The aim of this clinical trial is to determine whether deep brain stimulation (DBS) interventions improve rehabilitation and functional recovery in patients with post-stroke spasticity who meet the other inclusion criteria listed below.
Primary question(s) to be answered:
Is DBS stimulation effective in treating post-stroke spasticity? What stimulation frequency is most effective in treating post-stroke spasticity?
Study participants will:
* Undergo surgery to implant a DBS electrode targeting the DRTt (dentate-rubro-thalamic tract ) in close proximity of the dentate nucleus of the cerebellum ipsilateral to the spastic side of the body. * Each patient will then receive an initial stimulation frequency of 130 Hz (arm 1) and will be assigned to a 4- to 6-week rehabilitation program. After this period, the participant will return for a follow-up visit for a clinical evaluation. * The frequency will then be changed to 70Hz (arm 2). Patients who have undergone this change will also undergo a rehabilitation period of 4 to 6 weeks. After this period, they will return to the Clinic for a follow-up evaluation. * The frequency will then be changed to 30Hz (arm 3). Patients who have undergone this change will also undergo a rehabilitation period of 4 to 6 weeks.
Researchers will compare the results obtained from patients in each arm to determine the clinical effects of stimulation and whether they are dependent on the stimulation frequency.
One time stroke that occurred 9-36 months ago
Ischemic or hemorrhagic stroke
Spastic paresis of at least one limb
At least 3 months of poststroke rehabilitation in the past
Seizures after the stroke
Depression
Severe sensory deficits
Anosognosia
Crossover
Deep brain stimulation electrode implantation with an electrode target in the dentate nucleus
Procedure/SurgeryThe intervention will involve implantation of a directional electrode with a target in the dentate nucleus of the cerebellum, ipsilateral to the limbs affected by spasticity. Electrode implantation will be performed using a stereotaxic frame, following prior planning of the electrode trajectory and tractography of the dento-ruborothalamic tract using a planning station. The procedure will be performed under general anesthesia. The IPG stimulator will be placed in the subclavicular region.
Increase of FMA score after the rehabilitation with stimulation dentate-rubro-thalamic tract.
Increase of FMA score after the rehabilitation
Decrease of Ashworth Scale score after the rehabilitation with dentate-rubro-thalamic tract
Decrease of Ashworth Scale score
Improvement in motor function achieves in Motor Assessment Scale MAS with stimulation dentate-rubro-thalamic tract
Improvement in motor function achieves in Motor Assessment Scale
Improvement in Modified Rankin Scale after the rehabilitation with stimulation of dentato-rubro-thalamic tract
Improvement in Modified Rankin Scale
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