Brain plasticity after implanted peroneal nerve electrical stimulation to improve gait in chronic stroke patients: Two case reports

Article type: Case Report

Authors: Thibaut, Aurore^{a; b; *} | Moissenet, Florent^c | Di Perri, Carol^a | Schreiber, Céline^c | Remacle, Angélique^c | Kolanowski, Elisabeth^c | Chantraine, Frédéric^c | Bernard, Claire^d | Hustinx, Roland^d | Tshibanda, Jean-Flory^{a; e} | Filipetti, Paul^c | Laureys, Steven^a | Gosseries, Olivia^{a; f}

Affiliations: [a] Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium | [b] Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA | [c] CNRFR - Rehazenter, Laboratoire d’Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg | [d] Department of Nuclear Medicine, University Hospital of Liege, Liege, Belgium | [e] Department of Neuroimagery, University Hospital of Liege, Liege, Belgium | [f] Department of Psychiatry, University of Wisconsin, Madison, WI, USA

Correspondence: [*] Address for correspondence: Aurore Thibaut, Coma Science Group, CHU Sart Tilman, GIGA-Research B34-Quartier Hôpital, Avenue de l’Hôpital, 11, 4000 Liège, Belgium. Tel.: +32 4 366 97 93; Fax: +32 4 366 84 49; E-mail: athibaut@ulg.ac.be.

Abstract: BACKGROUND: Recent studies have shown that stimulation of the peroneal nerve using an implantable 4-channel peroneal nerve stimulator could improve gait in stroke patients. OBJECTIVES: To assess structural cortical and regional cerebral metabolism changes associated with an implanted peroneal nerve electrical stimulator to correct foot drop related to a central nervous system lesion. METHODS: Two stroke patients presenting a foot drop related to a central nervous system lesion were implanted with an implanted peroneal nerve electrical stimulator. Both patients underwent clinical evaluations before implantation and one year after the activation of the stimulator. Structural magnetic resonance imaging (MRI) and [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) were acquired before and one year after the activation of the stimulator. RESULTS: Foot drop was corrected for both patients after the implantation of the stimulator. After one year of treatment, patient 1 improved in three major clinical tests, while patient 2 only improved in one test. Prior to treatment, FDG-PET showed a significant hypometabolism in premotor, primary and supplementary motor areas in both patients as compared to controls, with patient 2 presenting more widespread hypometabolism. One year after the activation of the stimulator, both patients showed significantly less hypometabolism in the damaged motor cortex. No difference was observed on the structural MRI. CONCLUSION: Clinical improvement of gait under peroneal nerve electrical stimulation in chronic stroke patients presenting foot drop was paralleled to metabolic changes in the damaged motor cortex.

Keywords: Functional electrical stimulation, brain plasticity, stroke, positron emission tomography, ActiGait, motor deficit, gait

DOI: 10.3233/NRE-161410

Journal: NeuroRehabilitation, vol. 40, no. 2, pp. 251-258, 2017