Gavin J B Elias1, Andrew A Namasivayam1, Andres M Lozano2. 1. Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada. 2. Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada. Electronic address: lozano@uhnresearch.ca.
Abstract
BACKGROUND: Survivors of stroke often experience significant disability and impaired quality of life related to ongoing maladaptive responses and persistent neurologic deficits. Novel therapeutic options are urgently needed to augment current approaches. One way to promote recovery and ameliorate symptoms may be to electrically stimulate the surviving brain. Various forms of brain stimulation have been investigated for use in stroke, including deep brain stimulation (DBS). OBJECTIVE/ METHODS: We conducted a comprehensive literature review in order to 1) review the use of DBS to treat post-stroke maladaptive responses including pain, dystonia, dyskinesias, and tremor and 2) assess the use and potential utility of DBS for enhancing plasticity and recovery from post-stroke neurologic deficits. RESULTS/ CONCLUSIONS: A large variety of brain structures have been targeted in post-stroke patients, including motor thalamus, sensory thalamus, basal ganglia nuclei, internal capsule, and periventricular/periaqueductal grey. Overall, the reviewed clinical literature suggests a role for DBS in the management of several post-stroke maladaptive responses. More limited evidence was identified regarding DBS for post-stroke motor deficits, although existing work tentatively suggests DBS-particularly DBS targeting the posterior limb of the internal capsule-may improve paresis in certain circumstances. Substantial future work is required both to establish optimal targets and parameters for treatment of maladapative responses and to further investigate the effectiveness of DBS for post-stroke paresis.
BACKGROUND: Survivors of stroke often experience significant disability and impaired quality of life related to ongoing maladaptive responses and persistent neurologic deficits. Novel therapeutic options are urgently needed to augment current approaches. One way to promote recovery and ameliorate symptoms may be to electrically stimulate the surviving brain. Various forms of brain stimulation have been investigated for use in stroke, including deep brain stimulation (DBS). OBJECTIVE/ METHODS: We conducted a comprehensive literature review in order to 1) review the use of DBS to treat post-stroke maladaptive responses including pain, dystonia, dyskinesias, and tremor and 2) assess the use and potential utility of DBS for enhancing plasticity and recovery from post-stroke neurologic deficits. RESULTS/ CONCLUSIONS: A large variety of brain structures have been targeted in post-strokepatients, including motor thalamus, sensory thalamus, basal ganglia nuclei, internal capsule, and periventricular/periaqueductal grey. Overall, the reviewed clinical literature suggests a role for DBS in the management of several post-stroke maladaptive responses. More limited evidence was identified regarding DBS for post-stroke motor deficits, although existing work tentatively suggests DBS-particularly DBS targeting the posterior limb of the internal capsule-may improve paresis in certain circumstances. Substantial future work is required both to establish optimal targets and parameters for treatment of maladapative responses and to further investigate the effectiveness of DBS for post-stroke paresis.
Authors: Elise Gondard; Lucy Teves; Lihua Wang; Chris McKinnon; Clement Hamani; Suneil K Kalia; Peter L Carlen; Michael Tymianski; Andres M Lozano Journal: J Neurosci Date: 2019-01-29 Impact factor: 6.167
Authors: Jose L Herrero; Alexander Smith; Akash Mishra; Noah Markowitz; Ashesh D Mehta; Stephan Bickel Journal: J Neurophysiol Date: 2021-10-13 Impact factor: 2.714
Authors: R Gopalakrishnan; D A Cunningham; O Hogue; M Schroedel; B A Campbell; E B Plow; K B Baker; A G Machado Journal: J Neurosci Date: 2022-05-23 Impact factor: 6.709
Authors: Maurizio Gulino; Donghoon Kim; Salvador Pané; Sofia Duque Santos; Ana Paula Pêgo Journal: Front Neurosci Date: 2019-07-05 Impact factor: 4.677
Authors: Nienke E R van Bueren; Thomas L Reed; Vu Nguyen; James G Sheffield; Sanne H G van der Ven; Michael A Osborne; Evelyn H Kroesbergen; Roi Cohen Kadosh Journal: PLoS Comput Biol Date: 2021-09-09 Impact factor: 4.475