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

Ali R Rezai1, Per B Sederberg, Jennifer Bogner

  • 1Departments of *Neurological Surgery and Center for Neuromodulation, ‡Psychology, §Physical Medicine and Rehabilitation, and ¶Radiology, The Ohio State University, Columbus, Ohio.

Neurosurgery
|December 26, 2015
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Summary

Deep brain stimulation (DBS) is safe for chronic traumatic brain injury (TBI). This treatment improved self-regulation and functional independence in patients with severe TBI.

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Area of Science:

  • Neuroscience
  • Neurosurgery
  • Neurology

Background:

  • Severe traumatic brain injury (TBI) often damages frontal lobes, impairing executive functions like self-regulation.
  • Limited treatment options exist for chronic TBI, particularly for disabling executive dysfunction.

Purpose of the Study:

  • To assess the safety and effectiveness of deep brain stimulation (DBS) for individuals with chronic TBI and self-regulation deficits.
  • To investigate DBS's impact on behavioral and emotional regulation in TBI survivors.

Main Methods:

  • Open-label, prospective study involving 4 participants with severe TBI (6-21 years post-injury).
  • Bilateral DBS implants targeting the nucleus accumbens (NAcc) and anterior limb of the internal capsule (IC).
  • Serial assessments of behavioral outcomes and prefrontal cortex activity via positron emission tomography (PET) over 2 years.

Main Results:

  • DBS procedure was safe with improved functional outcomes observed.
  • 3 out of 4 participants met criteria for improvement on the Mayo-Portland Adaptability Inventory-4 (MPAI-4).
  • Improvements noted in emotional adjustment, functional capacity, and prefrontal cortex activation, correlating with cognitive changes.

Conclusions:

  • This study supports the safety of DBS targeting the NAcc and IC for severe TBI.
  • DBS shows potential effectiveness in improving behavioral and emotional self-regulation and functional independence years after TBI.