Transcranial Photobiomodulation Therapy in the Cognitive Rehabilitation of Patients with Cranioencephalic Trauma.

Objective: This research evaluated the hemodynamic conditions before and after the transcranial photobiomodulation therapy (PBMT) and investigated neurocognitive changes before and after treatment. Background: Traumatic brain injury (TBI) is the major cause of morbidity and mortality among individuals 21-60 years old and causes ∼500,000 people to be hospitalized in Brazil annually. Some survivors develop an irreversible decrease in neurological function, and the mortality rate is as high as 70% in severe cases. PBMT is an alternative to treat secondary injuries due to TBI. Methods: This multidisciplinary clinical study was carried out on 10 chronic adult patients with severe TBI, who were treated with PBMT with an optical device containing 13 sets of 4 light emitting diodes, and underwent hemodynamic transcranial Doppler and neuropsychological evaluation at three different times: pre-PBMT, post-PBMT (after a week), and late-PBMT, which occurred 3 months after the last session. The patients received PBMTs three times a week, for 6 weeks. PBMTs were performed for 18 sessions for 6 weeks and 30 min per session. Results: The results found an alteration in the cerebral blood flow (CBF) as well as a consequent increase of the cerebral oxygenation that helped to improve the cerebral function. Conclusions: The PBMT contributed to increased CBF, evidenced mainly by the increased left peak systolic velocity, which consequently increased the hemodynamic response after the PBMT and impacts on the peripheral cerebral perfusion contributing to improved cerebral function.

Effects of transcranial LED therapy on the cognitive rehabilitation for diffuse axonal injury due to severe acute traumatic brain injury: study protocol for a randomized controlled trial.

BACKGROUND: Photobiomodulation describes the use of red or near-infrared light to stimulate or regenerate tissue. It was discovered that near-infrared wavelengths (800-900 nm) and red (600 nm) light-emitting diodes (LED) are able to penetrate through the scalp and skull and have the potential to improve the subnormal cellular activity of compromised brain tissue. Different experimental and clinical studies were performed to test LED therapy for traumatic brain injury (TBI) with promising results. One of the proposals of this present study is to develop different approaches to maximize the positive effects of this therapy and improve the quality of life of TBI patients. METHODS/DESIGN: This is a double-blinded, randomized, controlled trial of patients with diffuse axonal injury (DAI) due to a severe TBI in an acute stage (less than 8 h). Thirty two patients will be randomized to active coil helmet and inactive coil (sham) groups in a 1:1 ratio. The protocol includes 18 sessions of transcranial LED stimulation (627 nm, 70 mW/cm2, 10 J/cm2) at four points of the frontal and parietal regions for 30 s each, totaling 120 s, three times per week for 6 weeks, lasting 30 min. Patients will be evaluated with the Glasgow Outcome Scale Extended (GOSE) before stimulation and 1, 3, and 6 months after the first stimulation. The study hypotheses are as follows: (1) transcranial LED therapy (TCLT) will improve the cognitive function of DAI patients and (2) TCLT will promote beneficial hemodynamic changes in cerebral circulation. DISCUSSION: This study evaluates early and delayed effects of TCLT on the cognitive rehabilitation for DAI following severe acute TBI. There is a paucity of studies regarding the use of this therapy for cognitive improvement in TBI. There are some experimental studies and case series presenting interesting results for TBI cognitive improvement but no clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03281759 . Registered on 13 September 2017.

Optimization of labeling conditions to produce N-isopropyl-p-[123I]-iodoamphetamine: a radiopharmaceutical for brain perfusion imaging

Brain SPECT tracers, such as [123I]-labeled amines and technetium-labeled compounds, offer high resolution SPECT images after intravenous injection using conventional rotating gamma cameras. The aim of this study was to optimize labeling conditions to produce N-isopropyl-p-[123I]-iodoamphetamine) and to propose an easy, rapid and inexpensive chromatography quality control procedure to determine radiochemical purity. [123I]-IMP was produced by isotopic exchange in presence of Cu(II) as catalyst and an excess of ascorbic acid as reducing agent. In order to obtain good radiochemical yield in a minimal reaction time, labeling reaction parameters were evaluated, with the study of different reaction temperatures and time, mass of ascorbic acid, reaction pH and [131I]NaI/IMP ratio. [123I]-IMP was obtained with radiochemical yield greater than 97 per cent using 3 mg of IMP.HCl, 3.15 mol of Cu++ and an excess of ascorbic acid in acid medium (pH 2.0) at 175oC and 30 minutes. Radiochemical purity was determined by paper chromatography with high resolution. Biological distribution studies in animals showed high and persistent cerebral uptake and in vivo stability of the compound

