Treatments for traumatic brain injury with emphasis on transcranial near-infrared laser phototherapy

Figures & data

Figure 1 Hypothesized mechanism of action of NIR light therapy.

Notes: NIR light (600–980 nm) penetrates tissue to variable depths depending on wavelength, the tissue involved, coherence, and time. A fraction of the photonic energy reaches the mitochondria and is absorbed by cytochrome c oxidase. This activates increased ATP production, increases production of ROS and RNS, and possibly increases NO. Downstream events include increased early-response genes (c-fos and c-jun) and activation of NF-κB, which in turn induces increased transcription of gene products leading to synaptogenesis, neurogenesis, and increased production of inflammatory mediators and growth factors.
Abbreviations: NIR, near-infrared; ATP, adenosine triphosphate; ROS, reactive oxygen species; RNS, reactive nitrogen species; NO, nitric oxide; NF-κB, nuclear factor kappa B.

Figure 2 Treatment parameters per individual, based on area of the skull treated.

Notes: Dimensions varied per head/skull size and hair line. Treatment was warm and comfortable for each patient. There were no incidences of discomfort. Areas treated were (A) temporal-bilateral, (B) frontal, and in patients 1–3, 5, and 6 (B) frontal only.

Table 1 Infrared light treatment parameters for each of the ten patients in the case series

Patient	Area treated	Sex	Mechanism of TBI	Interval since TBI before treatment	Wavelength of NIR-PT dual wave	Dosage per area	Duration per area
						Scanning technique pulsed 10 Hz
1	B, bilateral frontal	Male	Concussive blast	2 years	810 and 980 nm	2,700 J Fluence – 20.45 J/cm^2 Area – 132 cm^2	10 minutes 2 areas 10 visits
2	B, bilateral frontal	Female	MVA	18 years	810 and 980 nm	2,400 J Fluence – 18 J/cm^2 Area – 133 cm^2	9 minutes 2 areas 10 visits
3	B, bilateral frontal	Female	MVA Abuse	5 years	810 and 980 nm	2,400 J Fluence – 18.3 J/cm^2 Area – 131 cm^2	8 minutes 2 areas 10 visits
4	A–B, bilateral frontal, left temporal	Female	MVA ×2	8 years and 13 years	810 and 980 nm	2,400 J Fluence – 18.3 J/cm^2 Area – 131 cm^2	8 minutes 3 areas 10 visits
5	B, bilateral frontal	Male	Vietnam veteran Concussion Child abuse	20+ years	810 and 980 nm	3,000 J Fluence – 28.3 J/cm^2 Area – 106 cm^2	10 minutes 2 areas 10 visits
6	B, bilateral frontal	Male	Concussion	5+ years	810 and 980 nm	2,400 J Fluence – 14.8 J/cm^2 Area – 162 cm^2	12 minutes 2 areas 10 visits
7	B–A, bilateral frontal, left temporal	Male	Afghanistan, Iraqi Disability due to TBI	Disability 2 years	810 and 980 nm	3,000 J Fluence – 22.7 J/cm^2 Area – 132 cm^2	10 minutes 3 areas 20 visits
8	B–A, bilateral frontal, bilateral temporal	Female	Hypoxic encephalopathy	Childbirth-related injury, 8 years	810 and 980 nm	2,700 J Fluence – 27.8 J/cm^2 Area – 97 cm^2	9 minutes 3 areas 20 visits
9	B–A, bilateral frontal, bilateral temporal	Male	MVA-TBI Concussions	Numerous episodes	810 and 980 nm	3,000 J Fluence – 22.72 J/cm^2 Area – 132 cm^2	10 minutes 3 areas 20 visits
10	B–A, bilateral frontal, left temporal	Female	Bicycle vs car Concussion, amnesia, LOC	<30 days	810 nm single wavelength – different device	2,700 J Fluence – 17.1 J/cm^2 Area – 158 cm^2	9 minutes 3 areas 20 visits

Note: All safety precautions were followed, including metal protective eyewear (laser eye protection).

Abbreviation: LOC, loss of consciousness; MVA, motor vehicle accident; TBI, traumatic brain injury.

