Professor Alex Green's keynote lecture at the 'Consciousness: an interdisciplinary conference'.
Minimally Conscious State (MCS) has a prevalence of 1.5:100,000 and most commonly affects young people after severe traumatic brain injury. It is a state of wakefulness characterised by minimal but clearly discernible behavioural evidence of self or environmental awareness, accompanied by an increase in slow wave activity and reduction of faster brain rhythms. Deep Brain Stimulation (DBS) is a common therapy for movement disorders such as Parkinson’s disease. In MCS, DBS of various targets such as the thalamus have shown mixed results although good evidence is lacking. It is devastating both for the individual and their family and there is no proven efficacious treatment. We have previously demonstrated that Deep Brain Stimulation (DBS) of the Pedunculopontine Nucleus (PPN) in the brainstem can increase daytime vigilance and alter sleep states. Combined with our program of device development in this area, we will conduct a clinical first-in-man study of ten MCS subjects, using Oxford’s 'DyNEuMo' (Dynamic Neuromodulation System) DBS device designed by Prof Tim Denison, a collaborator in the Department of Engineering at Oxford. Primary endpoint is measurement of the Coma Recovery Scale (Revised) – CRS-R. Secondary endpoints will include quality of life, and the investigation of EEG and local field potentials (LFPs) recorded from the device to investigate whether we can use brain electrical activity to control the device in a closed loop manner. We will also investigate whole brain activity using fMRI and look at the effects of Transcranial Magnetic Stimulation (TMS) as a means to predict responders. If the trial is successful we will use the pilot data for a larger phase II/III trial.
Recorded at St Anne's College on 12 April 2023.