Sintesis, control y marcacion de d,I HM-PAO con tecnecio-99m y su aplicacion clinica en estudios neurologicos / Synthesis, control and bearing of d,I HM-PAO with technetium-99m and clinic aplication in neurology studies

Con el objeto de estimar los cambios funcionales en patologia del Sistema Nervioso Central, se estudio la perfusion encefalica con el isomero "d,I" del Hexametilpropilenaminooxima (HM-PAO), usando un tomografo por emision de foton unico (SPECT). La sintesis del radiofarmaco fue realizada mediante la tecnica de Schneider R.F. Se describe el metodo de preparacion y los controles correspondientes. La eficacia de la marcacion excedio el 85%en todos los casos. Cinco milimetros del complejo 99mTcHM-PAO (0.75 mg d.I HM-PAO, 25ug de Cl2Sn.2h2oy 25mCi de 99mTc) fueron inyectados en la vena antecubital. La adquisicion de datos se realiza antes de las 2 h de administrado el compuesto. La poblacion estudiada consiste en 28 controles normales y 140 pacientes con patologia neurologica (enfermedad cerebro-vascular isquemica o hemorragica 37, epilepsia 20, demencia vascular 22 y tipo Alzheimer 19, tumores 15 y miscelaneas 27), definidos por metodos clinicos, electrofisiologicos y radiologicos. Mediante el analisis semicuantitativo de los tomogramas transaxiales con 99mTc-HM-PAO, se descubrieron areas fotopenicas en el 90%de los pacientes con enfermedad cerebro-vascular, en el 65%de las demencias tipo Alzheimer, en el 80%de los epilepticos y en el 10%de los controles normales. El estudio de perfusion encefalica con 99mTc-HM-PAO y SPECT, permite diagnosticar la isquemia cerebral de diversa forma y etiologia, antes que la tomografia computada por Rxe, incluso, resulta mas util que la RMN para el diagnostico diferencial de las demencias

Sintesis, control y marcacion de d,I HM-PAO con tecnecio-99m y su aplicacion clinica en estudios neurologicos / Synthesis, control and bearing of d,I HM-PAO with technetium-99m and clinic aplication in neurology studies

Con el objeto de estimar los cambios funcionales en patologia del Sistema Nervioso Central, se estudio la perfusion encefalica con el isomero "d,I" del Hexametilpropilenaminooxima (HM-PAO), usando un tomografo por emision de foton unico (SPECT). La sintesis del radiofarmaco fue realizada mediante la tecnica de Schneider R.F. Se describe el metodo de preparacion y los controles correspondientes. La eficacia de la marcacion excedio el 85%en todos los casos. Cinco milimetros del complejo 99mTcHM-PAO (0.75 mg d.I HM-PAO, 25ug de Cl2Sn.2h2oy 25mCi de 99mTc) fueron inyectados en la vena antecubital. La adquisicion de datos se realiza antes de las 2 h de administrado el compuesto. La poblacion estudiada consiste en 28 controles normales y 140 pacientes con patologia neurologica (enfermedad cerebro-vascular isquemica o hemorragica 37, epilepsia 20, demencia vascular 22 y tipo Alzheimer 19, tumores 15 y miscelaneas 27), definidos por metodos clinicos, electrofisiologicos y radiologicos. Mediante el analisis semicuantitativo de los tomogramas transaxiales con 99mTc-HM-PAO, se descubrieron areas fotopenicas en el 90%de los pacientes con enfermedad cerebro-vascular, en el 65%de las demencias tipo Alzheimer, en el 80%de los epilepticos y en el 10%de los controles normales. El estudio de perfusion encefalica con 99mTc-HM-PAO y SPECT, permite diagnosticar la isquemia cerebral de diversa forma y etiologia, antes que la tomografia computada por Rxe, incluso, resulta mas util que la RMN para el diagnostico diferencial de las demencias