Study On Deep Brain Stimulation In Traumatic Brain Injury Patients (Research Paper Sample)

Does DSB help improve behavioral and emotional issues from a TBI compared to not receiving treatment? Last name and first name Institution Affiliation Course Number and Course Name Due Date 1224 Abstract Objective: To find out whether deep brain stimulation (DBS) improves behavioral and emotional issues, in patients with traumatic brain injuries. Method: relevant articles were searched from three data bases and later reviewed. Results: From the reviewed articles, it was established that DBS has positive results on TBI patients, and from the studies articles, it was determined that DBS can actually improve behavioral issues of TBI patients. More evidence is however needed to determine whether this procedure should be included in clinical practice for management of TBI patients. Key words: Deep Brain Stimulation, Traumatic Brain Injury, behavioral issues, emotional issues, rehabilitation. Introduction & Background Deep brain stimulation (DSB) is a functional neurosurgery that involves insertion of two specific pace-making probes, which are placed in specific deep brain nuclei.1 After the insertion has taken place, electrical stimulations are sent which either stimulate or suppress nerve groups in the nuclei. The procedure is normally used in treatment of Parkinson’s disease, obsessive compulsive disorder (OCD), essential trauma and dystonia. Researchers have also used the procedure to treat other chronic such as major depression but there are concerns that serious side effects and complications can result from the procedure. Traumatic brain injuries (TBIs) is a health issue that is slowly becoming an issue of public health concern, with close to 10 million people globally sustaining TBI every year. According to a 2013 report by the World Health Organization (WHO), on road safety, the problem is continuously escalating and therefore creating a need for management and rehabilitation programs that are well-designed and evaluated. TBI has been known to cause a number of complications, which have been attributed to involvement of deep brain nuclei.2 Some of these complications include trauma, behavioral changes, dystonia, somatic symptoms and cognitive impairment. Considering that DBS has been used for treatment of such symptoms, this paper will therefore attempt to establish whether DBS can help improve behavioral and emotional issues from a TBI as compared to not receiving treatment. Methods While conducting research on the topic, a number of databases were searched for articles dated between January 2015 and January 2018. These databases included NCBI, Google scholar and PubMed. The search began by use of key words such as Deep “Brain Stimulation” and “Traumatic Brain Injury”. The search was then expanded to the use of broader key words such as TBI management and rehabilitation, cognitive impairment and cognitive rehabilitation. Several descriptive words pertaining this particular topic were also used including “methods to facilitate trauma brain injury” and “brain stimulation using electrical impulses”. The search yielded 16 articles and out of these, only three were selected for use in this review. Inclusion criteria was all articles that exclusively discussed how DBS stimulation can cause behavior change and improved emotional state of brain trauma patients. All other articles that did not relate to TBI with DBS were excluded from the study. The PICOT question for this review did not change over time and the search results that were initially obtained were used for the research paper. The articles were later reviewed and results recorded. Results The first article to be reviewed was a case report of a clinical trial of bilateral DBS, on a brain injury patient. He injury on the patient had resulted to a slow thought process, low communication levels as well as an auto-aggressive behavior directed at the mouth. The auto-aggressive behavior led to multiple self-injuries on the lower lip area. To avoid self-mutilation incidences, the patient had to stay under constant surveillance. Pharmacological interventions including use of haloperidol, olanzapine and benzodiazepines among other did not prove beneficial. Other treatments including psychotherapeutic, and ergotherapeutic treatments concepts, as well as admission in psychiatric hospitals yielded futile results too. The auto-aggressive and self-injurious behavior was stated as involuntary and incontrollable. When quadripolar electrodes were inserted into the posterior hypothalamus appropriately, amd electrically stimulated, the patient experienced a sense of inner pacification and self-mutilation behavior as well as auto-aggressive behaviors completely ceased.1 The study investigated behavioral improvements associated with DBS involving insertion of electrodes bilaterally, within the central thalamus at the anterior intralaminar thalamic nuclei of a TBI patent. The patient’s history revealed that even after continuous inpatient rehabilitation, the patient could not communicate and had low behavioral responsiveness possible due to reduction in neuronal activity of the brain. The procedure (DBS) was carried out under varying stimulations in an attempt to identify optimal behavioral responses. Findings of the study established that DBS resulted in increased behavioral responsiveness to command, and intelligible verbalization. The study therefore concluded that behavioral improvements are associated with DBS, and thereby its significance in recovery of TBI patients.2 The third reviewed article3 establishes the effectiveness of DBS for improvement of the quality of life of TBI patients. The study was part of a large clinical trial carried out on four TBI patients who had spent several years recovering. The patients had symptoms such as low frustration tolerance, severe anxiety and depression; with periodic episodes that required hospitalization.in addition, the patients also presented with inability to control anger, irritability and impulsivity as well as poor judgement. Mayo-Portland adaptability inventory (MAPI) was used in the study to determine abilities and outcomes. Functional improvement was also measured using methods such as the ability to follow tasks, control their bladder and ability to birth dress and groom. After performing the DBS procedure (insertion of open-label DBS devices into the brain), significant improvements were recorded and all of the patients showed improvement in cognitive and motor scales. The study therefore established that overall behavior and cognitive function can result from DBS.3 Discussion Putting all the three articles reviewed together, reveals that indeed DBS can improve emotional and behavioral issues among TBI patients with severe complications. Exemplary results have been achieved with DSB procedure, in such a scale that no rehabilitation treatment has been able to achieve. The results from all three studies established that DBS jump-s...