A recent NIH Consensus Statement (JAMA 1999 282:974) noted that 70-90,000 Americans each year incur long-term substantial loss of function from traumatic brain injury (TBI). The panel further noted that """"""""the more problematic consequences involve the individual's cognition, emotional function, and behavior."""""""" The present studies are aimed at developing pilot data to guide a controlled trial for the use of deep brain stimulation technologies in selected TBI patients: those with recovery limited to regained consciousness, minimal self-awareness, and minimal interpersonal communication. Study patients will either be in a minimally conscious state (MCS) or have emerged from a MCS but remain incapable of independent activities of daily living as measured by the Disability Rating Scale. Emergence from MCS is suggested by reliable and consistent demonstration of functional interaction. Many of these patients demonstrate preserved, but fluctuating, capacities for basic communication, memory, attention, intention, and awareness of self and environment. These observations provide clinical evidence that their limited functional capacities do not represent entirely irreversible damage. The immediate goals of the proposed studies are to define appropriate clinical and imaging criteria and outcome measures to evaluate patients for selection into deep brain stimulation studies, and to evaluate physiological measures that can aid the design of stimulation parameters. We present preliminary neuroimaging data both from patients in chronic vegetative states, and from patients with other neurological conditions with implanted deep brain stimulators that demonstrate selective functional brain activations during neurostimulation. We detail potential strategies for selection of patients and for choosing targets within the thalamic intralaminar nuclei of these patients for electrical stimulation. The strategy of selection of patients for neuromodulation of impaired cognitive function will be evaluated via neuroimaging tools and neuropsychologic evaluation. The proposal combines the unique clinical expertise and experience of neurological, functional stereotactic neurosurgical, and neurorehabilitation investigators. To achieve these goals we will develop a strong multi- disciplinary team with recognized expertise in both investigational and therapeutic studies of brain injured patient populations. The long-range goal of the studies proposed here is to provide a foundation for rational therapies for chronic cognitive disabilities following complex brain injuries.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZHD1-RRG-K (16))
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Pancrazio, Joseph J
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Weill Medical College of Cornell University
Schools of Medicine
New York
United States
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Schiff, Nicholas D (2010) Recovery of consciousness after brain injury: a mesocircuit hypothesis. Trends Neurosci 33:1-9
Owen, Adrian M; Schiff, Nicholas D; Laureys, Steven (2009) A new era of coma and consciousness science. Prog Brain Res 177:399-411
Giacino, Joseph T; Hirsch, Joy; Schiff, Nicholas et al. (2006) Functional neuroimaging applications for assessment and rehabilitation planning in patients with disorders of consciousness. Arch Phys Med Rehabil 87:S67-76
Schiff, Nicholas D (2006) Multimodal neuroimaging approaches to disorders of consciousness. J Head Trauma Rehabil 21:388-97
Laureys, Steven; Giacino, Joseph T; Schiff, Nicholas D et al. (2006) How should functional imaging of patients with disorders of consciousness contribute to their clinical rehabilitation needs? Curr Opin Neurol 19:520-7
Schiff, Nicholas D (2006) Measurements and models of cerebral function in the severely injured brain. J Neurotrauma 23:1436-49
Schiff, Nicholas D (2005) Modeling the minimally conscious state: measurements of brain function and therapeutic possibilities. Prog Brain Res 150:473-93
Schiff, N D; Rodriguez-Moreno, D; Kamal, A et al. (2005) fMRI reveals large-scale network activation in minimally conscious patients. Neurology 64:514-23
Laureys, Steven; Owen, Adrian M; Schiff, Nicholas D (2004) Brain function in coma, vegetative state, and related disorders. Lancet Neurol 3:537-46