EEG Reflection of Clinical Effects Dynamics during Botulinum Toxin Therapy of Movement Disorders under Long-Term Consciousness Disorders

When studying the dynamics of brain electric activity (BEA) in the course of botulinum toxin (Incobotulinumtoxin A) injections into all hypertonic muscles of 16 patients suffering from post-coma longterm consciousness disorders, BEA changes were observed to start within the first minutes after the first intramuscular injection of botulinum toxin, while not being associated with any pain stimulus response. Despite the diversity of brain lesions in these patients, the dynamics of BEA reorganisation during botulinum toxin therapy showed the presence of pathological sensorimotor integration involving the whole brain in case of long-term consciousness disorders. In our opinion, it is expressed in a pathological state developing in the brain, which affects the polyfunctional capabilities of neurons. This state is unbalanced due to destabilizing effect at the beginning of the reduction by pathological hyperafferentation from muscles and, in principle, can be disrupted at a complete reduction. It is, however, maintained by memory matrix, which manifests itself in the shape of oscillation process during its disruption when the newly build-up BEA is occasionally displaced by the previous one. During the reduction of sensory hyperafferentation, BEA reorganisation initially involved the motor cortex (in 15 out of 16 patients) and then spread to other brain areas, including those responsible for the higher mental functions, vision, and hearing. The first transiently decreased muscle tone (in all patients) and improvement of neurological signs of awareness (in some patients) were observed immediately after injecting all hypertonic muscles with widespread BEA changes. The appearance of high-frequency EEG activity in the frontal areas was considered as a universal marker of an improved functional state of the brain during the disruption of pathological sensorimotor integration even before clinical signs, suggesting neuronal readiness to maintain various activities. In view of data obtained, the first-stage clinical measures in patients with disorders of consciousness should focus on disrupting pathological sensorimotor integration, opening a way for restoring neuronal functional activity, provided that all “pathological afferents” are reduced.