Stroke is the leading cause of long-term disabilities in the United States and Cleveland Clinic wants to do something about it.
The Clinic performed the nation’s first deep brain stimulation surgery for stroke recovery on Dec. 19 as part of an ongoing clinical trial assessing the procedure. The six-hour surgery was led by Dr. Andre Machado, chairman of Cleveland Clinic’s Neurological Institute, who patented the method.
“Stroke typically causes one area of the brain to die,” Machado said. “Unfortunately, quite often that area of the brain controls movement on the opposite side of the body. When a stroke damages that area, the patient becomes unable to move one side of the body.”
After years of lab research, Machado and his team found that deep brain stimulation consistently could help movement recover in a laboratory model and promote a process called elasticity, or the capacity of the brain to reorganize itself.
Current knowledge shows deep brain stimulation can help the brain adapt beyond what physical therapy can do alone, Machado said. The study’s goal is to “boost rehabilitation outcomes beyond what physical therapy alone could achieve.”
The patient who received the deep brain stimulation surgery has been discharged home and is in stable condition. She will continue to recover and receive physical therapy, without turning on the stimulation. Following a few weeks of rehabilitation, the deep brain stimulation device will be turned on in addition to physical therapy, and the patient will continue to be monitored.
“The goal of this different stimulation procedure is to boost the effects of physical therapy,” Machado said. “Therefore, by comparing how physical therapy works before and after you turn on the stimulation, we can learn how much the stimulation actually added to her recovery.”
Kenneth Baker of Cleveland Clinic’s department of neurosciences indicated that in addition to characterizing the effect of treatment on motor recovery, researchers also will examine how stimulation affects brain activity through both noninvasive imaging and electrophysiological techniques.
“Through these studies, we hope to gain further insight into its therapeutic mechanisms, and perhaps more importantly, how best to optimize delivery of the therapy as we move forward,” said Baker, the co-principal investigator on the National Institutes of Health Brain Initiative grant, brain research through advancing Innovative Neurotechnologies.
Machado’s previous research has demonstrated that deep brain stimulation targeting the same brain pathway in a laboratory model promotes the brain’s ability to form new neural connections while recovering from a stroke. This clinical trial expands on that work, but is still an experimental approach with risks including infection, hemorrhage and neurological complications.
Machado’s team is recruiting patients who had a stroke 12 to 24 months ago and remain with severe weakness on one side of the body.
Naomi Grant is the Violet Spevack Editorial Intern.