Cellular and Molecular Mechanisms and Innovative Neurostimulation Treatments in the Management of Traumatic Brain Injury.

Abstract

Traumatic brain injury (TBI) is one of the growing public health problems and a leading cause of disabilities and mortality worldwide. After the mechanical impact to the head, patients of all ages suffer from cognitive and neurological deficits, as well as psychological disorders to different extents. In the last years, the use of electrical impulses and magnetic currents to achieve therapeutic effects have shown promising results and became potential treatments for TBI. Potential mechanisms of action described so far include long term potentiation and depression of neuronal synapses, stimulation of neurotransmitters and growth factors release, and reduction of neuroinflammation, apoptosis and excitotoxicity, among others. Although promising results have been obtained in pre-clinical experiments and limited clinical studies, the high rate of variability in technical parameters and the limited number of patients enrolled have made difficult to clearly define the optimal conditions to obtain reliable therapeutic effects with these stimulation techniques in TBI patients. The present review aims to describe the molecular processes taking place in the brain after the injury, as well as to describe some of the neurostimulation treatments currently under development for TBI management.