Hypothalamic DBS therapy improves recovery of lower extremity movements after spinal cord injury

Hypothalamic DBS therapy improves recovery of lower extremity movements after spinal cord injury

Researchers from EPFL and Lausanne University Hospital (CHUV), led by Professors Grégoire Courtine and Jocelyne Bloch, have reached a major milestone in the treatment of spinal cord injury (SCI). By applying deep brain stimulation (DBS) to an unexpected region in the brain – the lateral hypothalamus (LH) – the team improved recovery of lower extremity movements in two people with partial SCI, significantly improving their autonomy and well-being.

Wolfgang Jäger, a 54-year-old from Kappel, Austria, has been in a wheelchair since 2006. When he participated in the clinical trial, he saw firsthand how deep brain stimulation could restore his mobility and independence. “Last year on vacation, it was no problem to walk a few steps down and back into the ocean with the stimulation,” Jaeger shared, describing the newfound freedom that DBS has given him. Beyond walking, the therapy has improved everyday tasks. “I can also reach things in my cupboards in the kitchen,” he added.

DBS is an established neurosurgical technique in which electrodes are implanted into specific brain regions to modulate neuronal activity. Traditionally, DBS has been used to treat movement disorders such as Parkinson's disease and tremor by targeting areas of the brain responsible for motor control. However, applying DBs to the lateral hypothalamus to treat partial paralysis is a new approach. By focusing on the LH, researchers are at. Neurorestore tapped into an unexpected neural pathway that had not previously been considered for motor recovery.

In the study published innatural medicine,Not only did the DBS show immediate results in extending walking during rehabilitation, but patients also showed long-term improvement that persisted even with stimulation turned off. These results suggest that the treatment promoted reorganization of remaining nerve fibers, contributing to sustained neurological improvements.

This research shows that the brain is needed to recover from paralysis. Surprisingly, the brain cannot fully utilize the neuronal projections that survive after a spinal cord injury. Here we discovered how to use a small region of the brain that was not known to be involved in producing walking to balance these remaining connections and increase neurological recovery in people with spinal cord injuries. “

Grégoire Courtine, Professor of Neuroscience at EPFL, the Lausanne University Hospital (CHUV) and a Unil and co-director of the Neurorestore Center

Basic neuroscience combined with neurosurgical precision

The success of this DBS therapy hinged on two complementary approaches: discoveries made possible by new methods in animal studies and the translation of these discoveries into precise surgical techniques in humans. For the operation, researchers used detailed brain scans to guide the exact locations of small electrodes into the brain, performed by Bloch in Chuv while the patient was fully awake.

“Once the electrode was in place and we applied the stimulation, the first patient immediately said, 'I feel my legs.' As we increased the stimulation, she said, 'I have the urge to walk!' This real-time feedback confirmed that we were targeting the correct region, even if that region had never been associated with leg control at that moment. “says Bloch, neurosurgeon and professor at Lausanne University Hospital (CHUV), UNIL and EPFL and co-director of the .neurorestore center.

The role of the lateral hypothalamus in recovery from walking

The identification of the LH as an important player in motor recovery after paralysis is in itself an important scientific discovery, as this region has traditionally been associated only with functions such as arousal and feeding. This breakthrough arose from the development of a novel multistage methodology that began with anatomical and functional mapping of the whole brain to determine the role of this region in walking, followed by experiments in preclinical models to identify the precise circuits involved in recovery. Ultimately, these results led to clinical trials in human participants.

"It was fundamental research through the creation of detailed brain-wide maps that allowed us to identify the lateral hypothalamus in walking recovery. Without this fundamental work, we would not have uncovered the unexpected role that this region plays in walking recovery," says Jordan Squair, a lead author of the study.

The advanced imaging platform at the WYSS Center played a critical role in this research by providing high-resolution imaging capabilities that allowed the team to image the anatomical and functional activity of neurons throughout the brain, enabling the identification of the lateral hypothalamus.

Combining DBs with spinal implants for enhanced recovery

These remarkable results pave the way for new therapeutic applications to enhance recovery from SCI. Future research will explore the integration of DBs with other technologies, such as: B. Spinal implants, which have already shown their potential to restore motion after SCI. “Integrating our two approaches – brain and spinal stimulation – provides patients with spinal cord injuries a more comprehensive recovery strategy,” says Courtine.

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