New treatment approaches to traumatic brain injury (TBI) are greatly needed. The annual economic cost of TBI has been estimated to be $76.5 billion. Though a variety of medical interventions can be implemented in the acute phase, many patients with mild to moderate TBI (mmTBI) remain symptomatic months and years after injury. Commonly available treatments are typically limited to conventional rehabilitation strategies, characterized by only modest efficacy. We propose to investigate transcranial direct current stimulation (tDCS) as a treatment for the cognitive and emotional difficulties commonly observed by clinicians in the post-acute period. Our research team has obtained striking data revealing that tDCS increases the rate of learning in healthy controls. Other researchers have shown that tDCS can facilitate recovery in chronic stroke patients with aphasia. As tDCS is safe, economical, and has the potential for widespread implementation in diverse health facilities, demonstration of clinical efficacy in mmTBI would represent a tremendous step forward for patients and their families. Several important features define the specific approach adopted here. First, we are interested in improving both cognitive function and mood, as these two types of symptoms occur in most patients. Given this goal, we are choosing to implement a tDCS protocol based on left prefrontal anodal stimulation. Though we believe this protocol provides the best chance for clinical success, we will carefully evaluate clinical predictors of outcome (such as severity of injury and premorbid intelligence). Second, we are interested in the persistence of any tDCS gains. Hence, we have designed both short-term (one month post- tDCS) and long-term (six month and one year) follow-ups. Third, our study design is based on an explicit tripartite model of prefrontal function that guided the development of NIH's Examiner battery of cognitive control tasks, which will serve as primary outcome measures. The neural circuitry underlying control overlaps with that of emotion regulation, suggesting that a single intervention may improve both domains. Fourth, our data analysis strategy (linear mixed models) provides longitudinal analyses minimally impacted by the types of missing data problems endemic to longitudinal clinical studies. These design features allow emergent synergy with other components of the Center, especially Cavanaugh's cognitive control/EEG study and Bragin's rodent TBI model/tDCS study. This study will also benefit greatly from the Clinical Core, which will provide equipment, neurocognitive assessments, patient recruitment, and mentoring for subsequent grant submissions.

Public Health Relevance

We simply do not have the tools needed to treat the long-term cognitive and emotional consequences of mmTBI. tDCS has emerged as a safe and readily-implemented technique for improving brain function in healthy controls and among individuals with other forms of brain injury. This proposal will evaluate if it works in mmTBI for cognitive deficits and emotional problems, and identify which patients are most apt to benefit

Agency
National Institute of Health (NIH)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Exploratory Grants (P20)
Project #
5P20GM109089-04
Application #
9525980
Study Section
Special Emphasis Panel (ZGM1)
Project Start
Project End
Budget Start
2018-07-01
Budget End
2019-06-30
Support Year
4
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of New Mexico Health Sciences Center
Department
Type
DUNS #
829868723
City
Albuquerque
State
NM
Country
United States
Zip Code
87131
Carlson, Andrew P; Abbas, Mohammad; Alunday, Robert L et al. (2018) Spreading depolarization in acute brain injury inhibited by ketamine: a prospective, randomized, multiple crossover trial. J Neurosurg :1-7
Reinhart, Katelyn M; Shuttleworth, C William (2018) Ketamine reduces deleterious consequences of spreading depolarizations. Exp Neurol 305:121-128
Gasparovic, Charles; Caprihan, Arvind; Yeo, Ronald A et al. (2018) The long-term effect of erythropoiesis stimulating agents given to preterm infants: a proton magnetic resonance spectroscopy study on neurometabolites in early childhood. Pediatr Radiol 48:374-382
Oliver, R J; Brigman, J L; Bolognani, F et al. (2018) Neuronal RNA-binding protein HuD regulates addiction-related gene expression and behavior. Genes Brain Behav 17:e12454
Mayer, Andrew R; Wertz, Christopher; Ryman, Sephira G et al. (2018) Neurosensory Deficits Vary as a Function of Point of Care in Pediatric Mild Traumatic Brain Injury. J Neurotrauma 35:1178-1184
Quinn, Davin K; Mayer, Andrew R; Master, Christina L et al. (2018) Prolonged Postconcussive Symptoms. Am J Psychiatry 175:103-111
Campbell, Richard A; Gorman, Stephanie A; Thoma, Robert J et al. (2018) Risk of Concussion During Sports Versus Physical Education Among New Mexico Middle and High School Students. Am J Public Health 108:93-95
Trofimov, Alexey O; Kalentiev, George; Karelsky, Michael et al. (2018) Cerebral Hemodynamics After Transcranial Direct Current Stimulation (tDCS) in Patients with Consequences of Traumatic Brain Injury. Adv Exp Med Biol 1072:59-62
Bragina, O A; Lara, D A; Nemoto, E M et al. (2018) Increases in Microvascular Perfusion and Tissue Oxygenation via Vasodilatation After Anodal Transcranial Direct Current Stimulation in the Healthy and Traumatized Mouse Brain. Adv Exp Med Biol 1072:27-31
Bikson, Marom; Brunoni, Andre R; Charvet, Leigh E et al. (2018) Rigor and reproducibility in research with transcranial electrical stimulation: An NIMH-sponsored workshop. Brain Stimul 11:465-480

Showing the most recent 10 out of 46 publications