Exploring the Potential of Deep Brain Stimulation in Poststroke Recovery: Kenneth Baker, PhD

WATCH TIME: 3 minutes

"We use stimulation at around 30 hz because we’re trying to actually augment a pathway, trying to enhance activity across a specific pathway in order to enhance the cortical excitability that we think will underlie the functional reorganization."

Over the last decade, deep brain stimulation (DBS) has become the most commonly used surgical approach for patients with essential tremor and Parkinson disease, sending electrical pulses to the brain to help control motor symptoms. Led by Cleveland Clinic and published in Nature Medicine, a recent phase 1 study tested the feasibility and safety of cerebellar DBS in poststroke patients with persistent, moderate-to-severe upper extremity impairment. All told, the study was a success, with patients showing rehabilitative effects and associated neurophysiological gains.

The small-scale trial featured 12 poststroke patients who underwent continuous stimulation of the cerebellar dentate nucleus (DN), a new, invasive way of extending the degree and temporal window of neuroplasticity. This approach aims to modulate neural activity and ipsilesional cortical excitability through activation of the robust, endogenous dentatothalamocortical pathway. Over 168 participant-months of DBS implant experience and 72 months of DN stimulation experience, findings from the study showed no device failures and no study-related, serious adverse events.

Led by Andre Machado, MD, PhD, and Kenneth Baker, MD, patients showed a modest 3-point (P = .0004) median improvement on upper extremity Fugl-Meyer Assessment across the pre-stimulation, 2-month rehab-only phase. When rehabilitation was combined with DN-DBS, patients gained (improved) an additional 7 points (P = .0005). Following the publication of the data, Baker, an associate staff member in the department of neurology at Cleveland Clinic, sat down to discuss the findings. He spoke specifically about the events leading up to the study, finding a representative population, and the advantages of targeting DN.

REFERENCE
1. Baker KB, Plow EB, Nagel S, et al. Cerebellar deep brain stimulation for chronic post-stroke motor rehabilitation: a phase 1 trial. Nature Medicine. Published online August 14, 2023. doi:10.1038/s41591-023-02507-0