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Central thalamic deep brain stimulation for cognitive neuromodulation – a review of proposed mechanisms and investigational studies
Author(s) -
Shah Sudhin A.,
Schiff Nicholas D.
Publication year - 2010
Publication title -
european journal of neuroscience
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.346
H-Index - 206
eISSN - 1460-9568
pISSN - 0953-816X
DOI - 10.1111/j.1460-9568.2010.07420.x
Subject(s) - deep brain stimulation , neuroscience , neuromodulation , context (archaeology) , psychology , cognition , neuroplasticity , thalamus , minimally conscious state , persistent vegetative state , medicine , stimulation , consciousness , biology , paleontology , disease , pathology , parkinson's disease
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.