Table 2 NILT case series with demographics, symptoms, and treatment response

Pretreatment									Posttreatment
Patient #	Sex	Occupation	Mechanism of TBI	Diagnoses	Sleep	Symptoms	Suicidal	BDI	Sleep	Symptoms	Suicidal	BDI
1	M	Veteran, unemployed	Blast – 5 years; Iraqi	TBI, PTSD, MDD	Primary and middle insomnia	H, S, I, D, X, L, A, M, C, SL	+	–	Resolved	None, back with spouse, working	No	–
2	F	Nurse, unemployed	MVA – 8 years	TBI, PTSD	Middle and terminal insomnia	H, F, I, X, C, A, StM, L, HA, SL	+	18	Resolved	A and HA – but mild, return to work	No	15
3	F	Unemployed	Assault and MVA, 5 years prior	TBI, PTSD, MDD, GAD, ADHD	Primary and middle insomnia, nightmares	D, X, P, M, L, HA, S, SA, C, N, StM	+	–	Resolved	HA – mild, back with spouse, no SA, working	No	–
4	F	Unemployed	MVA – 3 years, assault numerous	TBI, PTSD, MDD	Primary and middle insomnia, violent nightmares	D, X, HA, I, M, SA, S, N	+	23	Resolved	None, marriage improved, no SA, working	No	17
5	M	Veteran, unemployed	Blast – 20+ years 1960s; Vietnam	TBI, MDD, GAD	Primary and middle insomnia	D, X, I, S, SL	+	18	Resolved	None	No	1
6	M	Executive	Trauma –chronic	TBI, GAD, MDD	Primary insomnia	D, X, I, P, HA, A, S	−	–	Resolved	HA, X, and P – but improved	No	–
7	M	Veteran, disability	Multiple blasts (>12); Afghan and Iraqi wars	TBI, MDD, GAD	Primary and middle insomnia	S, D, I, X, C, A, S, StM, HA	−	22	Resolved	HA and C – mild, new career	No	16
8	F	Student	Childbirth	TBI, learning disorder	Primary insomnia	D, I, X, C, A, SL, F, StM	−	16	Resolved, no bad dreams	StM improved, reading >20% more animated	No	7
9	F	Sales	MVA and sports TBI	TBI, LOC	Primary and middle insomnia, nightmares	HA, SL, N, D, I, X, H, A	−	29	Resolved	Mild HA, job promotion	No	9
10	F	Physicist	Recent car–bicycle accident	TBI, LOC, amnesia	Primary and middle insomnia	D, I, X, neck, knee pain	−	51	Resolved	No loss of skills, maintain intellectual job	No	19

Notes: Demographics for each of the ten patients in this case study is presented. Also presented is their history of mechanism of injury, diagnosis, and related symptoms. Changes in anxiety levels, sleep patterns, depression, and suicidal ideation were important symptoms and outcomes to track. Patients were instructed for no medication changes, with their primary treatment provider’s approval. Cognitive difficulties, attention problems, and short-term memory difficulties were by patient interpretation of their symptomatic improvement and patient diary changes. Symptom occurrence % was as follows: anxiety – 100%, depression – 90%, irritability – 90%, primary and middle insomnia – 90%, headache – 60%, sadness – 60%, suicidal ideation – 50%, cognitive difficulties – 50%, attention problems – 50%, short-term memory problems – 40%, marital difficulties – 30%, loss of libido – 30%, substance abuse – 20%, fatigue – 20%, panic attacks – 20%.

Abbreviations: NILT, near-infrared light therapy; TBI, traumatic brain injury; PTSD, posttraumatic stress disorder; MDD, major depressive disorder; GAD, general anxiety disorder; ADHD, attention deficit/hyperactivity disorder; H, hyperarousal; S, sadness; I, irritability; D, depression; X, anxiety; L, loss of libido; A, attention problems; M, marital difficulties; C, cognitive problems; SL, sleep issues; F, fatigue; StM, short-term memory problems; HA, headache; P, panic attacks; SA, substance abuse; N, nightmares; BDI, Beck Depression Inventory; LOC, loss of consciousness; MVA, motor vehicle accident.