title: Noninvasive brain stimulation in traumatic brain injury.
abstract: OBJECTIVE
  To review novel techniques of noninvasive brain stimulation (NBS), which may have value in assessment and treatment of traumatic brain injury (TBI).
  
  
  METHODS
  Review of the following techniques: transcranial magnetic stimulation, transcranial direct current stimulation, low-level laser therapy, and transcranial Doppler sonography. Furthermore, we provide a brief overview of TMS studies to date.
  
  
  RESULTS
  We describe the rationale for the use of these techniques in TBI, discuss their possible mechanisms of action, and raise a number of considerations relevant to translation of these methods to clinical use. Depending on the stimulation parameters, NBS may enable suppression of the acute glutamatergic hyperexcitability following TBI and/or counter the excessive GABAergic effects in the subacute stage. In the chronic stage, brain stimulation coupled to rehabilitation may enhance behavioral recovery, learning of new skills, and cortical plasticity. Correlative animal models and comprehensive safety trials seem critical to establish the use of these modalities in TBI.
  
  
  CONCLUSIONS
  Different forms of NBS techniques harbor the promise of diagnostic and therapeutic utility, particularly to guide processes of cortical reorganization and enable functional restoration in TBI. Future lines of safety research and well-designed clinical trials in TBI are warranted to determine the capability of NBS to promote recovery and minimize disability.
authors.affiliation: Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Asli
authors.initials: A
authors.lastname: Demirtas-Tatlidede
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Vahabzadeh-Hagh
authors.forename: Montserrat
authors.initials: M
authors.lastname: Bernabeu
authors.forename: Jose M
authors.initials: JM
authors.lastname: Tormos
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual-Leone
mesh_terms: D000818:Animals; D001921:Brain / Q000502:physiology; D001930:Brain Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D020208:Brain Injury, Chronic / Q000503:physiopathology / Q000534:rehabilitation; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000293:injuries / Q000503:physiopathology; D003131:Combined Modality Therapy; D004195:Disease Models, Animal; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D019054:Evoked Potentials, Motor / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009416:Nerve Regeneration / Q000502:physiology; D009473:Neuronal Plasticity; D018377:Neurotransmitter Agents / Q000502:physiology; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015912:Thrombolytic Therapy; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects; D057170:Translational Research, Biomedical; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D018377:Neurotransmitter Agents