| 1. |
- Zafonte, RD, et al.
(author)
-
Serotonin agents in the treatment of acquired brain injury
- 2002
-
In: Journal of Head Trauma Rehabilitation. - : Ovid Technologies (Wolters Kluwer Health). - 0885-9701 .- 1550-509X. ; 17:4, s. 322-334
-
Journal article (peer-reviewed)abstract
- Background: The development of novel serotonin agents has led to an increased use of these medications throughout medical practice. An understanding of the basic pharmacological function of these agents is key to understanding their usefulness. Among persons with brain injury, serotonin agents have been used for the treatment of depression, panic disorder, obsessive-compulsive disorders, agitation, steep disorders, and motor dysfunction. Conclusion: This article will review the mechanisms, efficacy, and side effects of serotonin agents with a focus on persons with brain injury.
|
|
| 2. |
- Berginström, Nils, et al.
(author)
-
Pharmaco-fMRI in Patients With Traumatic Brain Injury : A Randomized Controlled Trial With the Monoaminergic Stabilizer (-)-OSU6162
- 2019
-
In: The journal of head trauma rehabilitation. - : Wolters Kluwer. - 0885-9701 .- 1550-509X. ; 34:3, s. 189-198
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To examine the effects of monoaminergic stabilizer (-)-OSU6162 on brain activity, as measured by blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI), in patients in the chronic phase of traumatic brain injury suffering from fatigue.SETTING: Neurorehabilitation clinic.PARTICIPANTS: Patients with traumatic brain injury received either placebo (n = 24) or active treatment (n = 28). Healthy controls (n = 27) went through fMRI examination at one point and were used in sensitivity analysis on normalization of BOLD response.DESIGN: Randomized, double-blinded, placebo-controlled design.MAIN MEASURES: Effects on BOLD signal changes from before to after treatment during performance of a fatiguing attention task.RESULTS: The fMRI results revealed treatment effects within the right occipitotemporal cortex and the right orbitofrontal cortex. In these regions, the BOLD response was normalized relative to healthy controls at the postintervention fMRI session. No effects were seen in regions in which we previously observed activity differences between patients and healthy controls while performing this fMRI task, such as the striatum.CONCLUSION: (-)-OSU6162 treatment had influences on functional brain activity, although the normalized regional BOLD response was observed in regions that were not a priori hypothesized to be sensitive to this particular treatment, and was not accompanied by any effects on in-scanner test performance or on fatigue.
|
|
| 3. |
- Berginström, Nils, et al.
(author)
-
The effects of (-)-OSU6162 on chronic fatigue in patients with traumatic brain injury : a randomized controlled trial
- 2017
-
In: The journal of head trauma rehabilitation. - 0885-9701 .- 1550-509X. ; 32:2, s. E46-E54
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To examine the effects of the monoaminergic stabilizer (-)-OSU6162 on mental fatigue in patients with traumatic brain injury.SETTING: Single-center Neurorehabilitation Clinic.DESIGN: Randomized, double-blind, placebo-controlled trial.PARTICIPANTS: Sixty-four subjects with traumatic brain injury were randomized to treatment (n = 33) and placebo (n = 31).MAIN MEASURES: The effects of (-)-OSU6162 at a dose of 15 mg twice a day were evaluated using self-assessment scales and neuropsychological tests measuring mental fatigue.RESULTS: No difference between groups was observed on any scale at baseline. At follow-up, both groups showed significant improvement on the Fatigue Severity Scale and the Mental Fatigue Scale (both Ps < .01). Similarly, the performance of both groups increased significantly on many neuropsychological tests. However, no significant between-group difference in changes on these scales was observed before or after adjustment for confounders except for one neuropsychological test favoring the control group. Sensitivity analyses showed significantly greater changes in levels of prolactin and folic acid and heart rate (all Ps < .05) in the treatment group. The mean plasma concentration after 4 weeks of treatment was 0.14 (range, 0.01-0.32) μM, which was lower than expected.INTERPRETATION: Treatment with (-)-OSU6162 had no significant effect on mental fatigue in patients with traumatic brain injury compared with placebo.
|
|
| 4. |
- Berginström, Nils, et al.
