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)  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 . 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, enhanceβ-EP level of migraine patient, adjust CCK8 level of Parkinson’s disease patient  , 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  , 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. [Reference Documents]  Zhu Yonglian. Neurology (No. 21), Neurological Rehabilitation. Beijing: The People’s Army Medical Publishing House, 2001, 493-500.  Xiao Xuechang, Zhe Xiaofan. Effects and Clinical New Development of Low Power Laser on Nerve Endocrine Immune (NEI). 2002,24(1): 46-48. Li Qingmei, Guo Kun, Kang Jingqiong etc. Study of EP before and after Low Power Laser Irradiation in Nasal Cavity in Treatment of Head and Face Ache. China Neurology Magazine, 1998, 31(2): 91. Li Qingmei, Guo Kun, Kang Jingqiong etc. Effect of Low Power Laser Irradiation In Nasal Cavity to CCK-8 contents in plasma of Parkinson’s disease patient. China Neurology Magazine, 1999, 32(6): 364. Cheng Baihua. Function and Mechanism of “Optical Acupuncture”. Shanghai Acupuncture Magazine, 1999, 18 (6): 34-36. 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