PhotoBioModulation And The Brain
PhotoBioModulation And The Brain
PhotoBioModulation
Systems For Hospitals
PBM | Moderate Traumatic Brain Injury
Light Therapy For Moderate Traumatic Brain Injury
★ Key Take-Aways ⮕
⮕ PhotoBioModulation is safe and has measurable effects in the brain
⮕ Light therapy could become the first widely-accepted treatment for moderate traumatic brain injury
Raj Gupta, MD, PhD
Director, Ultra-high Resolution | Volume CT Lab ❘ Director, Advanced X-ray Imaging Sciences (AXIS) Center ❘ Associate Professor of Radiology, Harvard Medical School
BOSTON – Light therapy is safe and has measurable effects in the brain, according to a
pioneering study by researchers from the Wellman Center for Photomedicine at
Massachusetts General Hospital (MGH). Senior investigators Rajiv Gupta, MD, PhD,
director of the Ultra-High Resolution Volume CT Lab at MGH and Benjamin Vakoc, PhD,
at the Wellman Center led the study, which was supported by a grant from the
Department of Defense (DOD) and published in JAMA Network Open September 14th.
This study is one of the first, if not the first, prospective, randomized, interventional clinical trials of near-infrared, low-level light therapy (LLLT) in patients who recently suffered a moderate brain injury. If further trials support these findings, light therapy could become the first widely-accepted treatment for this type of injury.
TBI is the leading cause of traumatic injury worldwide, and an estimated 69 million people
experience such an injury every year. However, there are no treatments for this condition
yet, largely because the underlying biological mechanisms are not well understood and it
is so challenging to do studies with actual patients in the acute stage of trauma.
“The Gulf War put TBI in the headlines,” says Gupta, “because body armor had been
greatly improved by then. But there were still brain injuries caused by the shock waves
from high powered explosives.” For a variety of reasons, the number of TBIs has
increased around the globe since then, but effective treatments are still sorely needed.
For this study, a special helmet had to be designed specifically to deliver the therapy, an
undertaking that required a mix of medical, engineering and physics expertise. This
multidisciplinary team included Gupta, a neuroradiologist, Vakoc, an applied physicist,
and others specializing in the development and translation of optical instrumentation to
the clinic and biologic laboratories. Both Gupta and Vakoc are also associate professors
at Harvard Medical School.
“For this study, we designed a practical, near-infrared treatment based on Wellman
Center research and working directly with DOD on the vexing problem of TBI, a condition
faced by so many,” says Rox Anderson, MD, the center’s director.
Another challenge was optimizing the wavelength of the near-infrared LLLT. “Nobody
knows how much light you need to get the optimal effect,” explains Lynn Drake, MD, one
of the study co-authors and director of business development at the Wellman Center.
“We tried to optimize the wavelength, dosing, timing of delivery, and length of exposure.”
This was done through a series of pre-clinical experiments led by Anderson. These
included multiple preclinical studies led by Michael Hamblin, PhD. Anderson and Hamblin
are both co-authors on this paper.
Near-infrared LLLT has already been considered for multiple uses, but to date, few if any
studies of this technology have been tested and none in patients with TBI. It has been
studied in stroke patients and Wellman basic laboratory research suggests it is
neuroprotective through a mechanism mediated by specialized intracellular organs called
mitochondria. It took several years of research at Wellman to understand the basic
mechanism prior to the clinical trial.
The randomized clinical trial included 68 patients with moderate traumatic brain injury
who were divided into two groups. One group received LLLT, via the special helmet,
which delivered the light. Patients in the control group wore the helmet for the same
amount of time, but did not receive the treatment. The helmet was designed by Vakoc’s
team at Wellman. During the study, the subjects’ brains were tested for neuroreactivity
using quantitative magnetic resonance imaging (MRI) metrics and the subjects also
underwent neurocognitive function assessment.
MRI was performed in the acute (within 72 hours of the injury), early subacute (2-3
weeks), and late subacute (approximately three months) stages of recovery. Clinical
assessments were performed during each visit and at six months, using the Rivermead
Post-Concussion Questionnaire, with each item assessed on a five-point scale.
