Clinical utility of brain stimulation modalities following traumatic brain injury: current evidence

Abstract

Traumatic brain injury (TBI) remains the main cause of disability and a major public health problem worldwide. This review focuses on the neurophysiology of TBI, and the rationale and current state of evidence of clinical application of brain stimulation to promote TBI recovery, particularly on consciousness, cognitive function, motor impairments, and psychiatric conditions. We discuss the mechanisms of different brain stimulation techniques including major noninvasive and invasive stimulations. Thus far, most noninvasive brain stimulation interventions have been nontargeted and focused on the chronic phase of recovery after TBI. In the acute stages, there is limited available evidence of the efficacy and safety of brain stimulation to improve functional outcomes. Comparing the studies across different techniques, transcranial direct current stimulation is the intervention that currently has the higher number of properly designed clinical trials, though total number is still small. We recognize the need for larger studies with target neuroplasticity modulation to fully explore the benefits of brain stimulation to effect TBI recovery during different stages of recovery.

Combination therapies for neurobehavioral and cognitive recovery after experimental traumatic brain injury: Is more better?

“…Stem cell implantation combined with EE and therapies directed at attenuating neuroinflammation produced the highest number of successes and thus these viable promising approaches warrant continued research. Other non-pharmacological therapies that have shown some success when provided singly include electrical and magnetic brain stimulation (Li et al, 2015; Zhang et al, 2015; Clayton et al, 2016), constrained-induced movement therapy (Brady and Garcia, 2009) and low-level laser therapy (Oron et al, 2012; Xuan et al, 2013) and may potentially be more effective when augmented by a secondary therapy. Lastly, it is important that potential therapies be evaluated by several independent groups so that the results are replicated.…”

Brain stimulation: Neuromodulation as a potential treatment for motor recovery following traumatic brain injury

“…Dhaliwal et al (2015) and Li et al (2015) have both recently reviewed the potential use of brain stimulation in TBI survivors. While most of the studies they review focus on non-motor impairments, they directly speak to the relative safety and potential benefit of brain stimulation in TBI individuals.…”

“…While most of the studies they review focus on non-motor impairments, they directly speak to the relative safety and potential benefit of brain stimulation in TBI individuals. Several studies demonstrate that rTMS and tDCS can reduce TBI related depression, tinnitus, neglect, and memory and attention disorders (see review: (Dhaliwal et al, 2015; Li et al, 2015)). Middleton et al (2014) also report that bi-hemispheric tDCS in two TBI survivors (one individual had a stroke and TBI) improved upper-extremity Fugl-Meyer scores for up to 6 months post-treatment (Middleton et al, 2014).…”

“…There is a growing interest in the potential use of brain stimulation to facilitate recovery of motor function following TBI (Adkins, 2015; Dhaliwal et al, 2015; Li et al, 2015). Until recently, CS was thought to be potentially unsafe for TBI survivors given that TBIs often result in a lower threshold for seizures.…”

Scales for assessment of patients with traumatic brain injury

“…Our group has great interest in the assessment of functional recovery of TBI patients analyzed by different scales, in particular, patients with severe diffuse axonal injury (DAI). 3 , 4 As discussed by Ślusarz et al, 1 the evaluation of consciousness is a widely used prognostic parameter in the acute phase of trauma and identifies early the outcome of patients with severe TBI, and it is relevant in the face of the impairment of brain functions caused after TBI and the mechanisms involved in the recovery process. Clinical observations of TBI patients have suggested improvement during the first year, particularly during the first 6 months, with stabilizing of the recovery process thereafter.…”