High-Definition Transcranial Direct Current Stimulation (HD-tDCS) for Sensory Deficits in Complex Traumatic Brain Injury
Abstract
Rationale: Approximately 20% of our returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) Service members and Veterans suffer from mild traumatic brain injuries (mTBI), a much higher rate than in previous conflicts. Although most Warfighters with mTBI will experience full recovery within 3 months, a substantial minority will have chronic disabling post-concussive symptoms (PCS) affecting their senses, such as vision (difficulty focusing), balance (dizziness), and hearing (difficulty understanding words). Until recently, the scientific community considered most such cases to be due to psychological reasons, but increasing evidence suggests there is underlying brain dysfunction in mTBI even when typical brain scans are normal. The studies our group has performed with special imaging techniques lead us to believe that the dysfunction is not in the sensory areas of the brain, but in the areas that function together as a “cognitive control network” (CCN) responsible for analyzing all types of information the brain receives. Unfortunately, there are currently no proven therapies for intractable sensory PCS after mTBI. A treatment that specifically fixes the CCN dysfunction and reduces the need for medications to manage symptoms (and avoids side effects) is urgently needed. Objectives: Our objective is to investigate whether an innovative electrical brain stimulation technique called high-definition transcranial direct current stimulation (HD-tDCS), when combined with rehabilitation training, can reduce sensory PCS and improve quality of life for Veterans and Warfighters with mTBI. We plan to recruit 120 participants ages 18-59 for this study: 80 with mTBI and chronic auditory, visual, or balance symptoms, and 40 with no mTBI, to serve as a comparison group. We will first gather information about background, attention and memory, sensory performance, and quality of life. Then all participants will undergo magnetic resonance imaging (MRI) and magnetoencephalography (MEG). These are advanced neuroimaging scans that provide a detailed picture of the brain indicating where and when malfunctions are occurring. Next, the 80 mTBI participants will undergo either active or inactive HD-tDCS intervention for 10 days, 30 minutes each day. Participants will be completely awake and comfortable during HD-tDCS and will be asked to perform sensory rehabilitation tasks on a computer and through a virtual reality display. These tasks activate the brain during stimulation, allowing the electric current to have a more robust effect. After the stimulation sessions are completed, we will gather the same information and scans as before, to see what effect active versus inactive HD-tDCS had on these tests. Finally, we will call the participants by phone after 1, 3, and 6 months have gone by, to see if there are any long-term improvements in symptoms and functioning from the intervention. Applicability/Impact: Type of patients helped; how it will help them: Our study is focused on Warfighters at high risk of being disabled by chronic mTBI-induced sensory symptoms. In order to make our results as widely applicable as possible to military populations, we will recruit both Veterans as well as Active Duty personnel to participate. We expect that not only will HD-tDCS be able to reduce sensory PCS, it will also improve attention and memory, and lead to better long-term quality of life for participants. We also expect that after HD-tDCS, signals on MRI and MEG associated with symptoms will look more like those in people without mTBI, indicating that the brain is recovering from its dysfunction. Potential clinical applications, benefits, risks: If successful, this study will validate a new treatment for sensory PCS that has the potential to profoundly change the approach to mTBI. This would be of great benefit to the military as well as the civilian population, given the large numbers of mT
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710432
Entities
People
- Davin Quinn
Organizations
- United States Army
- University of New Mexico