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

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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

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Persistent Vegetative State
Prospective Studies
Consciousness Disorders
Thalamus
Electrodes
Anterior Thalamic Nuclei
Intralaminar Thalamic Nuclei
Deep Brain Stimulation
Wakefulness
Coma
Electroencephalography
Consensus
Extremities

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

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title = "Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients",
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.",
keywords = "Deep brain stimulation, Minimally conscious state, Thalamic stimulation, Unresponsive wakefulness syndrome, Vegetative state",
author = "Lorenzo Magrassi and Giorgio Maggioni and Caterina Pistarini and {Di Perri}, Carol and Stefano Bastianello and Zippo, {Antonio G.} and Iotti, {Giorgio Antonio} and Biella, {Gabriele E M} and Roberto Imberti",
year = "2016",
month = "10",
day = "1",
doi = "10.3171/2015.7.JNS15700",
language = "English",
volume = "125",
pages = "972--981",
journal = "Journal of Neurosurgery",
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publisher = "American Association of Neurological Surgeons",
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TY - JOUR

T1 - Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients

AU - Magrassi, Lorenzo

AU - Maggioni, Giorgio

AU - Pistarini, Caterina

AU - Di Perri, Carol

AU - Bastianello, Stefano

AU - Zippo, Antonio G.

AU - Iotti, Giorgio Antonio

AU - Biella, Gabriele E M

AU - Imberti, Roberto

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

KW - Deep brain stimulation

KW - Minimally conscious state

KW - Thalamic stimulation

KW - Unresponsive wakefulness syndrome

KW - Vegetative state

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DO - 10.3171/2015.7.JNS15700

M3 - Article

VL - 125

SP - 972

EP - 981

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

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