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Nearly half of those who survive a stroke end up with a permanent disability severe enough that they need help to get through daily life. But a clinical trial testing a new approach to restoring movement to patients paralyzed by stroke is showing some early promise.
Cleveland Clinic researchers, led by neurosurgeon Andre Machado, MD, PhD and neuroscientist Kenneth Baker, PhD, are testing deep brain stimulation (DBS), a procedure used to treat Parkinson’s disease and other neurological conditions, on patients who make little progress with traditional physical therapy following a disabling stroke.
The researchers theorize that DBS, combined with physical therapy, can help the patient’s brain rewire itself and form new connections around the area damaged by stroke.
Improved ability to move
A woman was the first to undergo the procedure in December 2016. Paralyzed on one side following a stroke, she now sees improvement in her ability to move since undergoing DBS and physical therapy earlier this year.
The woman reports that for the first time since her stroke, she can use her affected arm for such activities as cooking and playing games with her grandchildren. She also can more efficiently complete a number of daily tasks, such as folding laundry.
“Within a few weeks she could move her arm in a way she had not been able to since the stroke. And she has made steady progress after the surgery,” Dr. Machado says. “Week after week, month after month, her function continues to improve.”
Forming new connections
In DBS, neurosurgeons place electrode leads into precisely targeted regions of the brain affected by the stroke. They connect the electrode with a wire beneath the skin to a pacemaker-like pulse generator, which is implanted in the chest.
The pacemaker-like device sends tiny electric pulses to the electrode, which encourages the brain to form new connections that bypass the damaged area, Dr. Machado says.
“That’s the hypothesis of our trial — that DBS targeting a particular brain area, the dentate nucleus of the cerebellum, can allow these patients to regain more function from therapy than they could with therapy alone,” Dr. Machado says.
The research team is tracking the study participants’ progress through a number of tests that measure arm and hand function. The researchers believe the woman has not yet reached her full potential of restored movement.
“After four months of DBS plus therapy, this patient’s function has not plateaued,” Dr. Machado says. “We haven’t yet found the limits of how much she can improve. This makes us hopeful that this strategy will help other patients too.”
Twelve people will eventually be enrolled in the clinical trial, which has approval from the Food and Drug Administration and support from the National Institutes of Health.
Although the early results are encouraging, Dr. Machado cautions that to be truly successful, the procedure must produce similar results in other patients.
“We look forward to learning much more as this trial continues,” Dr. Machado says. “We need a tool that enhances the effects of therapy alone. This first patient gives us hope that help may be on the way.”