Photobiomodulation using low-level laser therapy (LLLT) for patients with chronic traumatic brain injury: a randomized controlled trial study protocol

Abstract

BackgroundPhotobiomodulation using low-level laser therapy (LLLT) has been tested as a new technique to optimize recovery of patients with traumatic brain injury (TBI). The aim of this study is to evaluate inhibitory attentional control after 18 sessions of active LLLT and compare with the placebo group (sham LLLT). Our exploratory analysis will evaluate the efficacy of the active LLLT on verbal and visuospatial episodic memory, executive functions (working memory, verbal and visuospatial fluency, attentional processes), and anxiety and depressive symptoms compared to the sham group.Methods/DesignA randomized double-blinded trial will be made in 36 patients with moderate and severe TBI. The active LLLT will use an optical device composed of LEDs emitting 632 nm of radiation at the site with full potency of 830 mW. The cranial region with an area of 400 cm2 will be irradiated for 30 min, giving a total dose per session of 3.74 J/cm2. The sham LLLT group contains only an LED device with power < 1 mW, only serving to simulate the irradiation. Each patient will be irradiated three times per week for six weeks, totaling 18 sessions. Neuropsychological assessments will be held one week before the beginning of the sessions, after one week, and three months after the end of LLLT sessions. Memory domain, attention, executive functioning, and visual construction will be evaluated, in addition to symptoms of depression, anxiety, and social demographics.DiscussionLLLT has been demonstrated as a safe and effective technique in significantly improving the memory, attention, and mood performance in healthy and neurologic patients. We expect that our trial can complement previous finds, as an effective low-cost therapy to improve cognitive sequel after TBI.Trial registrationClinicalTrials.gov, NCT02393079. Registered on 20 February 2015.

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

“…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 ).…”

“…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. Since failing mitochondria can place the cell in energy crisis, mitochondrial dysfunction after injury could affect gene transcription, an energy demanding process ( Muir et al, 2016 ).…”

2018 Yearbook of Neurorestoratology

“…Poiani and colleagues report that a design of a randomized double-blinded trial of photobiomodulation using low-level laser therapy (LLLT) could be an effective low-cost treatment for patients with traumatic brain injury (TBI). The results were evaluated to see whether LLLT could improve or restore cognitive sequel after TBI [49]. Santos et al published a design of a double-blinded, randomized, controlled trial of patients with diffuse axonal injury due to a severe TBI in an acute stage.…”

Combined Behavioral and Mismatch Negativity Evidence for the Effects of Long-Lasting High-Definition tDCS in Disorders of Consciousness: A Pilot Study

“…Regarding treatment, peripheral treatment (e.g., physical therapy, speech therapy), pharmacological (i.e., amantadine, zolpidem) and nonpharmacological interventions (i.e., deep brain stimulation, spinal cord Stimulation) have been investigated in the last decade, however, there remain few effective therapies for patients with DOCs (Schiff et al, 2007;Della Pepa et al, 2013;Angelakis et al, 2014;Cossu, 2014;Tucker and Sandhu, 2016). Current evidence suggests that non-invasive brain stimulation (NIBS) including transcranial direct current stimulation (tDCS), Transcranial magnetic stimulation (TMS), and low-level laser therapy (LLLT), seems to be promising treatments (Thibaut et al, 2014;Xia et al, 2017;Poiani et al, 2018;Huang et al, 2019). For instance, Xia et al (2017) reported that 10 Hz multisession repetitive TMS applied to the left dorsolateral prefrontal cortex (DLPFC) has a potential benefit for the rehabilitation of patients with severe DOC, with an increase in CRS-R total scores in 5 out 5 MCS patients and 4 out of 11 VS/UWS patients after 30-day treatment.…”