Thalamic deep brain stimulation in traumatic brain injury: a phase 1, randomized feasibility study.
Nat Med. 2023-12-01; 29(12): 3162-3174
DOI: 10.1038/s41591-023-02638-4
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1. Nat Med. 2023 Dec;29(12):3162-3174. doi: 10.1038/s41591-023-02638-4. Epub 2023
Dec 4.
Thalamic deep brain stimulation in traumatic brain injury: a phase 1, randomized
feasibility study.
Schiff ND(1)(2), Giacino JT(3)(4), Butson CR(5)(6), Choi EY(7), Baker JL(8),
O’Sullivan KP(5), Janson AP(5)(9), Bergin M(3), Bronte-Stewart HM(7), Chua
J(10), DeGeorge L(8), Dikmen S(11), Fogarty A(7), Gerber LM(10)(12), Krel M(7),
Maldonado J(13), Radovan M(14), Shah SA(15), Su J(16), Temkin N(17), Tourdias
T(18), Victor JD(8)(19), Waters A(3), Kolakowsky-Hayner SA(7), Fins JJ(12),
Machado AG(20), Rutt BK(21)(22)(23), Henderson JM(24)(25)(26).
Author information:
(1)Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA.
.
(2)Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
.
(3)Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation
Hospital, Boston, MA, USA.
(4)Department of Physical Medicine and Rehabilitation, Harvard Medical School,
Boston, MA, USA.
(5)Scientific Computing and Imaging Institute Department of Bioengineering,
University of Utah, Salt Lake City, UT, USA.
(6)Norman Fixel Institute for Neurological Diseases Departments of Neurology and
Neurosurgery, University of Florida, Gainesville, FL, USA.
(7)Department of Neurosurgery, Stanford University, Stanford, CA, USA.
(8)Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA.
(9)Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN,
USA.
(10)Department of Population Health Sciences, Weill Cornell Medicine, New York,
NY, USA.
(11)Department of Rehabilitation Medicine, University of Washington, Seattle,
WA, USA.
(12)Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
(13)Department of Psychiatry, Stanford University, Stanford, CA, USA.
(14)Department of Computer Science, Stanford University, Stanford, CA, USA.
(15)Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
(16)Department of Electrical Engineering, Stanford University, Stanford, CA,
USA.
(17)Department of Neurological Surgery, University of Washington, Seattle, WA,
USA.
(18)Department of Neuroimaging, University of Bordeaux, Nouvelle-Aquitaine,
France.
(19)Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
(20)Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
(21)Department of Radiology, Stanford University, Stanford, CA, USA.
(22)Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.
(23)Bio-X Program, Stanford University, Stanford, CA, USA.
(24)Department of Neurosurgery, Stanford University, Stanford, CA, USA.
.
(25)Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.
.
(26)Bio-X Program, Stanford University, Stanford, CA, USA. .
Converging evidence indicates that impairments in executive function and
information-processing speed limit quality of life and social reentry after
moderate-to-severe traumatic brain injury (msTBI). These deficits reflect
dysfunction of frontostriatal networks for which the central lateral (CL)
nucleus of the thalamus is a critical node. The primary objective of this
feasibility study was to test the safety and efficacy of deep brain stimulation
within the CL and the associated medial dorsal tegmental (CL/DTTm) tract.Six
participants with msTBI, who were between 3 and 18 years post-injury, underwent
surgery with electrode placement guided by imaging and subject-specific
biophysical modeling to predict activation of the CL/DTTm tract. The primary
efficacy measure was improvement in executive control indexed by processing
speed on part B of the trail-making test.All six participants were safely
implanted. Five participants completed the study and one was withdrawn for
protocol non-compliance. Processing speed on part B of the trail-making test
improved 15% to 52% from baseline, exceeding the 10% benchmark for improvement
in all five cases.CL/DTTm deep brain stimulation can be safely applied and may
improve executive control in patients with msTBI who are in the chronic phase of
recovery.ClinicalTrials.gov identifier: NCT02881151 .
© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.
DOI: 10.1038/s41591-023-02638-4
PMID: 38049620 [Indexed for MEDLINE]