27. Deep Brain Stimulation
Nicholas Schiff
Nicholas D. Schiff, Neurology and Neuroscience, and Joseph J. Fins, Medicine/Public Health, Weill Cornell Medical College, and research colleagues performed the world’s first successful electrical stimulation for a minimally conscious brain-injured patient, who regained the power to communicate. The experimental study provided the first rigorous evidence that a prosthetic device can initiate and sustain recovery in such a severely disabled person years after the injury occurred. After his brain was stimulated with pulses of electric current, a 38-year-old man with a severe head injury who had spent more than five years in a minimally conscious state (MCS) could interact regularly with family members, while recovering his ability to move. The patient was treated with deep brain stimulation surgery, a technique that targets deep brain structures with millimeter precision using computer-generated maps, image-guided navigation and physiological brain mapping. Tiny electrodes implanted into the brain are then connected to programmable pacemaker batteries in the chest. The researchers knew that some patients in a MCS retain functioning brain networks above the brainstem. Activity within these integrated neural networks is supported by cells in an area of the brain called the central thalamus, which is key to adjusting brain activity as it responds to cognitive demands. Experts estimate that from 100,000 to 300,000 patients with traumatic brain injury are diagnosed as in a MCS. Under the current standard of care, most do not receive active rehabilitation and are cared for in long-term nursing facilities. This first deep brain stimulation procedure is part of an FDA-approved pilot study that will include 12 patients in post-traumatic MCS.