scholarly journals Deep brain stimulation for the treatment of disorders of consciousness and cognition in traumatic brain injury patients: a review

2018 ◽  
Vol 45 (2) ◽  
pp. E14 ◽  
Author(s):  
Bornali Kundu ◽  
Andrea A. Brock ◽  
Dario J. Englot ◽  
Christopher R. Butson ◽  
John D. Rolston
Keyword(s):  
Traumatic Brain Injury ◽  
Executive Function ◽  
Deep Brain Stimulation ◽  
Brain Injury ◽  
Brain Stimulation ◽  
Minimally Conscious State ◽  
Disorders Of Consciousness ◽  
Future Research ◽  
Attention And Memory ◽  
Deep Brain

Traumatic brain injury (TBI) is a looming epidemic, growing most rapidly in the elderly population. Some of the most devastating sequelae of TBI are related to depressed levels of consciousness (e.g., coma, minimally conscious state) or deficits in executive function. To date, pharmacological and rehabilitative therapies to treat these sequelae are limited. Deep brain stimulation (DBS) has been used to treat a number of pathologies, including Parkinson disease, essential tremor, and epilepsy. Animal and clinical research shows that targets addressing depressed levels of consciousness include components of the ascending reticular activating system and areas of the thalamus. Targets for improving executive function are more varied and include areas that modulate attention and memory, such as the frontal and prefrontal cortex, fornix, nucleus accumbens, internal capsule, thalamus, and some brainstem nuclei. The authors review the literature addressing the use of DBS to treat higher-order cognitive dysfunction and disorders of consciousness in TBI patients, while also offering suggestions on directions for future research.

scholarly journals Improved Function After Deep Brain Stimulation for Chronic, Severe Traumatic Brain Injury

Neurosurgery ◽  
2016 ◽  
Vol 79 (2) ◽  
pp. 204-211 ◽  
Author(s):  
Ali R. Rezai ◽  
Per B. Sederberg ◽  
Jennifer Bogner ◽  
Dylan M. Nielson ◽  
Jun Zhang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Prefrontal Cortex ◽  
Deep Brain Stimulation ◽  
Brain Injury ◽  
Brain Stimulation ◽  
Severe Traumatic Brain Injury ◽  
Emotional Adjustment ◽  
Functional Independence ◽  
Potential Effectiveness ◽  
Deep Brain

Abstract BACKGROUND: Severe traumatic brain injury (TBI) damages the frontal lobes and connecting networks, which impairs executive functions, including the ability to self-regulate. Despite significant disabling effects, there are few treatment options in the chronic phase after injury. OBJECTIVE: To investigate the safety and potential effectiveness of deep brain stimulation (DBS) for individuals with chronic, disabling TBI and problems of behavioral and emotional self-regulation. METHODS: This study was an open-label, prospective design with serial assessments of behavioral outcomes and positron emission tomography 2 years after DBS implantation. Four participants 6 to 21 years after severe TBIs from automobile crashes were included. Although alert and volitional, all experienced significant executive impairments, including either impulsivity or reduced initiation. DBS implants were placed bilaterally in the nucleus accumbens and anterior limb of the internal capsule to modulate the prefrontal cortex. RESULTS: The procedure was safe, and all participants had improved functional outcomes. Two years after implantation, 3 met a priori criteria for improvement on the Mayo-Portland Adaptability Inventory-4. Improvement was due largely to better emotional adjustment, although 1 participant showed marked increases in multiple domains. Significant improvement in a composite score of functional capacity indicated improved independence in self-care and activities of daily living. The pattern of change in cognition corresponded with changes in activation of the prefrontal cortex observed in serial scanning. CONCLUSION: This first study of DBS to this target for severe TBI supports its safety and suggests potential effectiveness to improve function years after injury. The primary impact was on behavioral and emotional adjustment, which in turn improved functional independence. Supplemental Digital Content is Available in the Text. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.neurosurgery-online.com).

scholarly journals Anesthesia for deep brain stimulation in traumatic brain injury‐induced hemidystonia

