Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients.
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| Abstract |
OBJECTIVE Deep brain stimulation of the thalamus was introduced more than 40 years ago with the objective of improving the performance and attention of patients in a vegetative or minimally conscious state. Here, the authors report the results of the Cortical Activation by Thalamic Stimulation (CATS) study, a prospective multiinstitutional study on the effects of bilateral chronic stimulation of the anterior intralaminar thalamic nuclei and adjacent paralaminar regions in patients affected by a disorder of consciousness. METHODS The authors evaluated the clinical and radiological data of 29 patients in a vegetative state (unresponsive wakefulness syndrome) and 11 in a minimally conscious state that lasted for more than 6 months. Of these patients, 5 were selected for bilateral stereotactic implantation of deep brain stimulating electrodes into their thalamus. A definitive consensus for surgery was obtained for 3 of the selected patients. All 3 patients (2 in a vegetative state and 1 in a minimally conscious state) underwent implantation of bilateral thalamic electrodes and submitted to chronic stimulation for a minimum of 18 months and a maximum of 48 months. RESULTS In each case, there was an increase in desynchronization and the power spectrum of electroencephalograms, and improvement in the Coma Recovery Scale-Revised scores was found. Furthermore, the severity of limb spasticity and the number and severity of pathological movements were reduced. However, none of these patients returned to a fully conscious state. CONCLUSIONS Despite the limited number of patients studied, the authors confirmed that bilateral thalamic stimulation can improve the clinical status of patients affected by a disorder of consciousness, even though this stimulation did not induce persistent, clinically evident conscious behavior in the patients. Clinical trial registration no.: NCT01027572 ( ClinicalTrials.gov ).
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| Authors | Lorenzo Magrassi, Giorgio Maggioni, Caterina Pistarini, Carol Di Perri, Stefano Bastianello, Antonio G Zippo, Giorgio A Iotti, Gabriele E M Biella, Roberto Imberti |
| Journal | Journal of neurosurgery (J Neurosurg) Vol. 125 Issue 4 Pg. 972-981 (10 2016) ISSN: 1933-0693 [Electronic] United States |
| PMID | 26745476 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't) |
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