relief in the chronic MCS(n = 7) and chronic DBS(n = 2) groups were 34.1% ± 18.2%and 37.5%, respectively, and there was no significant difference(P = 0.807). Five out of the seven MCS patients(71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions: With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.