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Concussion, Traumatic Brain Injury & tDCS

Traumatic brain injury (TBI) results from an acute alteration in brain function such as loss of consciousness, post-traumatic amnesia, and acute neurologic deficits such as vision or radiologic evidence caused by an external force. TBI causes a broad spectrum of impairments including changes in cognitive, psychological, and motor function. Less than a quarter of moderate and severe TBI patients improve in their cognition after 5 years. These persisting impairments are significant enough to limit activities of daily living, reduce quality of life, and increase socioeconomic burden.

Standard brain imaging generally appears normal even with persisting cognitive and emotional symptoms. It is reported that impaired neurovascular coupling, reduced cerebral blood flow and inflammation, and catecholamine deficiency are some of the leading concerns causing post concussive symptoms. 

Transcranial direct current stimulation (tDCS) represents a promising noninvasive neuromodulation treatment to improve cognitive, motor function, and emotional function by boosting adaptive neuroplasticity and reducing the pathological sequelae following a TBI. Multiple studies have examined tDCS for enhancement of cognition after TBI, predominantly in the moderate-severe range of TBI severity, with most studies demonstrating significant improvements in attention and executive function domains. tDCS is a safe, non-invasive neuromodulatory technique that can be given as monotherapy but may be best combined with other therapeutic strategies such as cognitive rehabilitation, physical therapy, Hyperbaric Oxygen therapy, and Neurofeedback Therapy to further improve cognitive and motor function. tDCS sessions last 20 minutes are easily implemented in a flexible at home therapy that is very safe and convenient.

Enhance Neurological Repair & Regeneration

  • Reduces Inflammation in the Brain
  • Promotes Generation of New Tissue
  • Improves Neuroplasticity

Improve Overall Function

  • Advances Cognitive Function
  • Improves Gross/Fine Motor Skills
  • Decreases time for complete recovery
  • Increases chances for optimal recovery

REFERENCE

  1. Davin K. Quinn et al; Transcranial direct current stimulation modulates working memory and prefrontal-insula connectivity after mild-moderate traumatic brain injury. Front Hum Neurosci. 2022; 16: 1026639. Published online 2022 Oct 13. doi: 10.3389/fnhum.2022.1026639. PMID: 36310843. PMCID: PMC9608772
  2. Adriano Mollica et al; Neuromodulation Treatments for Mild Traumatic Brain Injury and Post-concussive Symptoms. Curr Neurol Neurosci Rep. 2022 Mar;22(3):171-181. doi: 10.1007/s11910-022-01183-w. Epub 2022 Feb 17. PMID: 35175543
  3. Tehila Eilam-Stock et al; Cognitive Telerehabilitation with Transcranial Direct Current Stimulation Improves Cognitive and Emotional Functioning Following a Traumatic Brain Injury: A Case Study. Arch Clin Neuropsychol. 2021 Apr 21;36(3):442-453. doi: 10.1093/arclin/acaa059. PMID: 33885138
  4. Michael A Motes et al; High-Definition Transcranial Direct Current Stimulation to Improve Verbal Retrieval Deficits in Chronic Traumatic Brain Injury. J Neurotrauma. 2020 Jan 1;37(1):170-177. doi: 10.1089/neu.2018.6331. Epub 2019 Sep 3. PMID: 31354040
  5. Ana Luiza Zaninotto et al; Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery: A systematic review. Dement Neuropsychol. 2019 Apr-Jun; 13(2): 172–179.doi: 10.1590/1980-57642018dn13-020005. PMID: 31285791.PMCID: PMC6601308
  6. Won-Seok Kim et al; Transcranial direct current stimulation for the treatment of motor impairment following traumatic brain injury. J Neuroeng Rehabil. 2019; 16: 14.Published online 2019 Jan 25. doi: 10.1186/s12984-019-0489-9. PMID: 30683136. PMCID: PMC6347832

Study: Transcranial direct current stimulation modulates working memory and prefrontal-insula connectivity after mild-moderate traumatic brain injury

Background: Persistent posttraumatic symptoms (PPS) may manifest after a mild-moderate traumatic brain injury (mmTBI) even when standard brain imaging appears normal. Transcranial direct current stimulation (tDCS) represents a promising treatment that may ameliorate pathophysiological processes contributing to PPS.

Objective/Hypothesis: We hypothesized that in a mmTBI population, active tDCS combined with training would result in greater improvement in executive functions and post-TBI cognitive symptoms and increased resting state connectivity of the stimulated region, i.e., left dorsolateral prefrontal cortex (DLPFC) compared to control tDCS.

Methods: Thirty-four subjects with mmTBI underwent baseline assessments of demographics, symptoms, and cognitive function as well as resting state functional magnetic resonance imaging (rsfMRI) in a subset of patients (n = 24). Primary outcome measures included NIH EXAMINER composite scores, and the Neurobehavioral Symptom Inventory (NSI). All participants received 10 daily sessions of 30 min of executive function training coupled with active or control tDCS (2 mA, anode F3, cathode right deltoid). Imaging and assessments were re-obtained after the final training session, and assessments were repeated after 1 month. Mixed-models linear regression and repeated measures analyses of variance were calculated for main effects and interactions.

Results: Both active and control groups demonstrated improvements in executive function (EXAMINER composite: p < 0.001) and posttraumatic symptoms (NSI cognitive: p = 0.01) from baseline to 1 month. Active anodal tDCS was associated with greater improvements in working memory reaction time compared to control (p = 0.007). Reaction time improvement correlated significantly with the degree of connectivity change between the right DLPFC and the left anterior insula (p = 0.02).

Conclusion: Anodal tDCS improved reaction time on an online working memory task in a mmTBI population, and decreased connectivity between executive network and salience network nodes. These findings generate important hypotheses for the mechanism of recovery from PPS after mild-moderate TBI.

REFERENCE

  1. Davin K. Quinn et al; Transcranial direct current stimulation modulates working memory and prefrontal-insula connectivity after mild-moderate traumatic brain injury. Front Hum Neurosci. 2022; 16: 1026639. Published online 2022 Oct 13. doi: 10.3389/fnhum.2022.1026639. PMID: 36310843. PMCID: PMC9608772

These statements have not been evaluated or approved by the FDA. All of the statements made on this document are not anecdotal and have been taken directly from clinical data.