For more than 40 years, Stan Nicholas has been seen playing guitar on weekends and attending bike rallies and festivals around Cleveland. The Ford retired and the rock and blues of the Burnt River Band had been attracting crowds since his teenage years. Nicholas thought he would play for the rest of his life, but one night in 2017 the music stopped in front of him.
A 66-year-old man living alone was making mashed potatoes for dinner when he lost his balance and fell to the floor, unable to get up.
“I broke my knee every time I climbed halfway up and then fell again,” Nicolas recalled.
Nicholas was one of about 795,000 people in the United States. stroke every year.
Stroke is the fifth leading cause of death in the United States, but it’s also one of the leading causes of disability. So far, physical and occupational therapy are the only options to help people like Nicholas, but they weren’t enough to restore all his physical abilities.
Nicholas volunteered to be one of the first people in the world to try to restore bodily function with the help of tiny devices implanted in his brain and chest. Doctors hoped that the device would also stimulate parts of the brain that were failing to start working. The stroke seemed to go away.
The results, detailed in a study published Monday in the journal Nature Medicine, are encouraging for Nicholas and, if replicated, for thousands of people left disabled by stroke. The results can be promising.
After that dreadful night in 2017, Nicholas underwent months of physical and occupational therapy to regain some, but not all, of his abilities.
“I thought I would be disabled for the rest of my life, so walking again was a priority,” he said.
Movement on the left side was still very difficult. Early scans showed that one of the brain’s major arteries had lost its blood supply, part of the right brain had died, and the left side of the body was affected.
He worked hard on his treatment and started walking a little. He got some movement in his shoulders and elbows as well, but at first his hands didn’t want to move at all. Eventually I got better at grabbing his things, but it seemed impossible to move his wrist up and down or even open his hand.
About a year after his stroke and after several months of PT treatment, doctors thought that was the extent of his progress.
“It was a disappointment,” he said neurosurgeon Dr. Andre Machado of the Cleveland Clinic who treated Nicolas. “Despite his early improvement, he was stable. He was no longer improving, so it was unlikely he would improve on his own.”
For years, Machado has worked on a technique called deep brain stimulation. In this technology, doctors implant electrodes in specific areas of the brain to generate electrical impulses to control abnormal impulses. He used the method successfully with Parkinson’s disease, but it was ineffective with stroke.
In previous trials, researchers had attempted to use this technique to directly stimulate the part of the brain where the stroke occurred. Machado said the idea was initially promising, but it didn’t pan out in large-scale clinical trials.
“We had to innovate,” Machado said.
Instead of stimulating the part of the brain where the stroke occurred, he thought, maybe a part of the cerebellum called the dentate nucleus should be stimulated.
The cerebellum helps balance. It is related to walking and hand movements. The dentate nucleus helps collect information from the cerebellum and transmit it to the cerebral cortex. Machado reasoned that its high degree of connectivity might make it a suitable pathway for reflecting the effects of stimulation on other parts of the brain, including those that died from a stroke.
Nicholas read about the piece online and applied to participate in Machado’s trial. After he went through an extensive screening process and had conversations with doctors and psychiatrists, a neurosurgeon asked him if he wanted to undergo this experimental procedure for the first time in the world. Nicholas was the winner.
“I was ready to withdraw and quit”
Doctors did not operate immediately. First, Nicholas needed more physical therapy from Machado’s team to establish a new baseline and see how much that alone would improve him. Then came the day of surgery.
“It was scary,” said Nicholas. “I was ready to withdraw and quit.”
Like any surgery, this surgery had its risks. It could be ineffective, worse, and even slightly fatal.
“I had no idea how much profit it would make,” Machado said.
But after talking with friends, he became convinced that surgery was the best option.
Machado respects those who actively participate in research.
“There is a certain amount of altruism in patients who participate in clinical trials. I also want you to,” he said.
Nicholas’ surgery involved placing electrodes, or wires, in the cerebellum at the back of his brain. Doctors attached the wires to a small device under the skin on her chest.
He said he was relieved when Nicolas woke up recovering.
“I was worried that I would lose my memory and not be able to recognize people,” he says. “So I’m just trying to remember what I can do, who I am, what I was there for, what I’ve done, remember my family, and make sure I’m still intact. , began to identify himself as me.”
Nicolas’ first goal was to return to physical therapy, and after a few months, doctors turned on his deep brain stimulation system. They adjusted it for several weeks while Nicholas did more physical therapy.
After a few months, Nicholas began to see the device working. His left hand and arm began to move, though he couldn’t feel it in his head. He began to find it easier to do things around the house like washing dishes, gardening, cooking and cleaning up. He also began to walk more easily.
“Without the surgery, I would have been much more disabled than I am now,” said Nicholas, adding that he would not be able to live alone. He estimates he’s 40% to 50% better than he would have been if he had done physical therapy alone.
Machado said he was “pleasantly surprised” by everything Nicholas could do. On a scale that doctors commonly use to assess recovery from stroke (improvement is about 6 to 8 points), he would rate the improvement during the trial at about 15 points.
“He’s actually been able to do things that are useful in his daily life again,” Machado said. “The whole team was very happy.”
As part of the trial, doctors removed the device and Nicholas is no longer on PT. He hopes to play the guitar again someday, but so far his progress has been remarkable.
“It was the greatest feeling in the world. I was so happy, so confident,” Nicholas said. “There was hope.”
Machado believes deep brain stimulation, in addition to physical therapy, has the potential to improve movement in more people, even years after a stroke.
“This could move from current hopes to treatments that will probably become the standard of care in the future,” he said.