Central thalamic deep brain stimulation for cognitive neuromodulation - a review of proposed mechanisms and investigational studies.

Publication Type	Review
Authors	Shah S, Schiff N
Journal	Eur J Neurosci
Volume	32
Issue	7
Pagination	1135-44
Date Published	10/01/2010
ISSN	1460-9568
Keywords	Cognition, Coma, Deep Brain Stimulation, Persistent Vegetative State, Thalamus
Abstract	We review the history of efforts to apply central thalamic deep brain stimulation (CT/DBS) to restore consciousness in patients in a coma or vegetative state by changing the arousal state. Early experimental and clinical studies, and the results of a recent single-subject human study that demonstrated both immediate behavioral facilitation and carry-over effects of CT/DBS are reviewed. We consider possible mechanisms underlying CT/DBS effects on cognitively-mediated behaviors in conscious patients in light of the anatomical connectivity and physiological specializations of the central thalamus. Immediate and carry-over effects of CT/DBS are discussed within the context of possible effects on neuronal plasticity and gene expression. We conclude that CT/DBS should be studied as a therapeutic intervention to improve impaired cognitive function in severely brain-injured patients who, in addition to demonstrating clinical evidence of consciousness and goal-directed behavior, retain sufficient preservation of large-scale cerebral networks within the anterior forebrain. Although available data provide evidence for proof-of-concept, very significant challenges for study design and development of CT/DBS for clinical use are identified.
DOI	10.1111/j.1460-9568.2010.07420.x
PubMed ID	21039953
PubMed Central ID	PMC3058925