(author)
-
Using Functional Magnetic Resonance Imaging to Detect Chronic Fatigue in Patients With Previous Traumatic Brain Injury : changes linked to altered Striato-Thalamic-Cortical Functioning
- 2018
-
In: The journal of head trauma rehabilitation. - : Wolters Kluwer. - 0885-9701 .- 1550-509X. ; 33:4, s. 266-274
-
Journal article (peer-reviewed)abstract
- Objective: To investigate whether functional magnetic resonance imaging (fMRI) can be used to detect fatigue after traumatic brain injury (TBI).Setting: Neurorehabilitation clinic.Participants: Patients with TBI (n = 57) and self-experienced fatigue more than 1 year postinjury, and age- and gender-matched healthy controls (n = 27).Main Measures: Self-assessment scales of fatigue, a neuropsychological test battery, and fMRI scanning during performance of a fatiguing 27-minute attention task.Results: During testing within the fMRI scanner, patients showed a higher increase in self-reported fatigue than controls from before to after completing the task (P < .001).The patients also showed lower activity in several regions, including bilateral caudate, thalamus, and anterior insula (all P < .05). Furthermore, the patients failed to display decreased activation over time in regions of interest: the bilateral caudate and anterior thalamus (all P < .01). Left caudate activity correctly identified 91% of patients and 81% of controls, resulting in a positive predictive value of 91%.Conclusion: The results suggest that chronic fatigue after TBI is associated with altered striato-thalamic-cortical functioning. It would be of interest to study whether fMRI can be used to support the diagnosis of chronic fatigue in future studies.
|
|
| 5. |
|
|
| 6. |
- Farisco, Michele, et al.
(author)
-
American and European Guidelines on Disorders of Consciousness : Ethical Challenges of Implementation
- 2022
-
In: The journal of head trauma rehabilitation. - : Wolters Kluwer. - 0885-9701 .- 1550-509X. ; 37:4, s. 258-262
-
Journal article (peer-reviewed)abstract
- The recently published Guidelines on Disorders of Consciousness (DoCs) by the European Academy of Neurology (EAN) and by the American Academy of Neurology (AAN) in collaboration with the American Congress of Rehabilitation Medicine (ACRM) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) stand as the most ambitious international attempts to provide clear and standardized recommendations to clinicians working with patients with DoCs. They offer an updated, timely, and wide-ranging list of recommendations for the diagnosis, prognosis, and clinical care of affected patients. However, while commendable, the guidelines pose a number of questions including some related to the practical implementation of their recommendations. The paper introduces the Distributed Responsibility Model as a tool for maximizing the impact of recommendations in clinical practice
|
|
| 7. |
|
|
| 8. |
- Godbolt, Alison K., et al.
(author)
-
Associations between care pathways and outcome 1 year after severe traumatic brain injury
- 2015
-
In: The journal of head trauma rehabilitation. - Philadelphia : Lippincott Williams & Wilkins. - 0885-9701 .- 1550-509X. ; 30:3, s. E41-E51
-
Journal article (peer-reviewed)abstract
- Objective: To assess associations between real-world care pathways for working-age patients in the first year after severe traumatic brain injury and outcomes at 1 year.Setting and Design: Prospective, observational study with recruitment from 6 neurosurgical centers in Sweden and Iceland. Follow-up to 1 year, independently of care pathways, by rehabilitation physicians and paramedical professionals.Participants: Patients with severe traumatic brain injury, lowest (nonsedated) Glasgow Coma Scale score 3 to 8 during the first 24 hours and requiring neurosurgical intensive care, age 18 to 65 years, and alive 3 weeks after injury.Main Measures: Length of stay in intensive care, time between intensive care discharge and rehabilitation admission, outcome at 1 year (Glasgow Outcome Scale Extended score), acute markers of injury severity, preexisting medical conditions, and post-acute complications. Logistic regression analyses were performed.Results: A multivariate model found variables significantly associated with outcome (odds ratio for good outcome [confidence interval], P value) to be as follows: length of stay in intensive care (0.92 [0.87-0.98], 0.014), time between intensive care discharge and admission to inpatient rehabilitation (0.97 [0.94-0.99], 0.017), and post-acute complications (0.058 [0.006-0.60], 0.017).Conclusions: Delays in rehabilitation admission were negatively associated with outcome. Measures to ensure timely rehabilitation admission may improve outcome. Further research is needed to evaluate possible causation.
