Functional restoration for neurological trauma: Current therapies and future directions

Abstract

Neuromodulation devices and surgical techniques are available to alleviate some sequela of neurological trauma. Many times posttraumatic epilepsy is controlled by medications. But when medications alone are unable to control posttraumatic epilepsy, surgical interventions including surgical resection of the epileptic focus or stimulation with the vagal nerve stimulator or the neuropace responsive neurostimulator can be helpful in gaining improved epilepsy control. Neurological trauma is also often associated with deficits in memory and cognition. There is some evidence from a limited number of case series that deep brain stimulation may hold promise in improvement in memory and cognition. Deep brain stimulation has also demonstrated limited efficacy on a case by case basis for the treatment of medically refractory depression, another frequent sequela of neurological trauma. Traumatic injury to the brain and spinal cord are associated with spasticity. When spasticity is severe and medically refractory, intrathecal baclofen pump therapy is effective in alleviating the symptoms. Spinal cord and brain stimulators may be helpful in the control of pain resulting from neurological injuries. Newer therapies including robotics and brain--machine interface technologies are in their early phases of development but may provide future therapeutic options as well. All of these techniques and technologies have the potential for restoring some degree of normal function following severe neurological trauma.