Improving recovery from stroke
This research was completed on 22 April 2009
Published on 6 October 2006
Stroke is a major cause of death and disability.1 Ongoing clinical trials suggest an exciting new treatment, which involves electrical stimulation of the brain, might help patients regain more control over movement in their arms and hands. Researchers are investigating exactly how treatment aids the brain’s recovery, so they can maximise the benefits to patients.
What's the problem and who does it affect?
Stroke is a major and growing problem
Over 100,000 people in England and Wales suffer their first stroke each year.2,3,4 About one third of those who survive are left with permanent disabilities, such as paralysis, weakness, stiffness or clumsiness, often in one of their arms or hands.5 Everyday tasks like getting dressed, eating and cooking can become difficult or even impossible.
Rehabilitative therapy can help, but many people find their symptoms stabilise after about six months. Sadly, stroke survivors often remain dependent on the help of carers for the rest of their lives.
Brain stimulator offers new hope
Preliminary results from ongoing clinical trials in North America suggest a new treatment can help people regain more control over the movement in their arms and hands,6 even if it’s been years since they suffered their stroke. Patients have an electrode surgically implanted on the surface of their brain. The electrode is turned on during rehabilitation therapy, when it stimulates the brain by applying electric currents.6
Very little is known about how this electrical stimulation helps promote the brain’s recovery. Doctors believe that finding out more about the fundamental mechanism of action would enable them to make stimulation even more effective.
What is the project trying to achieve?
What does electrical stimulation do to the brain?
Strokes can damage the pathways of nerves within the brain that control movement. Researchers suspect electrical stimulation works by encouraging alternative pathways to take over control.
The team is testing this theory by applying electrical stimuli, like those used in therapy, to slices of brain tissue in the laboratory. They are recording how individual nerve cells respond to the stimulation. They are also studying how connections between the nerves are affected, as these connections play a key role in the transmission of impulses along pathways of nerves.
Researchers are also modifying the type of electrical stimulation used to explore how this changes the nerves’ response. Modifications include changing the direction and strength of the electrical current. As the current is normally applied in pulses, they are also varying the frequency and duration of these pulses.
What are the researchers' credentials?
|Project Leader||Professor J G R Jefferys, FMedSci|
|Location||Division of Neuroscience, University of Birmingham|
|Grant awarded||6 July 2006|
|Start date||23 April 2007|
|End date||22 April 2009|
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The project leader, Professor John Jefferys, is a world expert in the interaction of electric currents with brain tissue, and has an excellent publication record in this area. He also has an international reputation for his expertise in the fundamental causes of epilepsy.
The researchers working with Professor Jefferys form one of the leading groups in the world in studying how electric currents affect the activity of nerve cells in the brain. Their previous research has helped define the exposure limits of people to low-frequency electromagnetic fields. The group’s electrophysiology laboratory is perfectly equipped for studying brain tissue.
Who stands to benefit from this research and how?
Maximising the benefits of stimulation therapy
The team hopes that everyone who has developed problems moving their arms or hands after a stroke will eventually benefit from their work – even people who had their stroke a long time ago.
The ultimate aim is to find out how to get the most of the new stimulation therapy for stroke. The results of this study may, for example, help surgeons when they’re deciding where to place electrodes in relation to the damaged tissue, or lead to changes in the type of electric current used so that it is more effective.
If patients make a better recovery, they may keep their independence and have an improved quality of life. Reducing the need for long-term care, which often continues for life, would also bring substantial cost benefits.
Research is in its early stages and this project may well prompt further laboratory studies. But any information the team reveals on how stimulation therapy affects the brain will be of major significance to the treatment of stroke – it might lead to improvements in the treatment of other neurological disorders as well.
- MacKay J, Mensah GA, Mendis S, Greenlund K. The Atlas of Heart Disease and Stroke. World Health Organization (WHO). Geneva: WHO, 2004:25.
- Mant J, Wade D, Winner S (2004) ‘Health care needs assessment: stroke’. In: Stevens A, Raftery J, Mant J, Simpson S (eds) (2004) Health care needs assessment: the epidemiologically based needs assessment reviews. Second edition. Oxford: Radcliffe Medical.
- National clinical guidelines for stroke. Second edition. Intercollegiate Stroke Working Party ROYAL COLLEGE OF PHYSICIANS ISBN 1 86016 208 8.
- Mitchell E, Moore K. Stroke: Hollistic care and management. Nursing Standard 2004;33(18):43-52.
- Aziz NA, Leonardi-Bee J, Walker MF, Phillips M, Gladman JRF, Legg L. Therapy-based rehabilitation services for patients living at home more than one year after stroke. (Protocol) Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD005952. DOI: 10.1002/14651858.CD005952
- Brown JA, Lutsep, H, Weinand M and Cramer S . Motor cortex stimulation for the enhancement of recovery from stroke: a prospective, multicenter safety study. Neurosurgery 2006;58:3:464-72.