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

Rezai, Ali R. et al.

Neurosurgery. Volume 79:Issue 2 (2016, August) -- Oxford University Press

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  • Title:
    Improved Function After Deep Brain Stimulation for Chronic, Severe Traumatic Brain Injury
  • Author: Rezai, Ali R.;
    Sederberg, Per B.;
    Bogner, Jennifer;
    Nielson, Dylan M.;
    Zhang, Jun;
    Mysiw, W. Jerry;
    Knopp, Michael V.;
    Corrigan, John D.
  • Found In: Neurosurgery. Volume 79:Issue 2 (2016, August)
  • Journal Title: Neurosurgery
  • Subjects: Nervous system--Surgery--Periodicals; Adult brain injury--Deep brain stimulation--Nucleus accumbens--Traumatic brain injury; Dewey: 617.48005
  • Rights: legaldeposit
  • Publication Details: Oxford University Press
  • Abstract: Abstract : 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 stimulation

    IC, internal capsule

    MPAI-4, Mayo-Portland Adaptability Inventory-4

    NAcc, nucleus accumbens

    TBI, traumatic brain injury

    Abstract :

    Supplemental Digital Content is Available in the Text.


  • Identifier: System Number: LDEAvdc_100042611309.0x000001; Journal ISSN: 0148-396X; 10.1227/NEU.0000000000001190
  • Publication Date: 2016
  • Physical Description: Electronic
  • Shelfmark(s): ELD Digital store

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