Thalamic deep brain stimulation in traumatic brain injury: a phase 1, randomized feasibility study.

Autor:	Schiff ND; Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA. nds2001@med.cornell.edu.; Department of Neurology, Weill Cornell Medicine, New York, NY, USA. nds2001@med.cornell.edu., Giacino JT; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA.; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA., Butson CR; Scientific Computing and Imaging Institute Department of Bioengineering, University of Utah, Salt Lake City, UT, USA.; Norman Fixel Institute for Neurological Diseases Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, USA., Choi EY; Department of Neurosurgery, Stanford University, Stanford, CA, USA., Baker JL; Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA., O'Sullivan KP; Scientific Computing and Imaging Institute Department of Bioengineering, University of Utah, Salt Lake City, UT, USA., Janson AP; Scientific Computing and Imaging Institute Department of Bioengineering, University of Utah, Salt Lake City, UT, USA.; Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA., Bergin M; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA., Bronte-Stewart HM; Department of Neurosurgery, Stanford University, Stanford, CA, USA., Chua J; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA., DeGeorge L; Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA., Dikmen S; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA., Fogarty A; Department of Neurosurgery, Stanford University, Stanford, CA, USA., Gerber LM; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.; Department of Medicine, Weill Cornell Medicine, New York, NY, USA., Krel M; Department of Neurosurgery, Stanford University, Stanford, CA, USA., Maldonado J; Department of Psychiatry, Stanford University, Stanford, CA, USA., Radovan M; Department of Computer Science, Stanford University, Stanford, CA, USA., Shah SA; Department of Radiology, Weill Cornell Medicine, New York, NY, USA., Su J; Department of Electrical Engineering, Stanford University, Stanford, CA, USA., Temkin N; Department of Neurological Surgery, University of Washington, Seattle, WA, USA., Tourdias T; Department of Neuroimaging, University of Bordeaux, Nouvelle-Aquitaine, France., Victor JD; Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA.; Department of Neurology, Weill Cornell Medicine, New York, NY, USA., Waters A; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA., Kolakowsky-Hayner SA; Department of Neurosurgery, Stanford University, Stanford, CA, USA., Fins JJ; Department of Medicine, Weill Cornell Medicine, New York, NY, USA., Machado AG; Neurological Institute, Cleveland Clinic, Cleveland, OH, USA., Rutt BK; Department of Radiology, Stanford University, Stanford, CA, USA.; Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.; Bio-X Program, Stanford University, Stanford, CA, USA., Henderson JM; Department of Neurosurgery, Stanford University, Stanford, CA, USA. henderj@stanford.edu.; Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA. henderj@stanford.edu.; Bio-X Program, Stanford University, Stanford, CA, USA. henderj@stanford.edu.
Jazyk:	angličtina
Zdroj:	Nature medicine [Nat Med] 2023 Dec; Vol. 29 (12), pp. 3162-3174. Date of Electronic Publication: 2023 Dec 04.
DOI:	10.1038/s41591-023-02638-4
Abstrakt:	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.)
Databáze:	MEDLINE
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