Twenty-eight patients completed at least one LLLT session and none reported any
adverse reactions. In addition, the researchers found that they could measure the effects
of transcranial LLLT on the brain. The MRI studies showed statistically significant
differences in the integrity of myelin surrounding the neurons of treated patients versus
the control group. Both these findings support follow-up trials, especially since there are
no other treatments for these patients.
The study also showed the light does impact the cells. While it is well established that
cells have light receptors, “going into this trial, we had several unanswered questions
such as whether the light would go through the scalp and skull, whether the dose was
sufficient, and whether it would be enough to engage the neural substrates responsible
for repair after TBI,” says Gupta.
It’s important to note, he adds, that for this initial study, the researchers focused on
patients with moderate traumatic brain injury. That helped to ensure their study could
have statistically significant findings because patients in this category are more likely to
demonstrate a measurable effect. “It would be much more difficult to see such changes
in patients with mild injuries and it is quite likely that in patients with severe brain injuries
the effect of light therapy would be confounded by other comorbidities of severe trauma,”
says Gupta.
He adds that researchers are still very early in the development of this therapy, and it is
not known if it could be applied to other types of brain injury, such as chronic traumatic
encephalopathy (CTE), which has received a lot of public attention over the last few
years. CTE is a progressive degenerative disease associated with a history of repetitive
brain trauma such as that experienced by certain types of athletes, most notably football
players.
This study opens up many possibilities for broader use of photomedicine. “Transcranial
LED therapy is a promising area of research, with potential to help various brain disorders
where therapies are limited,” says Margaret Naeser, PhD, a prominent researcher in
photomedicine and research professor of Neurology at Boston University School of
Medicine. She was not affiliated with this particular study.
This research was partially supported by grants from Air Force contract FA8650-17-C-
9113; Army USAMRAA Joint Warfighter Medical Research Program, contract W81XWH-
15-C-0052; and Congressionally Directed Medical Research Program W81XWH-13-2-
0067.
About the Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching
hospital of Harvard Medical School. The MGH Research Institute conducts the largest
hospital-based research program in the nation, with an annual research budget of more
than $1 billion and comprises more than 8,500 researchers working across more than 30
institutes, centers and departments. In August 2020 the MGH was named #6 in the
nation by U.S. News & World Report in its list of "America’s Best Hospitals."
pioneering study by researchers from the Wellman Center for Photomedicine at
Massachusetts General Hospital (MGH). Senior investigators Rajiv Gupta, MD, PhD,
director of the Ultra-High Resolution Volume CT Lab at MGH and Benjamin Vakoc, PhD,
at the Wellman Center led the study, which was supported by a grant from the
Department of Defense (DOD) and published in JAMA Network Open September 14th.
This study is one of the first, if not the first, prospective, randomized, interventional clinical trials of near-infrared, low-level light therapy (LLLT) in patients who recently suffered a moderate brain injury. If further trials support these findings, light therapy could become the first widely-accepted treatment for this type of injury.
TBI is the leading cause of traumatic injury worldwide, and an estimated 69 million people
experience such an injury every year. However, there are no treatments for this condition
yet, largely because the underlying biological mechanisms are not well understood and it
is so challenging to do studies with actual patients in the acute stage of trauma.
“The Gulf War put TBI in the headlines,” says Gupta, “because body armor had been
greatly improved by then. But there were still brain injuries caused by the shock waves
from high powered explosives.” For a variety of reasons, the number of TBIs has
increased around the globe since then, but effective treatments are still sorely needed.
For this study, a special helmet had to be designed specifically to deliver the therapy, an
undertaking that required a mix of medical, engineering and physics expertise. This
multidisciplinary team included Gupta, a neuroradiologist, Vakoc, an applied physicist,
and others specializing in the development and translation of optical instrumentation to
the clinic and biologic laboratories. Both Gupta and Vakoc are also associate professors
at Harvard Medical School.
“For this study, we designed a practical, near-infrared treatment based on Wellman
Center research and working directly with DOD on the vexing problem of TBI, a condition
faced by so many,” says Rox Anderson, MD, the center’s director.