|
|
| 9. |
|
|
| 10. |
- Lexell, Jan
(author)
-
Ginseng
- 2003
-
In: The journal of head trauma rehabilitation. - : Ovid Technologies (Wolters Kluwer Health). - 0885-9701 .- 1550-509X. ; 18:2, s. 196-200
-
Journal article (peer-reviewed)
|
|
| 11. |
- Lexell, Jan
(author)
-
Ginseng
- 2003
-
In: Journal of Head Trauma Rehabilitation. - 0885-9701. ; 18:2, s. 196-200
-
Journal article (peer-reviewed)
|
|
| 12. |
|
|
| 13. |
- Lexell, Jan
(author)
-
Rehabilitation of traumatic brain injuries in sweden
- 2007
-
In: The journal of head trauma rehabilitation. - 0885-9701 .- 1550-509X. ; 22:4, s. 229-33
-
Journal article (peer-reviewed)abstract
- In Sweden, traumatic brain injury (TBI) is a major cause of disability across all ages, and the need for rehabilitation and long-term follow-up is as important as in many other countries. This article presents the rehabilitation of TBI in Sweden. Strengths and weaknesses of TBI rehabilitation within the Swedish healthcare system are described, together with examples of research and development.
|
|
| 14. |
- Muresanu, Dafin Fior, et al.
(author)
-
Hypertension Associated With Silica Dust Intoxication Aggravates Brain Pathology Following Traumatic Brain Injury : New Roles of Neurotrophic Factors
- 2017
-
In: The journal of head trauma rehabilitation. - 0885-9701 .- 1550-509X. ; 32:6, s. E68-E69
-
Journal article (other academic/artistic)abstract
- Introduction/Rational: Military personnel engaged in combat operation are often exposed to desert storm resulting in silica dust (SiO2 nanoparticles) intoxication. In addition, combat stress, sleep deprivation and continuous attention for enemy group results in mild to moderate hypertension. Under such situations, any traumatic brain or spinal cord injury could result in massive brain pathology due to stress induced hypertension and possibly SiO2 nanoparticles intoxication. However, effects of trauma in hypertension and SiO2 intoxication are still not well known. In present study we investigated the effects of hypertension and SiO2 intoxication of the pathophysiology of traumatic brain injury (TBI).Method/Approach: Male Wistar rats (250-300 g) were made renal hypertensive by 2kidney 1clip (2K1C) procedure allowing mean arterial blood pressure (MABP) reaching 180 ± 8 torr over 6 weeks. These hypertensive rats were exposed to SiO2NPs (40-50 nm) once daily (50 mg/kg, i.p.) for 8 days. On the 9th day these hypertensive and SiO2NPs intoxicated animals were subjected to TBI under anesthesia by making an incision (3 mm long and 2.5 mm deep) on the right parietal cerebral cortex after opening the skull (4mmOD) on both sides. The animas were allowed to survive 48 h after TBI.Results/Effects: TBI in hypertensive and SiO2 nanoparticles intoxicated rats showed 4-to-6 fold higher breakdown of the blood-brain barrier (BBB) to Evans blue albumin (EBA) and [131]-Iodine, edema formation and neuronal injuries as compared to TBI in normal animals at 48 h. Treatment with a multimodal drug Cerebrolysin-containing balanced composition of neurotrophic factors and active peptide fragments (10 ml/kg, i.v.) started 4 h after TBI followed by 4 injections at every 8 h markedly reduced brain pathologies. Whereas only 5 ml/kg of the drug is needed to achieve identical neuroprotection in normal rats after TBI.Conclusions/Limitations: These observations are the first to show that a combination of hypertension and SiO2 nanoparticles worsens brain pathology in TBI. Under these situations almost double dose of drugs is needed to induce neuroprotection, not reported earlier. Our laboratory is engaged to see whether nanodelivery of cerebrolysin could have an added therapeutic value in this complicated situation of brain injury, a subject that is currently being investigated in our laboratory.
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
|
|
| 18. |
- Sharma, Aruna, et al.
