Behavioural improvements with thalamic stimulation after severe traumatic brain injury

Area of Science:

• Neuroscience
• Neurosurgery
• Rehabilitation Medicine

Background:

• Severe traumatic brain injury (TBI) often leads to persistent disorders of consciousness (DoC), considered immutable after 12 months.
• Current treatments do not accelerate recovery or improve outcomes in chronic DoC.
• Patients in the minimally conscious state (MCS) may retain residual capacity, suggesting potential for therapeutic intervention.

Observation:

• Large-scale cerebral networks show unexpected preservation in patients with MCS.
• Patients with MCS exhibit intermittent awareness of self or environment.
• Chronic underactivation of recruitable networks may limit recovery in MCS.

Findings:

• Bilateral deep brain electrical stimulation (DBS) of the central thalamus modulated behavioral responsiveness in a chronic MCS patient.
• Cognitively mediated behaviors, limb control, and oral feeding improved during DBS 'on' periods compared to 'off' periods.
• Functional improvements were statistically linked to recent stimulation history.

Implications:

• DBS may compensate for arousal regulation deficits following TBI.
• Deep brain stimulation offers a potential therapeutic strategy for promoting late functional recovery after severe TBI.
• Findings challenge early treatment discontinuation for patients with inconsistent interactive behaviors, advocating for further research.