Another challenge was optimizing the wavelength of the near-infrared LLLT. “Nobody
knows how much light you need to get the optimal effect,” explains Lynn Drake, MD, one
of the study co-authors and director of business development at the Wellman Center.
“We tried to optimize the wavelength, dosing, timing of delivery, and length of exposure.”
This was done through a series of pre-clinical experiments led by Anderson. These
included multiple preclinical studies led by Michael Hamblin, PhD. Anderson and Hamblin
are both co-authors on this paper.
Near-infrared LLLT has already been considered for multiple uses, but to date, few if any
studies of this technology have been tested and none in patients with TBI. It has been
studied in stroke patients and Wellman basic laboratory research suggests it is
neuroprotective through a mechanism mediated by specialized intracellular organs called
mitochondria. It took several years of research at Wellman to understand the basic
mechanism prior to the clinical trial.
The randomized clinical trial included 68 patients with moderate traumatic brain injury
who were divided into two groups. One group received LLLT, via the special helmet,
which delivered the light. Patients in the control group wore the helmet for the same
amount of time, but did not receive the treatment. The helmet was designed by Vakoc’s
team at Wellman. During the study, the subjects’ brains were tested for neuroreactivity
using quantitative magnetic resonance imaging (MRI) metrics and the subjects also
underwent neurocognitive function assessment.
MRI was performed in the acute (within 72 hours of the injury), early subacute (2-3
weeks), and late subacute (approximately three months) stages of recovery. Clinical
assessments were performed during each visit and at six months, using the Rivermead
Post-Concussion Questionnaire, with each item assessed on a five-point scale.
Twenty-eight patients completed at least one LLLT session and none reported any
adverse reactions. In addition, the researchers found that they could measure the effects
of transcranial LLLT on the brain. The MRI studies showed statistically significant
differences in the integrity of myelin surrounding the neurons of treated patients versus
the control group. Both these findings support follow-up trials, especially since there are
no other treatments for these patients.
The study also showed the light does impact the cells. While it is well established that
cells have light receptors, “going into this trial, we had several unanswered questions
such as whether the light would go through the scalp and skull, whether the dose was
sufficient, and whether it would be enough to engage the neural substrates responsible
for repair after TBI,” says Gupta.
It’s important to note, he adds, that for this initial study, the researchers focused on
patients with moderate traumatic brain injury. That helped to ensure their study could
have statistically significant findings because patients in this category are more likely to
demonstrate a measurable effect. “It would be much more difficult to see such changes
in patients with mild injuries and it is quite likely that in patients with severe brain injuries
the effect of light therapy would be confounded by other comorbidities of severe trauma,”
says Gupta.
He adds that researchers are still very early in the development of this therapy, and it is
not known if it could be applied to other types of brain injury, such as chronic traumatic
encephalopathy (CTE), which has received a lot of public attention over the last few
years. CTE is a progressive degenerative disease associated with a history of repetitive
brain trauma such as that experienced by certain types of athletes, most notably football
players.
This study opens up many possibilities for broader use of photomedicine. “Transcranial
LED therapy is a promising area of research, with potential to help various brain disorders
where therapies are limited,” says Margaret Naeser, PhD, a prominent researcher in
photomedicine and research professor of Neurology at Boston University School of
Medicine. She was not affiliated with this particular study.
This research was partially supported by grants from Air Force contract FA8650-17-C-
9113; Army USAMRAA Joint Warfighter Medical Research Program, contract W81XWH-
15-C-0052; and Congressionally Directed Medical Research Program W81XWH-13-2-
0067.
About the Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching
hospital of Harvard Medical School. The MGH Research Institute conducts the largest
hospital-based research program in the nation, with an annual research budget of more
than $1 billion and comprises more than 8,500 researchers working across more than 30
institutes, centers and departments. In August 2020 the MGH was named #6 in the
nation by U.S. News & World Report in its list of "America’s Best Hospitals."
