Effects of transcranial LED therapy on the cognitive rehabilitation for diffuse axonal injury due to severe acute traumatic brain injury: study protocol for a randomized controlled trial

Abstract

BackgroundPhotobiomodulation describes the use of red or near-infrared light to stimulate or regenerate tissue. It was discovered that near-infrared wavelengths (800–900 nm) and red (600 nm) light-emitting diodes (LED) are able to penetrate through the scalp and skull and have the potential to improve the subnormal cellular activity of compromised brain tissue. Different experimental and clinical studies were performed to test LED therapy for traumatic brain injury (TBI) with promising results. One of the proposals of this present study is to develop different approaches to maximize the positive effects of this therapy and improve the quality of life of TBI patients.Methods/designThis is a double-blinded, randomized, controlled trial of patients with diffuse axonal injury (DAI) due to a severe TBI in an acute stage (less than 8 h). Thirty two patients will be randomized to active coil helmet and inactive coil (sham) groups in a 1:1 ratio. The protocol includes 18 sessions of transcranial LED stimulation (627 nm, 70 mW/cm2, 10 J/cm2) at four points of the frontal and parietal regions for 30 s each, totaling 120 s, three times per week for 6 weeks, lasting 30 min. Patients will be evaluated with the Glasgow Outcome Scale Extended (GOSE) before stimulation and 1, 3, and 6 months after the first stimulation. The study hypotheses are as follows: (1) transcranial LED therapy (TCLT) will improve the cognitive function of DAI patients and (2) TCLT will promote beneficial hemodynamic changes in cerebral circulation.DiscussionThis study evaluates early and delayed effects of TCLT on the cognitive rehabilitation for DAI following severe acute TBI. There is a paucity of studies regarding the use of this therapy for cognitive improvement in TBI. There are some experimental studies and case series presenting interesting results for TBI cognitive improvement but no clinical trials.Trial registrationClinicalTrials.gov, NCT03281759. Registered on 13 September 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2632-5) contains supplementary material, which is available to authorized users.

Photobiomodulation of Human Fibroblasts and Keratinocytes with Blue Light: Implications in Wound Healing

“…In the last 20 years, the technology development brought to the market new LEDs, emitting in a broad wavelength range, including the blue region. These compact and low-cost light sources opened up the possibility to design novel light-based therapies, for the treatment of different pathologies, e.g., several different dermatological conditions, brain injuries and spinal cord damages [3][4][5][6][7]. Despite an increasing number of studies regarding the effect of blue light in tissues and cells, the reported information is often incomplete, and it is hard to have a clear and objective comparison of different approaches [5], therefore the underlying mechanism is not deeply understood.…”

Photobiomodulation (660 nm) therapy reduces oxidative stress and induces BDNF expression in the hippocampus

“…Photobiomodulation therapy (PBMT), a treatment method using infrared or near-infrared light (600–1100 nm), is used in traumatic and degenerative brain diseases 11,12 . PBMT (808 nm) irradiation could help cerebrospinal fluid (CSF) to induce neuronal differentiation of human umbilical cord mesenchymal stem cells (hUC-MSCs) in early stage, and can enhance the mesenchymal stem cell (MSC) tissue repair, differentiation and proliferation 13 .…”

Inhibiting Mitochondrial Cytochrome c Oxidase Downregulates Gene Transcription After Traumatic Brain Injury in Drosophila

“…However, for w 1118 males exposed to NIR, there were fewer significant changes observed than for females, and gene expression related to “nervous system development” and “neurogenesis” was altered after NIR exposure ( Figure 2B , Table 2 , and Supplementary Data 1 ). Previous studies involving the use of PBM for TBI patients have also reported downregulation of immune response and upregulation of neurogenesis as an effect of NIR treatment ( Hennessy and Hamblin, 2017 ; Santos et al, 2018 ). There was no overlap in biological processes affected across all three TBI time-points shared by both sexes.…”

“…Different studies have suggested a positive effect of PBM treatment in TBI patients ( Naeser et al, 2014 ; Poiani et al, 2018 ; Carneiro et al, 2019 ). NIR between 700–1000 nm readily penetrates the scalp and skull and has the potential to improve cellular activity of compromised brain tissue ( Santos et al, 2018 ). Most studies employing NIR treatment have focused on evaluating the efficacy of this exposure on neuropsychological defects like impaired cognition and mood arising from brain injury ( Poiani et al, 2018 ; Santos et al, 2018 ) but none have looked at the effect of NIR on gene transcription.…”