Research Reports - Improved function after deep brain stimulation for traumatic brain injury

Neurosurgery. 2015 Dec 21. [Epub ahead of print]

Rezai AR(1), Sederberg PB, Bogner J, Nielson DM, Zhang J, Mysiw WJ, Knopp MV,
Corrigan JD.

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.
ABBREVIATIONS: DBS, deep brain stimulationIC, internal capsuleMPAI-4,
Mayo-Portland Adaptability Inventory-4NAcc, nucleus accumbensTBI, traumatic brain
injury. 

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