Massachusetts General Hospital | 2020
PBM And Parkinson's Disease
Light Therapy Treatment For Moderated PD symptoms
★ Key Take-Aways ⮕
⮕ Potentially Effective Treatment for a Range of Clinical Signs & Symptoms of PD
⮕ PBM treatment may be one of the few, and perhaps only, treatments for Parkinson’s disease that can be translated from pre-clinical experiments to a clinical effect
Brian Bicknell, Ann Liebert, and Geoffrey Herkes,
Liang Cheng, Academic Editor and Edward J. Modestino, Academic Editor
Abstract
Parkinson’s disease is the second most common neurodegenerative disease and is increasing in inci‐ dence. The combination of motor and non-motor symptoms makes this a devastating disease for people with Parkinson’s disease and their care givers. Parkinson’s disease is characterised by mitochondrial dysfunction and neuronal death in the substantia nigra, a reduction in dopamine, accumulation of α- synuclein aggregates and neuroinflammation. The microbiome–gut–brain axis is also important in Parkinson’s disease, involved in the spread of inflammation and aggregated α-synuclein. The mainstay of Parkinson’s disease treatment is dopamine replacement therapy, which can reduce some of the motor signs. There is a need for additional treatment options to supplement available medications.
Photobiomodulation (PBM) is a form of light therapy that has been shown to have multiple clinical benefits due to its enhancement of the mitochondrial electron transport chain and the subsequent increase in mito‐chondrial membrane potential and ATP production. PBM also modulates cellular signalling and has been shown to reduce inflammation. Clinically, PBM has been used for decades to improve wound healing, treat pain, reduce swelling and heal deep tissues. Pre-clinical experiments have indicated that PBM has the potential to improve the clinical signs of Parkinson’s disease and to provide neuroprotec‐ tion. This effect is seen whether the PBM is directed to the head of the animal or to other parts of the body (remotely). A small number of clinical trials has given weight to the possibility that using PBM can improve both motor and non-motor clinical signs and symptoms of Parkinson’s disease and may potentially slow its progression.
1. Introduction
Parkinson’s disease is the second most prevalent neurodegenerative disease after Alzheimer’s disease, affecting up to 10 million people worldwide and almost 1 million in the USA alone as of 2017 (https://www.parkinson.org/understanding-parkinsons/statistics; URL accessed on 16 November 2023). Parkinson’s disease is the most rapidly increasing neurodegenerative disease worldwide [1] due a longer disease duration and an increasing incidence with age [2]. It is also possible that the current COVID-19 pandemic could further accelerate the number of Parkinson’s disease cases [3,4], along with a worsen‐ ing of the motor and non-motor signs and symptoms [5]. Parkinson’s disease has a huge social and economic cost, with people with Parkinson’s disease (PwP) living in a state of dependence for many years, at an estimated cost of USD 51.9 billion in 2017, including USD 26.5 billion in care giver, non-medical costs and productivity losses [6]. This is projected to rise to USD 79 billion by 2037.
This review will discuss the current state of Parkinson’s disease diagnosis, pathology, symptoms, treat‐ ment and the microbiome–gut–brain axis (MGBA) and will present an argument for the use of photo‐ biomodulation as an adjunct treatment for the symptoms of Parkinson’s disease.
Parkinson’s disease is the second most common neurodegenerative disease and is increasing in inci‐ dence. The combination of motor and non-motor symptoms makes this a devastating disease for people with Parkinson’s disease and their care givers. Parkinson’s disease is characterised by mitochondrial dysfunction and neuronal death in the substantia nigra, a reduction in dopamine, accumulation of α- synuclein aggregates and neuroinflammation. The microbiome–gut–brain axis is also important in Parkinson’s disease, involved in the spread of inflammation and aggregated α-synuclein. The mainstay of Parkinson’s disease treatment is dopamine replacement therapy, which can reduce some of the motor signs. There is a need for additional treatment options to supplement available medications.
