You’re going down the road when another driver decides to pass you. For a split second your brain considers two options — slow down or speed up.
You slow down to avoid a crash, right?
“You feel impulsive, you feel angry, irritable, but in our day-to-day lives … we’re able to regulate and control it,” said Dr. Ali Rezai, a neurosurgeon and director of the neurological institute at Ohio State University’s Wexner Medical Center.
But for some who suffer from a severe traumatic brain injury, the answer isn’t obvious.
Traumatic brain injuries occur every 15 seconds, affecting 1.7 million people in the United States each year. About 80,000 people suffer with disabilities as a result, Rezai said. For them, there often is serious damage to the brain’s frontal lobe, which helps regulate decision making.
If patients don’t recover after two years, there is no treatment, said Dr. W. Jerry Mysiw, chairman of the Department of Physical Medicine and Rehabilitation at Ohio State.
“We got to a point where we hit a ceiling and there was nothing more we could offer these people,” Mysiw said. “We knew that there had to be another intervention that would help us to improve their lives.”
In 2011, Rezai, Mysiw, John Corrigan, Ohio State’s director of the Division of Rehabilitation Psychology, and a team of researchers began a five-year study to find whether deep-brain stimulation — which uses electricity to regulate, block or stimulate brain waves — could improve patients with severe traumatic brain injuries.
Deep-brain stimulation is approved by the Food and Drug Administration to treat Parkinson’s disease, epilepsy and obsessive compulsive disorder. Because of its success, researchers think it could be used to rewire damaged areas in the brain.
Mysiw, who has been working with traumatic brain injury patients for years, selected four patients for the study. Two often behaved inappropriately and impulsively and two had to be prompted to do even simple things such as eating, Mysiw said. All required care around the clock.
After patients were selected, Rezai performed the 10-hour surgery, placing an implant in an area in the brain involved in behavioral regulation. The implant works like a pacemaker, Rezai said, with a device in the chest sending signals to a receiver in the brain.
Currently, about 140,000 people have the implant to treat other neurological disorders, he said.
Because Mysiw had spent years with each patient, he chose how much stimulation each would receive.
“It’s a daunting thing to consider that these families have given you the responsibility to help them in programming their life,” Mysiw said. “You have a device in your hand and depending on what they’re telling you, you’re adjusting electrodes in their brain.”
From there, Corrigan and other researchers set out to gather data. After five years of observation, three patients showed significant improvements in behavior regulation, though all showed some improvement, Corrigan said.
“Their greater emotional control made them able to be part of a community and their families,” Corrigan said.
Encouraged by the results, Rezai said it is time to expand the study to 50 patients in multiple centers.
“I think that we are pleasantly surprised and we are optimistic about what this is going to do,” he said.
The team is working with Veterans Affairs to find participants.
Mysiw said he was excited to see what the future will hold for patients and their families.
“They can hope against hope.”