Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients

Research output: Contribution to journalArticle

Abstract

Objective: Deep brain stimulation of the thalamus was introduced more than 40 years ago with the objective of improving the performance and attention of patients in a vegetative or minimally conscious state. Here, the authors report the results of the Cortical Activation by Thalamic Stimulation (CATS) study, a prospective multiinstitutional study on the effects of bilateral chronic stimulation of the anterior intralaminar thalamic nuclei and adjacent paralaminar regions in patients affected by a disorder of consciousness. Methods: The authors evaluated the clinical and radiological data of 29 patients in a vegetative state (unresponsive wakefulness syndrome) and 11 in a minimally conscious state that lasted for more than 6 months. Of these patients, 5 were selected for bilateral stereotactic implantation of deep brain stimulating electrodes into their thalamus. A definitive consensus for surgery was obtained for 3 of the selected patients. All 3 patients (2 in a vegetative state and 1 in a minimally conscious state) underwent implantation of bilateral thalamic electrodes and submitted to chronic stimulation for a minimum of 18 months and a maximum of 48 months. Results: In each case, there was an increase in desynchronization and the power spectrum of electroencephalograms, and improvement in the Coma Recovery Scale-Revised scores was found. Furthermore, the severity of limb spasticity and the number and severity of pathological movements were reduced. However, none of these patients returned to a fully conscious state. Conclusions: Despite the limited number of patients studied, the authors confirmed that bilateral thalamic stimulation can improve the clinical status of patients affected by a disorder of consciousness, even though this stimulation did not induce persistent, clinically evident conscious behavior in the patients.

Original languageEnglish
Pages (from-to)972-981
Number of pages10
JournalJournal of Neurosurgery
Volume125
Issue number4
DOIs
Publication statusPublished - Oct 1 2016

Keywords

  • Deep brain stimulation
  • Minimally conscious state
  • Thalamic stimulation
  • Unresponsive wakefulness syndrome
  • Vegetative state

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

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