(author)
-
Spinal Cord Injury at Hot Environment Exacerbates Blood-spinal Cord Barrier Disruption, Edema Formation and Cellular Damages. Effective Treatment With a Multimodal Drug Cerebrolsyi
- 2017
-
In: The journal of head trauma rehabilitation. - 0885-9701 .- 1550-509X. ; 32:6, s. E68-E68
-
Journal article (other academic/artistic)abstract
- Introduction/Rational: Traumatic injuries to the central nervous system (CNS) occurring at cold or hot environments may affect the pathological outcome. In addition, this is not known whether injuries at these ambient temperatures may also affect the therapeutic potential of the drug treatments. Military personnel engaged in combat operations are often exposed to high environmental heat and thus under such situations if they are inflicted with trauma to the CNS their pathological outcome and drug therapy requires further investigation. In this investigation pathology and pharmacology of a focal spinal cord injury (SCI) at high environment was examined in a model experiment.Method/Approach: SCI was produced in Equithesin anesthetized rats either at room temperature (21 ± 1°C) or animals exposed to 38°C 1 h daily for 1 week by making a longitudinal incision (4 mm long and 2 mm deep) of the right dorsal horn of the T10-11 segments. In separate groups, Cerebrolsyin (2.5 ml or 5 ml/kg; Ever NeuroPharma, Austria) either as such or with TiO2 nanowired formulations was delivered intravenously 4 and 8 after SCI. After 48 h SCI blood-spinal cord barrier (BSCB), edema and neuronal injuries were examined. Uninjured animals at room or hot temperatures served as controls.Results/Effects: A focal SCI inflicted at hot environment resulted in marked exacerbation of BSCB breakdown to Evans blue albumin, edema formation and neuronal injuries as compared to identical SCI at room temperature. Treatment with 2.5 ml/kg cerebrolysin resulted in good neuroprotection in SCI at room temperature. However, either TiO2 nanowired cerebrolysin (2.5 ml) or higher dose of the drug (5 ml/kg) is needed to induce significant neuroprotection in SCI at inflicted at hot environment. TiO2 nanowires alone or TiO2 nanowired cerebrolysin did not influence cord pathology in normal animals at room temperature or at hot environment.Conclusions/Limitations: These observations are the first to demonstrate that SCI occurring at hot environments exacerbate pathological outcome. Furthermore injuries inflicted at hot temperatures require either higher doses of the therapeutic agents or their delivery through nanotechnologies to induce good neuroprotection, not reported earlier. It would be interesting to find out whether TiO2 nanowired cerebrolysin if given 12 to 24 hours after SCI could also reduce the pathological outcome at 48 hours or longer durations.
|
|
| 19. |
|
|
| 20. |
- Sharma, Hari Shanker, et al.
(author)
-
Nanowired Delivery of Cerebrolysin and Mesenchymal Stem Cells Potentiate Neuroprotection Following Concussive Head Injury
- 2017
-
In: The journal of head trauma rehabilitation. - 0885-9701 .- 1550-509X. ; 32:6, s. E67-E68
-
Journal article (other academic/artistic)abstract
- Introduction/Rational: Military personnel are highly vulnerable to concussive head injury (CHI) during combat operations resulting in long-term disability. Since no suitable treatments are available novel therapeutic strategies using combination therapy is needed. Since, stem cells and/or neurotrophic factors are shown to induce neuroprotection in central nervous system (CSN) injuries and nanodelivery of therapeutic agents have superior effects on neuroprotection in brain injury, in this investigation we used nanowired delivery of mesenchymal stem cells (MSCs) together with a multimodal drug cerebrolysin- a powerful combination of various neurotrophic factors and active peptide fragments in CHI to induce neuroprotection in CHI.Method/Approach: CHI was inflicted in rats using a weight drop of 114.6 g on the right parietal skull under Equithesin anesthesia from a 20 cm height causing an impact of 0.224 N and mimic the “counter-coup” phenomenon as seen 48 h after the primary insult. In separate groups, commercially available MSCs (1 million cells) in combination with Cerebrolsyin (2.5 ml/kg; Ever NeuroPharma, Austria) either as such or with TiO2 nanowired formulations were delivered intravenously 4 and 8 after CHI. After 48 h CHI blood-brain barrier (BBB) to Evans blue and radioiodine, brain edema and neuronal injuries were examined.Results/Effects: A focal CHI induced massive breakdown of the BBB to Evans blue albumin and [131]-Iodine and volume swelling at 48 h that was significantly higher in the left hemisphere as compared to the right side. Neuronal damages using Nissl staining was also prominent in the cortex, hippocampus, thalamus and hypothalamus in the left side. Treatment with TiO2 nanowired MSCs and cerebrolysin resulted in significant reduction in brain pathology that was seen in both the right and left hemispheres. Whereas, normal MSCs and cerebrolysin were able to reduce brain pathology largely in the right side only.Conclusions/Limitations: These observations are the first to demonstrate that a combination of nanowired Cerebrolsyin and MSCs synergistically induced efficient neuroprotection in CHI, not reported earlier. It would be interesting to see whether this combination when administered 8 or 12 h after CHI whether neuroprotective effects are still visible at 48 h, a feature currently being investigated in our laboratory.
|
|
| 21. |
|
|
| 22. |
|
|
| 23. |
|
|
