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Diagnosis and Treatment of Traumatic Brain Injury

Joseph J. Fins, MD; Nicholas D. Schiff, MD
JAMA. 2000;283(18):2392. doi:10.1001/jama.283.18.2387.
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To the Editor: The National Institutes of Health (NIH) Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury,1 as forward thinking as it was, failed to address the increasing role of advances in neuroimaging and neuromodulation in the diagnosis and treatment of traumatic brain injury (TBI).

In the past several years, there has been a revolution in cognitive neuroscience that may soon transform the diagnosis, treatment, and rehabilitation of persons with TBI. For instance, diagnostic functional positron emission tomography has demonstrated a heterogeneity of brain states that can lead to impaired consciousness such as coma and the persistent vegetative state.2,3 Kennedy and Bakay4 have reported restoring communication for a patient with locked-in syndrome using an implantable electrode grafted to the motor cortex. Rinaldi et al5 demonstrated that stimulation of the left medial thalamus can modulate working memory and verbal fluency in patients with chronic pain. This observation suggests that impaired cognitive abilities can be augmented. Bejjani et al6 found that deep-brain stimulation, intended to treat the motor function of a patient with Parkinson disease, unexpectedly caused a transient depression. This serendipitous finding has the potential for developing new treatments for affective disorders and providing insight into their basic mechanisms.


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