Hypothalamic Deep Brain Stimulation (DBSLH)
SCI disrupts communication between the brain and the lumbar spinal networks required for walking (Arber & Costa 2018; Courtine & Sofroniew 2019). In cases of incomplete SCI, reorganization of remaining descending pathways may allow partial recovery of locomotor function (Cho et al. 2024). Recent research has identified the lateral hypothalamus (LH) as a brain region activated during walking in healthy individuals, leading to investigation of hypothalamic deep brain stimulation (DBSLH) as a potential therapeutic strategy. Preliminary evidence from a pilot clinical study suggests that DBSLH, combined with rehabilitation, may safely enhance walking performance (10MWT, 6MWT) and lower extremity strength (LEMS) in individuals with chronic, incomplete SCI. While these findings are promising, they remain early-stage, and larger studies are required to more firmly establish the safety and efficacy of this approach.
Discussion
Cho et al. (2024) aimed to identify brain regions that steer the recovery of walking after incomplete SCI. Before conducting the pilot clinical trial, the authors acquired functional magnetic resonance imaging (fMRI) data from 21 healthy people showing bilateral activations of the lateral hypothalamus (LH) during walking (Cho et al. 2024). Following this, the authors translated this discovery into a pilot clinical trial with deep brain stimulation therapy of the LH (DBSLH) in two individuals with incomplete SCI (Cho et al. 2024). It was shown that DBSLH immediately improved walking and, in conjunction with rehabilitation, mediated functional recovery that persisted when DBSLH was turned off, without serious AEs (Cho et al. 2024). Further trials should be performed in larger studies to more firmly establish the safety and efficacy of DBSLH, including potential changes in body weight, psychological status, hormonal profiles and autonomic functions (Cho et al. 2024).
Conclusions
There is level 4 evidence (from 1 pre-post study: Cho et al. 2024) that a DBSLH was safe and, with the addition of rehabilitation, that improved walking and functional recovery (10MWT, 6MWT, and LEMS) in two participants with chronic and incomplete SCI.
