Epidural cortical stimulation and aphasia therapy

Abstract

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and primary outcomes of a safety and feasibility study (Cherney, Erickson & Small, 2010), and provide previously unpublished data regarding secondary behavioral outcomes from that study.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.

Validation of Computational Studies for Electrical Brain Stimulation With Phantom Head Experiments

“…EBS has long been used to relieve neurological disorders, including essential tremor [1], chronic stroke [2], chronic pain [3], Parkinson's disease [4,5], movement disorders [6], refractory epilepsy [7], depression [8], aphasia [9], and dystonia [10], among others. Thus, EBS has gained more attention recently in treating brain disorders and brain diseases, and various preclinical animal and human studies have been conducted.…”

Reversible Functional Changes Evoked by Anodal Epidural Direct Current Electrical Stimulation of the Rat Auditory Cortex

“…These techniques allow us to precisely stimulate the brain of a patient with low current intensities. Electric stimulation of the brain has been effective in neuro-otological diseases such as auditory hallucinations (Koops et al, 2015), tinnitus (Zeng et al, 2015), aphasia (Cherney, 2011, 2016; Cherney et al, 2012), and auditory agnosia (Bestelmeyer et al, 2018). Among these clinical applications, electrostimulation currently stands out for its effectiveness in treating a wide range of central hearing disorders.…”

Cortical stimulation in aphasia following ischemic stroke: toward model-guided electrical neuromodulation

“…A large number of invasive and noninvasive stimulation studies based on electrical epidural stimulation, transcranial magnetic stimulation and various types of transcranial electrical stimulation have produced promising results (Töpper et al 1998;Kim et al 2008;Flöel et al 2008;Naeser et al 2005;Baker et al 2010;Cherney et al 2012;Balossier et al 2012;Cherney 2016;Duncan and Small 2016;Hamilton et al 2011;Hamilton 2016;Turkeltaub et al 2016; Wortman-Jutt and Edwards 2017; Harwigsen and Saur 2017). These approaches have limitations which have been discussed (Beuter et al 2018).…”