A new technique that uses deep brain stimulation tailored to each patient has exceeded researchers’ expectations in the treatment of cognitive impairments caused by moderate to severe traumatic brain injury.
In 2001, Gina Arata was in her last semester of college and planning to apply to law school, when she suffered a traumatic brain injury in a car accident. The injury compromised her ability to concentrate so much that she had trouble at a job sorting mail.
“I couldn’t remember anything,” said Arata, who lives in Modesto with his parents. “My left foot fell off, so he was tripping over things all the time. I was always in car accidents. And I had no filter: I got angry very easily.”
His parents heard about the research being done at Stanford Medicine and reached out; Arata was accepted as a participant. In 2018, doctors surgically implanted a device deep in his brain and then carefully calibrated the device’s electrical activity to stimulate networks that the injury had attenuated.
She noticed the difference right away: When asked to list items in the produce aisle of a grocery store, she could recite fruits and vegetables. A researcher then turned off the device and could not name any.
“Since the implant, I have not received fines for speeding,” Arata said. “I don’t stumble anymore. I can remember how much money is in my bank account. I couldn’t read, but after the implant I bought a book, Where the Crabs Sing, I loved it and I remembered it. And I don’t have that quick temper.”
Advances in the treatment of brain injuries
For Arata and four others, the experimental deep brain stimulation device restored, to varying degrees, the cognitive abilities they had lost to brain injuries years earlier. The new technique, developed by researchers at Stanford Medicine and collaborators at other institutions, is the first to show promise against lasting impairments resulting from moderate to severe traumatic brain injuries.
More than 5 million Americans live with the lasting effects of a moderate to severe traumatic brain injury: difficulty concentrating, remembering, and making decisions. Although many recover enough to live independently, their impairments prevent them from returning to school or work and resuming their social lives.
“In general, there is very little treatment for these patients,” said Jaimie Henderson, MD, professor of neurosurgery and co-senior author of the study.
However, the fact that these patients had emerged from comas and regained a good amount of cognitive function suggested that the brain systems that support attention and arousal (the ability to stay awake, pay attention to a conversation, and concentrate on a task) ) were relatively preserved.
Understanding and targeting the brain
These systems connect the thalamus, a relay station deep in the brain, with points along the cortex, the outer layer of the brain, which controls higher cognitive functions.
“In these patients, those pathways are largely intact, but everything has been downregulated,” said Henderson, the John and Jene Blume-Robert and Ruth Halperin Professor. “It’s like the lights have gone dim and there just isn’t enough electricity to turn them back on.”
More than 5 million Americans live with the lasting effects of a moderate to severe traumatic brain injury: difficulty concentrating, remembering, and making decisions. Although many recover enough to live independently, their impairments prevent them from returning to school or work and resuming their social lives.
“In general, there is very little treatment for these patients,” said Jaimie Henderson, MD, professor of neurosurgery and co-senior author of the study.
However, the fact that these patients had emerged from comas and regained a good amount of cognitive function suggested that the brain systems that support attention and arousal (the ability to stay awake, pay attention to a conversation, and concentrate on a task) ) were relatively preserved.
Understanding and targeting the brain
These systems connect the thalamus, a relay station deep in the brain, with points along the cortex, the outer layer of the brain, which controls higher cognitive functions.
“In these patients, those pathways are largely intact, but everything has been downregulated,” said Henderson, the John and Jene Blume-Robert and Ruth Halperin Professor. “It’s like the lights have gone dim and there just isn’t enough electricity to turn them back on.”
In particular, an area of the thalamus called the central lateral nucleus acts as a center that regulates many aspects of consciousness.
“The central lateral nucleus is optimized to drive things broadly, but its vulnerability is that if you have a multifocal injury, it tends to take a bigger hit because a hit can come from almost any part of the brain,” said Nicholas Schiff, MD, professor at Weill Cornell Medicine and co-senior author of the study.
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