Rekha Swamy - Department of Neurosurgery
Ischemic strokes are often devastating. These types of strokes occur when there is a decrease in the blood flow to a specific part of the brain. The deficits a patient experiences are highly dependent on many factors, but the location of the lesion is the most important. Considering the neuroplastic capabilities of the brain, researchers at Clevland Clinic have proposed to implement deep brain stimulation (DBS) - implantation of electrodes for electrical stimulation of a certain brain area - to help with a variety of movement disorders.
In this Phase 1 study, the authors focused on the implantation of a single electrode in the dentate nucleus (DN) which is an important deep nucleus that is responsible for fine motor movements, language, and cognition, and has therefore, been deemed an advantageous stimulation point for stroke patients who experience substantial physical disability. This invasive surgical procedure was performed on 12 eligible patients who had experienced a “first-time, unilateral, ischemic stroke affecting the middle cerebral artery 12-26 months before surgery” resulting in upper extremity movement impairment [1].
Once the surgery was completed, patients had 1 month of post-operative recovery followed by a 2-month rehab-only phase. From there, trial participants had 4-8 months of DBS along with rehab. Various measures were used to assess the efficacy of DN-DBS + rehab. Measures such as FM-EU (Fugl-Meyer Assessment of Motor Recovery after Stroke) and the AMAT Test (Arm Motor Ability Test) were indicative of both “reduction of motor impairments and gains in motor function” [1]. At the end of the DBS + rehab phase, participants experienced a rehab-carryover phase and slow reduction of stimulation followed by an explant of the DBS hardware. With that being said, this preliminary phase 1 study demonstrates possible therapeutic neurophysiological benefits of DN-DBS for stroke patients experiencing chronic disabilities.
References:
Baker, K.B., Plow, E.B., Nagel, S. et al. Cerebellar deep brain stimulation for chronic post-stroke motor rehabilitation: a phase I trial. Nat Med 29, 2366–2374 (2023). https://doi.org/10.1038/s41591-023-02507-0
Edited By: Firas Batrash, Editor-in-Chief
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