Model System:

TBI

Reference Type:

Journal

Accession No.:

J76088

Journal:


Neurosurgery

Year, Volume, Issue, Page(s):

, 79, 2, 204-211

Publication Website:

Abstract:

Study investigated the safety and potential effectiveness of deep brain stimulation (DBS) for individuals with chronic, disabling traumatic brain injury (TBI) and problems of behavioral and emotional self-regulation. Four participants were included in this study 6 to 21 years after severe TBIs from automobile crashes. 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. Serial assessments of behavioral outcomes and positron emission tomography were performed 2 years after DBS implantation. Results indicated that the procedure was safe, and all participants had improved functional outcomes. Two years after implantation, 3 of the 4 subjects 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. This study of DBS for severe TBI supports its safety and suggests its potential effectiveness to improve function years after injury. The primary impact was on behavioral and emotional adjustment, which in turn improved functional independence.

Author(s):


Rezai, Ali R., Sederberg, Per B., Bogner, Jennifer, Nielson, Dylan M., Zhang, Jun, Mysiw, W. Jerry, Knopp, Michael V., Corrigan, John D.

Participating Centers: