Deep brain stimulation of the mesencephalic locomotor region or lateral hypothalamus for facilitation of walking after spinal cord injury

PURPOSE OF REVIEW: Spinal cord injury (SCI) causes profound gait impairment and autonomic dysfunction. Deep brain stimulation (DBS) of supraspinal locomotor centers may strengthen spared descending motor and autonomic pathways to improve walking. Preclinical and clinical studies have targeted the cuneiform nucleus (CnF) and pedunculopontine nucleus (PPN) of the mesencephalic locomotor region (MLR) and the lateral hypothalamus. To summarize recent progress in DBS as a strategy to facilitate locomotion with a particular focus on SCI. RECENT FINDINGS: DBS of the CnF, PPN, and lateral hypothalamus enhances gait and cardiorespiratory function in animal models and early human trials. Directional electrodes and individualized programming appear to reduce risks and optimize efficacy. Evidence suggests DBS can amplify supraspinal command circuits, supporting locomotor facilitation after injury. SUMMARY: DBS of MLR and lateral hypothalamus circuits represent a promising therapeutic approach for gait recovery in SCI. Key priorities for future clinical trials include stratification by injury severity, monitoring of autonomic outcomes, and assessment of long-term effects on mobility and quality of life. Integration with physiotherapy may further augment recovery. Collectively, current findings support DBS as an emerging intervention to restore locomotor function following SCI. The use of DBS for motor recovery after SCI is investigational.