CLEVELAND, Ohio — New research from the Cleveland Clinic has shown that stroke victims whose recovery has stalled can benefit from a procedure known as deep brain stimulation when combined with physical therapy.
Even years after the initial stroke, the combination of deep brain stimulation and physical therapy dramatically improved patient quality of life and ability to function independently, the study found.
Deep brain stimulation, or DBS, uses surgically implanted electrodes to deliver electrical stimulation to specific areas of the brain.
The technique has a proven track record of success in the treatment of a variety of physical, psychological and movement disorders, including depression, Tourette’s syndrome, Parkinson’s disease, Huntington’s disease, headaches, chronic pain and epilepsy.
However, this is the first evidence that DBS can successfully be used to improve brain function after a stroke.
The 12 participants in the study had been disabled for more than a year and, in some cases, three years after their stroke.
Each participant underwent DBS surgery, which involved the surgical implantation of electrodes into a part of the brain called the dentate nucleus – a region which regulates fine-control of voluntary movements, cognitive, language and sensory functions.
Afterward, the electrodes were connected to a pacemaker-like device that delivered small electric pulses to help people recover control of their movements. Following recovery from the surgery, participants completed months of physical therapy, first with the DBS device turned off for several weeks and then turned on for four to eight months.
The authors report that it was after turning the device on that the most significant improvements were observed. Following DBS, nine out of 12 patients demonstrated improvements in both motor impairment and function, and some almost tripled their initial motor function scores.
The research was published Aug. 14 in the journal Nature Medicine.
This gives us a potential opportunity for much needed improvements in rehabilitation in the chronic phases of stroke recovery,” said Dr. Andre Machado, chair of Cleveland Clinic’s Neurological Institute. “We saw patients in the study regain levels of function and independence they did not have before enrolling in the research.”
Machado has patented the DBS method in stroke recovery. Boston Scientific owns a license to those patents and provided the DBS systems used in the trial. Enspire DBS Therapy Inc., a Cleveland Clinic portfolio company, is commercializing technology.
Approximately 800,000 people in the United States suffer strokes every year. There are over 7 million stroke survivors who live in United States and approximately 50% of them have disabilities that are severe enough to require assistance with daily activities.
Although a stroke can happen at any age, it is most common among older adults. According to the Centers for Disease Control and Prevention, about 1-in-7 strokes occur in adolescents and young adults ages 15 to 49, and the chance of having a stroke about doubles every 10 years after age 55.
For patients who have any deficits after a stroke, physical therapy is often the only treatment option available. This research shows DBS surgery may be an option for some patients to regain function, even years later.
“There are currently no effective methods to improve the outcomes of physical rehabilitation for the hundreds of thousands of stroke survivors,” said Ken Baker, one of the lead researchers on the study at the Cleveland Clinic Lerner Research Institute.
“Deep brain stimulation, paired with physical therapy, improved movement in patients who were more than a year out from their stroke and whose motor improvements had largely plateaued. This tells us the research warrants further investigation in larger patient samples.”
Physical therapy will remain the standard for rehabilitation after stroke, Machado said. However, by combining it with targeted electrical brain stimulation, he says the effectiveness of physical therapy is greatly enhanced.
The present study demonstrated that the treatment could be done safely and was only the first small step, say the researchers. In the future they will complete a larger trial to establish the effectiveness of DBS in a greater number of patients.