Traumatic brain injuries (TBI) have long been a research topic for neuroscientists across the globe. TBIs typically occur after a forceful blow to the skull or an object piercing the skull and entering the brain with severity ranging from mild to severe. Typical treatment methods include physical therapy, medication, occupational therapy, and speech therapy. However, in recent years researchers have begun to explore the possibility of Transcranial Magnetic Stimulation (TMS) aiding in TBI recovery. TMS therapy may hold the key for the successful recovery of TBI patients in the future.
In the article Neuromodulatory Interventions for Traumatic Brain Injury published by Pape et al., the authors explore the possibility of using repetitive TMS (rTMS) to induce brain activity. rTMS has been the focus of much of this research because it in non-invasive and can stimulate multiple sites at varying strengths. Additionally, in her talk, Dr. Pape detailed how rTMS has been used in clinical applications to improve the cognitive and behavioral functioning of people with moderate to severe truamatic brain injuries. She detailed a double-blind randomized placebo-control clinical trial with subjects in a vegetative or minimally conscious state, ranging from three months to two years post-TBI. Participants were taken off their CNS stimulants and subjected to Repetitive TMS (rTMS) treatments. Experimenters discovered that the application of rTMS improved neurobehavioral effects when compared to the placebo group. Additionally, they explored the impact of combining rTMS with Amantadine, a drug that increases dopamine release and blocks its reuptake. The results of this experiment displayed that the pairing of rTMS and Amantadine can help to improve the clinical states of participants. Both of these experiments were cruical in determining the efficacy of rTMS in treating and improving TBI symptoms in humans.
In a paper titled Transcranial magnetic stimulation and environmental enrichment enhances cortical excitability and functional outcomes after traumatic brain injury by Shin, et al., the authors hypothesize that combining 10Hz rTMS with rehabilitive training in an environmental enrichement (EE) setting can help initiate TBI recovery through cortical excitability and reorganization. The experiments supporting this hypothesis were performed in rats that underwent a controlled cortical impact to initiate a TBI. They were then divided into four groups: TBI (control), TBI+EE, TBI+TMS, and TBI+TMS/EE. The mice were treated and monitored for 7 days. After one week, experimenters found that the TBI+TMS and TBI+TMS/EE groups had the greatest improvement in primary somatosensory cortex local field potential when compared to the control and TBI+EE groups. Additionally, the TBI+TMS/EE group showed improved performance on the beam walk test, increased motor evoked potentials, challenge ladder test performance, and fMRI responses to paw stimulation after 6 weeks of treatment. These results give supporting evidence that rTMS combined with environmental enrichment is beneficial in increasing functional activity after a traumatic brain injury.
While these two studies differ in their subject type and approach, they offer promising results for the benefits of rTMS in the rehabilitation of TBIs, especially when paired with another therapy type. When combining TMS techniques with other rehabilitive therapies, patients may see a more significant improvement in functional and cognitive abilities than when compared to rTMS alone or other forms of cognitive and physical therapy. This is because rTMS is able to target specific brain areas and increase functional connectivity, thus offering a hope for successful treatment. Continuing to explore the possibilities of rTMS and how it impacts cortical excitability, in both human and animal models, may be the key to treating traumatic brain injuries in the future.
References:
Bender Pape, T. L., Herrold, A. A., Guernon, A., Aaronson, A., & Rosenow, J. M. (2020). Neuromodulatory interventions for traumatic brain injury. Journal of Head Trauma Rehabilitation, 35(6), 365–370. https://doi.org/10.1097/htr.0000000000000643
Shin, S. S., Fecteau, S., Chistyakov, A. V., Jones, T. A., Nishibe, M., Nudo, R. J., Sung, W. H., Bolognini, N., Celnik, P., Lu, H., Guo, T., & Brys, M. (2018, July 25). Transcranial magnetic stimulation and environmental enrichment enhances cortical excitability and functional outcomes after traumatic brain injury. Brain Stimulation. https://www.sciencedirect.com/science/article/abs/pii/S1935861X18302547?fr=RR-2&ref=pdf_download&rr=813bce673cf7117b
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