Effects of Bilateral Extradural Cortical Stimulation for Plegic Stroke Rehabilitation

Canavero, Sergio; Bonicalzi, Vincenzo; Intonti, Stefania; Crasto, S.; Castellano, Giancarlo

doi:10.1111/j.1525-1403.2006.00039.x

Cited by 18 publications

(21 citation statements)

References 23 publications

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“…Most interpretations suggest that enhanced neuroplasticity with more robust long-term learning and reorganization of neural circuits, possibly mediated by GABA-ergic intracortical networks, may contribute to the improved language associated with CS/LT. 24,44 This hypothesis is consistent with the findings of our study, in which language improvements were maintained to some degree for more than 3 months and as many as 21 months after the end of treatment. Improvements were not dependent on the continued presence of CS, unlike the case presented by Balossier et al, 26,27 in which language improvements were reversible and occurred only when the CS was on.…”

Section: Discussionsupporting

confidence: 94%

Epidural Cortical Stimulation as Adjunctive Treatment for Nonfluent Aphasia

Cherney

2015

Neurorehabil Neural Repair

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Section: Discussionsupporting

confidence: 94%

Epidural Cortical Stimulation as Adjunctive Treatment for Nonfluent Aphasia

Cherney

2015

Neurorehabil Neural Repair

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“…Unilateral ECS is known to recruit both hemispheres (via callosal and/or corticocortical connections) [2,3] and also to induce post- stimulation after-effects [2,3]. ECS can also enhance neuroplasticity during stroke rehabilitation [4], by altering, among others, neurotransmitter levels in the brain [4].…”

mentioning

confidence: 99%

“…Isolated thalamocortical ''island'' circuits may be working in PVS [6][7][8][9]11]. We now find that bifocal, extradural cortical stimulation (b-ECS), a very safe minimally invasive surgical method [2][3][4], can restore conscious contents in the PVS. The present result differs from recent reports of an improvement of the minimally conscious state by DBS [13]: it is known that PVS and the MCS are different physiological entities, with large-scale ''higher order'' cortical activation on functional neuroimaging in MCS, normally not observed in PVS patients, a much better prognosis for the MCS even past 12 months, and sporadic, weak, inconsistent, but clearly intentional actions in MCS, but not PVS [9].…”

mentioning

confidence: 99%

Bifocal extradural cortical stimulation-induced recovery of consciousness in the permanent post-traumatic vegetative state

Canavero¹,

Massa-Micon²,

Cauda³

et al. 2009

J Neurol

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“…CS/RT studies for upper extremity movement deficits following stroke in humans are summarized in Table 2. Promising results have been evident in case reports (Canavero, Bonicalzi, Intonti, Crasto, & Castellano, 2006; Kim et al, 2008), small phase 1 pilot studies (Brown, Lutsep, Cramer, & Weinand, 2003; Brown, Lutsep, Weinand, & Cramer, 2006), and larger Phase 2 studies (Levy et al, 2008; Huang et al, 2008). In the Phase 1 study (Brown et al, 2003, 2006), CS was applied at 50 Hz at 50% MT up to a maximum of 6.5 mA, using an implantable epidural electrode device with a 3 × 3 array of electrodes and an external electrode lead and external pulse generator.…”

Section: Cortical Stimulation Combined With Rehabilitation Training Fmentioning

confidence: 97%

Epidural cortical stimulation and aphasia therapy

et al. 2012

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Background There are several methods of delivering cortical brain stimulation to modulate cortical excitability and interest in their application as an adjuvant strategy in aphasia rehabilitation after stroke is growing. Epidural cortical stimulation, although more invasive than other methods, permits high frequency stimulation of high spatial specificity to targeted neuronal populations. Aims First, we review evidence supporting the use of epidural cortical stimulation for upper limb recovery after focal cortical injury in both animal models and human stroke survivors. These data provide the empirical and theoretical platform underlying the use of epidural cortical stimulation in aphasia. Second, we summarize evidence for the application of epidural cortical stimulation in aphasia. We describe the procedures and primary outcomes of a safety and feasibility study (Cherney, Erickson & Small, 2010), and provide previously unpublished data regarding secondary behavioral outcomes from that study. Main Contribution In a controlled study comparing epidural cortical stimulation plus language treatment (CS/LT) to language treatment alone (LT), eight stroke survivors with nonfluent aphasia received intensive language therapy for 6 weeks. Four of these participants also underwent surgical implantation of an epidural stimulation device which was activated only during therapy sessions. Behavioral data were collected before treatment, immediately after treatment, and at 6 and 12 weeks following the end of treatment. The effect size for the primary outcome measure, the Western Aphasia Battery Aphasia Quotient, was benchmarked as moderate from baseline to immediately post-treatment, and large from baseline to the 12-week follow-up. Similarly, effect sizes obtained at the 12-week follow-up for the Boston Naming Test, the Communicative Effectiveness Index, and for correct information units on a picture description task were greater than those obtained immediately post treatment. When effect sizes were compared for individual subject pairs on discourse measures of content and rate, effects were typically larger for the investigational subjects receiving CS/LT than for the control subjects receiving LT alone. These analyses support previous findings regarding therapeutic efficacy of CS/LT compared to LT i.e. epidural stimulation of ipsilesional premotor cortex may augment behavioral speech-language therapy, with the largest effects after completion of therapy. Conclusions Continued investigation of epidural cortical stimulation in combination with language training in post-stroke aphasia should proceed cautiously. Carefully planned studies that customize procedures to individual profiles are warranted. Information from research on non-invasive methods of CS/LT may also inform future studies of epidural cortical stimulation.

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Effects of Bilateral Extradural Cortical Stimulation for Plegic Stroke Rehabilitation

Cited by 18 publications

References 23 publications

Epidural Cortical Stimulation as Adjunctive Treatment for Nonfluent Aphasia

Epidural Cortical Stimulation as Adjunctive Treatment for Nonfluent Aphasia

Bifocal extradural cortical stimulation-induced recovery of consciousness in the permanent post-traumatic vegetative state

Epidural cortical stimulation and aphasia therapy

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