Photobiomodulation (PBM) is a form of light therapy that has been shown to have multiple clinical benefits due to its enhancement of the mitochondrial electron transport chain and the subsequent increase in mito‐chondrial membrane potential and ATP production. PBM also modulates cellular signalling and has been shown to reduce inflammation. Clinically, PBM has been used for decades to improve wound healing, treat pain, reduce swelling and heal deep tissues. Pre-clinical experiments have indicated that PBM has the potential to improve the clinical signs of Parkinson’s disease and to provide neuroprotec‐ tion. This effect is seen whether the PBM is directed to the head of the animal or to other parts of the body (remotely). A small number of clinical trials has given weight to the possibility that using PBM can improve both motor and non-motor clinical signs and symptoms of Parkinson’s disease and may potentially slow its progression.
1. Introduction
Parkinson’s disease is the second most prevalent neurodegenerative disease after Alzheimer’s disease, affecting up to 10 million people worldwide and almost 1 million in the USA alone as of 2017 (https://www.parkinson.org/understanding-parkinsons/statistics; URL accessed on 16 November 2023). Parkinson’s disease is the most rapidly increasing neurodegenerative disease worldwide [1] due a longer disease duration and an increasing incidence with age [2]. It is also possible that the current COVID-19 pandemic could further accelerate the number of Parkinson’s disease cases [3,4], along with a worsen‐ ing of the motor and non-motor signs and symptoms [5]. Parkinson’s disease has a huge social and economic cost, with people with Parkinson’s disease (PwP) living in a state of dependence for many years, at an estimated cost of USD 51.9 billion in 2017, including USD 26.5 billion in care giver, non-medical costs and productivity losses [6]. This is projected to rise to USD 79 billion by 2037.
This review will discuss the current state of Parkinson’s disease diagnosis, pathology, symptoms, treat‐ ment and the microbiome–gut–brain axis (MGBA) and will present an argument for the use of photo‐ biomodulation as an adjunct treatment for the symptoms of Parkinson’s disease.
PubMed | PMID: 38276234 PMCID: PMC10819946 DOI: 10.3390/jpm14010112 | 2024
PBM Light Therapy And Bell's Palsy
An Effective Therapeutic Option for Patients with Bell's Palsy
★ Key Take-Aways ⮕
⮕ A therapy that is painless, comfortable, and without systemic side effects
⮕ Regardless of the age, shortening the recovery time obtained with conventional therapies and avoiding sequelae
João Paulo Colesanti Tanganeli, Simone Saldanha Ignácio de Oliveira, Tamiris da Silva,
Kristianne Porta Santos Fernandes, Lara Jansiski Motta, and Sandra Kalil Bussadori
Abstract
Idiopathic facial paralysis, also known as Bell's palsy, exerts a negative effect on the quality of life. Although the prognosis is good in the majority of cases, a significant percentage of affected individuals may have sequelae that can negatively affect their lives. The use of therapeutic measures as early as possible can improve the prognosis. This article describes the successful use of laser-photobiomodulation as a single therapy in a patient with Bell's palsy and confirms the possibility of using this therapeutic modality as a good choice, since it is a therapy that is painless, comfortable, and without systemic side effects. The findings demonstrate that the adequate use of laser-photobiomodulation can be an effective therapeutic option for patients with Bell's palsy, regardless of the age, shortening the recovery time obtained with conventional therapies and avoiding sequelae.
Further studies are needed for the establishment of adequate protocols.
Idiopathic facial paralysis, also known as Bell's palsy, exerts a negative effect on the quality of life. Although the prognosis is good in the majority of cases, a significant percentage of affected individuals may have sequelae that can negatively affect their lives. The use of therapeutic measures as early as possible can improve the prognosis. This article describes the successful use of laser-photobiomodulation as a single therapy in a patient with Bell's palsy and confirms the possibility of using this therapeutic modality as a good choice, since it is a therapy that is painless, comfortable, and without systemic side effects. The findings demonstrate that the adequate use of laser-photobiomodulation can be an effective therapeutic option for patients with Bell's palsy, regardless of the age, shortening the recovery time obtained with conventional therapies and avoiding sequelae.
Further studies are needed for the establishment of adequate protocols.
PubMed | PMID: 32231809 PMCID: PMC7091526 DOI: 10.1155/2020/9867693
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