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

Area of Science:

• Neuroscience
• Neurosurgery
• Rehabilitation Medicine

Background:

• Moderate-to-severe traumatic brain injury (msTBI) often results in executive function and information-processing speed deficits.
• These cognitive impairments significantly impact quality of life and social reintegration post-injury.
• Frontostriatal network dysfunction, involving the central lateral (CL) nucleus of the thalamus, underlies these deficits.

Purpose of the Study:

• To assess the safety and efficacy of deep brain stimulation (DBS) targeting the CL nucleus and the medial dorsal tegmental (CL/DTTm) tract.
• To evaluate the potential of CL/DTTm DBS to improve executive control in individuals with chronic msTBI.

Main Methods:

• A feasibility study involving six participants with msTBI (3-18 years post-injury).
• Surgical implantation of electrodes guided by imaging and subject-specific biophysical modeling.
• Primary efficacy measure: improvement in processing speed on Trail-Making Test Part B.

Main Results:

• All six participants underwent safe electrode implantation.
• Five participants completed the study, demonstrating significant improvements in processing speed (15%-52% from baseline).
• All completers exceeded the 10% improvement benchmark for Trail-Making Test Part B.

Conclusions:

• Deep brain stimulation of the CL/DTTm tract is a safe procedure for patients in the chronic phase of msTBI recovery.
• CL/DTTm DBS shows potential efficacy in improving executive control, specifically processing speed.
• Further investigation is warranted to explore the therapeutic benefits of CL/DTTm DBS for msTBI-related cognitive deficits.