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

Nicholas D. Schiff, Joseph T. Giacino, Christopher R. Butson, Eun Young Choi, Jonathan L. Baker, Kyle P. O’Sullivan, Andrew P. Janson, Michael Bergin, Helen M. Bronte-Stewart, Jason Chua, Laurel DeGeorge, Sureyya Dikmen, Adam Fogarty, Linda M. Gerber, Mark Krel, Jose Maldonado, Matthew Radovan, Sudhin A. Shah, Jason Su, Nancy TemkinThomas Tourdias, Jonathan D. Victor, Abigail Waters, Stephanie A. Kolakowsky-Hayner, Joseph J. Fins, Andre G. Machado, Brian K. Rutt, Jaimie M. Henderson

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

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 Five participants completed the study and one was withdrawn for protocol non-compliance.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 .

Original languageEnglish
Pages (from-to)3162-3174
Number of pages13
JournalNature Medicine
Volume29
Issue number12
DOIs
StatePublished - Dec 2023
Externally publishedYes

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