Poststroke arm and hand paresis: should we target the cervical spinal cord?

Pirondini, Elvira; Carranza, Erick; Balaguer, Josep-Maria; Sorensen, Erynn; Weber, Douglas J.; Krakauer, John W.; Capogrosso, Marco

doi:10.1016/j.tins.2022.05.002

Cited by 18 publications

(17 citation statements)

References 59 publications

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“…However, limited understanding of the underlying mechanisms of stimulation led to suboptimal choices of the implant location and stimulation protocols affecting size and consistency of the observed effects. DBS of the VIM/VOP facilitated M1 DCS MEPs in the upper extremity muscles via the CST and enhanced grip forces, which suggests that this therapy could be effective in restoring motor functions by addressing two of the main symptoms after damage to the CST: muscle weakness and loss of strength 9,59 . Indeed, our method availed a fully implanted TBI patient to volitionally modulate grip force, demonstrating that continuous DBS improves fine motor control.…”

Section: Discussionmentioning

confidence: 92%

Potentiation of Cortico-Spinal Output via Targeted Electrical Stimulation of the Motor Thalamus

Grigsby

Damiani

et al. 2023

Preprint

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Cerebral white matter tract lesions prevent cortico-spinal descending inputs from effectively activating spinal motoneurons, leading to untreatable muscle paralysis. However, in most cases the damage to cortico-spinal axons is incomplete and the spared connections could be potentiated by neurotechnologies to restore motor function. Here we hypothesized that, by engaging direct excitatory connections to cortico-spinal motoneurons, deep brain stimulation (DBS) of the motor thalamus could facilitate activation of spared cortico-spinal fibers improving movements of the paretic limb. We first identified, in monkeys, optimal stimulation targets and parameters that enhanced motor evoked potentials to arm, hand, and face muscles, as well as grip forces. This potentiation persisted after cerebral white matter lesions. We then translated these results to human subjects by identifying the corresponding optimal thalamic targets (VIM/VOP nuclei) and replicated the results obtained in monkeys. Finally, we designed a DBS protocol that immediately improved voluntary grip force control in a patient with a chronic traumatic brain injury. Our results suggest that targeted DBS of the motor thalamus may become an effective therapy for motor paralysis.

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Section: Discussionmentioning

confidence: 92%

Potentiation of Cortico-Spinal Output via Targeted Electrical Stimulation of the Motor Thalamus

Grigsby

Damiani

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…DBS of the VIM/VOP facilitated M1 DCS MEPs in the upper extremity muscles via the CST and enhanced grip forces, which suggests that this therapy could be effective in restoring motor functions by addressing two of the main symptoms after damage to the CST: muscle weakness and loss of strength 9,59 . Indeed, our method availed a fully implanted TBI patient to volitionally modulate grip force, demonstrating that continuous DBS improves ne motor control.…”

Section: Discussionmentioning

confidence: 93%

“…Similar considerations could apply to motor thalamus DBS. Finally, the therapeutic effects of VIM/VOP-DBS might be more clinically relevant when compared to non-invasive cortical stimulation because of the higher selectivity 14,15 and continuous nature 59 of DBS, akin to DBS therapy in patients with Parkinson's disease and Essential Tremor. In fact, non-invasive systems cannot be implanted and consequently be utilized all day.…”

Section: Discussionmentioning

confidence: 99%

Targeted Deep Brain Stimulation of the Motor Thalamus Facilitates Voluntary Motor Control After Cortico-spinal Tract Lesions

Grigsby

Damiani

et al. 2023

Preprint

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Cerebral white matter tract lesions prevent cortico-spinal descending inputs from effectively activating spinal motoneurons, leading to untreatable muscle paralysis. However, in most cases the damage to cortico-spinal axons is incomplete and the spared connections could be potentiated by neurotechnologies to restore motor function. Here we hypothesized that, by engaging direct excitatory connections to cortico-spinal motoneurons, deep brain stimulation (DBS) of the motor thalamus could facilitate activation of spared cortico-spinal fibers improving muscle activation of the paretic limb. We first identified, in monkeys, optimal stimulation targets and parameters that enhanced motor evoked potentials to arm, hand, and face muscles, as well as grip forces. This potentiation persisted after cerebral white matter lesions. We then translated these results to human subjects by identifying the corresponding optimal thalamic targets (VIM/VOP nuclei) and replicated the results obtained in monkeys. Finally, we designed a DBS protocol that immediately improved voluntary grip force control in a patient with a chronic traumatic brain injury. Our results suggest that targeted DBS of the motor thalamus may become an effective therapy for motor paralysis.

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“…31 All told, scES remains an incredibly promising restorative technique for individuals with SCI. Indeed, a case has been made for cervical cord stimulation for upper limb paresis in chronic stroke 34 and initial results are exciting. 35 Further research investigating the potential mechanism of action in more detail, as well as optimizing stimulation protocols is required, not to mention an exploration of the role of scES in other forms of neurological injury and disease.…”

Section: Invasive Brain Stimulationmentioning

confidence: 99%

Neurotechnology’s Prospects for Bringing About Meaningful Reductions in Neurological Impairment

Putrino

Krakauer

2022

Neurorehabil Neural Repair

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Here we report and comment on the magnitudes of post-stroke impairment reduction currently observed using new neurotechnologies. We argue that neurotechnology’s best use case is impairment reduction as this is neither the primary strength nor main goal of conventional rehabilitation, which is better at targeting the activity and participation levels of the ICF. The neurotechnologies discussed here can be divided into those that seek to be adjuncts for enhancing conventional rehabilitation, and those that seek to introduce a novel behavioral intervention altogether. Examples of the former include invasive and non-invasive brain stimulation. Examples of the latter include robotics and some forms of serious gaming. We argue that motor learning and training-related recovery are conceptually and mechanistically distinct. Based on our survey of recent results, we conclude that large reductions in impairment will need to begin with novel forms of high dose and high intensity behavioral intervention that are qualitatively different to conventional rehabilitation. Adjunct forms of neurotechnology, if they are going to be effective, will need to piggyback on these new behavioral interventions.

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Poststroke arm and hand paresis: should we target the cervical spinal cord?

Cited by 18 publications

References 59 publications

Potentiation of Cortico-Spinal Output via Targeted Electrical Stimulation of the Motor Thalamus

Potentiation of Cortico-Spinal Output via Targeted Electrical Stimulation of the Motor Thalamus

Targeted Deep Brain Stimulation of the Motor Thalamus Facilitates Voluntary Motor Control After Cortico-spinal Tract Lesions

Neurotechnology’s Prospects for Bringing About Meaningful Reductions in Neurological Impairment

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