Schiff Nicholas D, Giacino Joseph T, Butson Christopher R, Choi Eun Young, Baker Jonathan L, O'Sullivan Kyle P, Janson Andrew P, Bergin Michael, Bronte-Stewart Helen M, Chua Jason, DeGeorge Laurel, Dikmen Sureyya, Fogarty Adam, Gerber Linda M, Krel Mark, Maldonado Jose, Radovan Matthew, Shah Sudhin A, Su Jason, Temkin Nancy, Tourdias Thomas, Victor Jonathan D, Waters Abigail, Kolakowsky-Hayner Stephanie A, Fins Joseph J, Machado Andre G, Rutt Brian K, Henderson Jaimie M
Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA.
Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
Nat Med. 2023 Dec;29(12):3162-3174. doi: 10.1038/s41591-023-02638-4. Epub 2023 Dec 4.
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 Five participants completed the study and one was withdrawn for protocol non-compliance.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 .
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