A long-established treatment for Parkinson’s Disease may also help people suffering from the after-effects of severe head trauma, suggests a small but long-running pilot trial.
A team of researchers led by Dr. Ali Rezai, director of the Neurological Institute at Ohio State University, recruited four patients with a severe traumatic brain injury (TBI) to undergo deep brain stimulation (DBS). After two years of the therapy, all had recovered some degree of mental functioning lost following their injury. The biggest gains were seen in the patients’ ability to better manage their emotions, but there was improvement seen across different areas of cognition and attention as well.
"There are few treatment options to help these individuals,” Rezai told HealthDay. “The outcomes of this study demonstrate, however, improvements in disability, functional outcomes, independence, behavioral and emotional regulation, and self-control after two years with DBS [deep brain stimulation] treatment."
Deep brain stimulation, often used to treat Parkinson's Disease, may also help people with severe head trauma, suggests a small study. Above, an X-ray showing the placement of electrodes in the thalamic ventralis intermedius nucleus region of the brain. Photo By BSIP/UIG Via Getty Images
DBS, as Medical Daily has previously explained, involves implanting a battery-powered device outfitted with electrode leads into the brain. Electrical pulses are sent from the device to the leads and disrupt nearby neural activity. Because conditions like Parkinson’s Disease, which gradually erodes a person’s ability to move normally, involve erratic neural activity, the pulses are thought to act as a sort of a brain pacemaker, temporarily restoring a healthy rhythm of activity. The invasive treatment is relatively safe, but it can cause side-effects ranging from an increased risk of infections to hallucinations.
Though DBS is currently only approved by the FDA for Parkinson’s and other similar movement disorders, researchers have found evidence that DBS may even help people suffering from depression, epilepsy, and Tourette’s syndrome. More recent research is less encouraging with regards to depression, however.
Rezai’s study, which was published last December in the journal Neurosurgery, isn’t the first to test out DBS as a treatment for severe TBI, but it is the first to target the specific regions of the brain known as the nucleus accumbens and anterior (front) limb of the internal capsule, All four volunteers were the victims of a car accident. Though they were still able to stay alert and awake, the injury left them unable to take care of themselves without daily supervision from a caretaker. And while they still required supervision following DBS treatment, two required less assistance with their day-to-day tasks, and three were able to spend more time outside.
Encouraging as the results are, they’ll need to be replicated in larger and better-controlled trials. For instance, the patients and doctors all knew they were getting DBS, which means at least some of their improvement could have been chalked to the placebo effect. And because DBS works by shocking specific areas of the brain and severe head trauma can affect the brain differently from person to person, there may yet be room for improvement in choosing DBS targets, especially on an individual basis.
Rezai and his team plan to conduct these more extensive studies in the near future. And ultimately, they believe that DBS could someday be used to treat the 80,000 or so cases of severe head trauma that lead to disability annually, whether they’re caused by car accidents or sports injuries.
Source: Rezai A, Sederberg P, Bogner J, et al. Improved Function After Deep Brain Stimulation for Chronic, Severe Traumatic Brain Injury.
Brian P. McDonough, MD, FAAFPPeer
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