2015 ◽  
Vol 3 (6) ◽  
pp. 492-495 ◽  
Author(s):  
Jill M. Jani ◽  
Chima O. Oluigbo ◽  
Srijaya K. Reddy
Keyword(s):  
Traumatic Brain Injury ◽  
Deep Brain Stimulation ◽  
Brain Injury ◽  
Brain Stimulation ◽  
Deep Brain

Medial Septal Nucleus Theta Frequency Deep Brain Stimulation Improves Spatial Working Memory after Traumatic Brain Injury

2013 ◽  
Vol 30 (2) ◽  
pp. 131-139 ◽  
Author(s):  
Darrin J. Lee ◽  
Gene G. Gurkoff ◽  
Ali Izadi ◽  
Robert F. Berman ◽  
Arne D. Ekstrom ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Working Memory ◽  
Deep Brain Stimulation ◽  
Brain Injury ◽  
Brain Stimulation ◽  
Spatial Working Memory ◽  
Septal Nucleus ◽  
Theta Frequency ◽  
Medial Septal Nucleus ◽  
Deep Brain

scholarly journals Temporally-patterned deep brain stimulation in a mouse model of multiple traumatic brain injury

2014 ◽  
Vol 273 ◽  
pp. 123-132 ◽  
Author(s):  
Inna Tabansky ◽  
Amy Wells Quinkert ◽  
Nadera Rahman ◽  
Salomon Zev Muller ◽  
Jesper Lofgren ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Deep Brain Stimulation ◽  
Brain Injury ◽  
Mouse Model ◽  
Brain Stimulation ◽  
Deep Brain

scholarly journals The Effect of Non-Invasive Brain Stimulation (NIBS) on Executive Functioning, Attention and Memory in Rehabilitation Patients with Traumatic Brain Injury: A Systematic Review

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 627
Author(s):  
Takatoshi Hara ◽  
Aturan Shanmugalingam ◽  
Amanda McIntyre ◽  
Amer M. Burhan
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Brain Injury ◽  
Brain Stimulation ◽  
Control Group ◽  
Attention And Memory ◽  
Stimulation Site ◽  
Non Invasive

In recent years, the potential of non-invasive brain stimulation (NIBS) for therapeutic effects on cognitive functions has been explored for populations with traumatic brain injury (TBI). However, there is no systematic NIBS review of TBI cognitive impairment with a focus on stimulation sites and stimulation parameters. The purpose of this study was to conduct a systematic review examining the effectiveness and safety of NIBS for cognitive impairment after a TBI. This study was prospectively registered with the PROSPERO database of systematic reviews (CRD42020183298). All English articles from the following databases were searched from inception up to 31 December 2020: Pubmed/MEDLINE, Scopus, CINAHL, Embase, PsycINFO and CENTRAL. Randomized and prospective controlled trials, including cross-over studies, were included for analysis. Studies with at least five individuals with TBI, whereby at least five sessions of NIBS were provided and used standardized neuropsychological measurement of cognition, were included. A total of five studies met eligibility criteria. Two studies used repetitive transcranial magnetic stimulation (rTMS) and three studies used transcranial direct current stimulation (tDCS). The pooled sample size was 44 individuals for rTMS and 91 for tDCS. Three of five studies combined cognitive training or additional therapy (computer assisted) with NIBS. Regarding rTMS, target symptoms included attention (n = 2), memory (n = 1), and executive function (n = 2); only one study showing significant improvement compared than control group with respect to attention. In tDCS studies, target symptoms included cognition (n = 2), attention (n = 3), memory (n = 3), working memory (WM) (n = 3), and executive function (n = 1); two of three studies showed significant improvement compared to the control group with respect to attention and memory. The evidence for NIBS effectiveness in rehabilitation of cognitive function in TBI is still in its infancy, more studies are needed. In all studies, dorsolateral prefrontal cortex (DLPFC) was selected as the stimulation site, along with the stimulation pattern promoting the activation of the left DLPFC. In some studies, there was a significant improvement compared to the control group, but neither rTMS nor tDCS had sufficient evidence of effectiveness. To the establishment of evidence we need the evaluation of brain activity at the stimulation site and related areas using neuroimaging on how NIBS acts on the neural network.

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