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World Journal of Neuroscience, 2012, 2, ***-***                                                                       WJNS
Published Online November 2012 (http://www.SciRP.org/journal/wjns/)



Efficacy of super-pulsed 905 nm Low Level Laser Therapy
(LLLT) in the management of Traumatic Brain Injury
(TBI): A case study
William Stephan1, Louis J. Banas1, Matthew Bennett2, Huseyin Tunceroglu3
1
  William Stephan M.D., Limited Liability Company (LLC), New York, USA
2
  Bennett Health and Wellness, New York, USA
3
  University of Buffalo School of Medicine and Biomedical Sciences, New York, USA
Email: huseyint@buffalo.edu

Received****************2012


ABSTRACT                                                         isting symptoms. These symptoms, as described by the
                                                                 National Institutes of Health, range from mild to severe
Traumatic brain injury is a major health concern
                                                                 and include: headaches, nausea, vomiting, confusion, and
worldwide with massive financial and social impact.
                                                                 blurry vision. Current theory on alleviating the symp-
Conventional treatments primarily focus on the pre-
                                                                 toms of TBIs is based on reducing inflammatory and oxi-
vention of further damage to the brain parenchyma,
                                                                 dative stress and increasing perfusion to support meta-
while failing to address the already existent symptoms.
                                                                 bolic needs [3]. A study by Naeser et al. looked at the use
Previous clinical studies have shown that Low Level
                                                                 of Near Infra Red (NIR) light for the treatment of TBI,
Laser Therapy (LLLT) can significantly reduce pain
                                                                 stroke, and neurodegenerative disease. Their results were
and induce temporary vasodilation in capillaries,
                                                                 very promising, showing that nightly treatments with
which the authors hypothesize can be used to improve
                                                                 NIR LED over a period of months to years improved
the quality of life in TBI patients by treating their
                                                                 cognitive abilities [4]. Furthermore, they showed that the
current symptoms, which are predominately migraine-
                                                                 use of NIR light increased ATP production, caused vaso-
like headaches. This case report illustrates the use of
                                                                 dilation, and improved perfusion. We believe that the
LLLT in the treatment of a patient with a TBI and
                                                                 superpulsed 905 nm LLLT system employed in this case
the great clinical success achieved in the reduction of
                                                                 study operates through similar mechanisms of action and
pain, as measured by VAS—achievable within five
                                                                 to support our hypothesis we present a case report of a
treatments of 10 minutes in duration.
                                                                 patient with a traumatic brain injury that was treated with
                                                                 the superpulsed 905 nm LLLT system two years after the
Keywords: Traumatic Brain Injury; Low Level Laser
                                                                 injury occurred.
Therapy; LLLT; Chronic Migraines; Headaches
                                                                 2. CASE REPORT
1. INTRODUCTION                                                  A 25-year-old man with no pertinent past medical history
Traumatic brain injury (TBI) typically occurs when there         presented as a new patient. His only complaint was
is any sudden trauma to the skull that induces damage to         chronic debilitating migraines since a traumatic brain
the brain. There are many causes of TBIs, but unfortu-           injury which occurred in May of 2010. He was attacked
nately no documented cures. According to Faul et al., the        and repeatedly hit over the head with a lead pipe, cons-
annual incidence of TBI in the United States is approxi-         quently requiring many sutures and leaving a scar on the
mately 1.7 million incidents, which account for 30.5% of         brain as evidenced by the MRI performed subsequent to
injury related deaths [1]. The direct and indirect costs of      the incident. Since the attack, he has been experiencing
TBI totaled an estimated 76.5 billion dollars in the             excruciating migraines daily which he rates at ranging
United States in 2000 [2]. Traumatic brain injuries play a       from 7/10 to 10/10 using a Visual Analog Scale (VAS)
major role in the health care of our nation, especially in       reference and physically describes them as: throbbing,
our armed forces, where the men and women serving our            squeezing sensations located primarily to the occipital
country are at a higher risk to suffer a TBI.                    region of his skull. He complains of being unable to have
   Treatment is centered on preventing future insult to the      a peaceful night of sleep or to participate in play with his
brain, but very little can be done to treat the already ex-      four children, the oldest being 9, due to the constant pain


Published Online November 2012 in SciRes. http://www.scirp.org/journal/wjns
2                              W. Stephan et al. / World Journal of Neuroscience 2 (2012) **-**


and agony he experiences.                                        3. DISCUSSION
   After undergoing multiple previous treatment modali-
                                                                 Low Level Laser Therapy (LLLT) has been used in many
ties, which included: medications, vitamin supplements,
                                                                 acute and chronic conditions, but its effectiveness is yet
and chiropractic massage therapies, all of which were
                                                                 to be fully documented by human clinical trials for mi-
unsuccessful at alleviating his symptoms, he had all but
                                                                 graine, stroke or TBI. Currently Dr. Michael Whalen,
given up hope. Willing to try anything to rid himself of         working at Massachusetts General Hospital, is conduct-
the chronic pain, he agreed to undergo LLLT treatment.           ing controlled studies using a low level laser with the
Using a Theralase® superpulsed LLLT medical laser sys-           hopes of bringing this new technology into the forefront
tem equipped with a multiple probe handpiece (5 × 905            of neuroscience and medicine. This case study gives one
nm wavelength @ 0 to 100 mW average power per laser              example of how LLLT can be used to treat chronic mi-
diode + 4 × 660 nm wavelength @ 25 mW average                    graines, specifically those that are a result of traumatic
power per laser diode), he was given a total of five treat-      brain injuries. LLLT has been shown to reduce pain and
ments delivered over a two week period, with the 905 nm          inflammation, create a state of vasodilation by activating
laser diodes set to 50 mW average power. The LLLT was            the nitric oxide pathway and further even promote an-
targeted to a total of four areas on the scalp for two and a     giogenesis. The present theory is that by increasing blood
half minutes each: midline occipital region just below the       flow to the brain, and subsequently, increasing oxygen
lamboidal suture, superior aspect of the nape to target the      delivery to the brain, the symptoms of a migraine can be
Circle of Willis and over the mastoid processes bilate-          mitigated. This case differs from previous studies per-
rally. We selected 905 nm wavelength based on a previ-           formed using laser therapy to help patients with TBIs in
ous scientific study that demonstrated that the 905 nm           that the type of laser and the settings used were unique.
superpulsed wavelength employed by the system was                Specifically, unlike the LED light used by Naeser et al.,
able to increase inducible Nitric Oxide Synthase (iNOS)          the therapeutic laser we utilized only required five treat-
expression by 700%, as compared to numerous other                ments over two weeks to be effective with immediate re-
wave-lengths that showed little or no effect [5]. iNOS           sults after the first treatment.
has been well documented in numerous clinical studies               It is currently unclear whether or not our patient will
to cause temporary vasodilation by signaling endothelial         need maintenance therapy. He was interviewed at two
cells located in capillary walls to become flaccid and           weeks and two months post treatment and remains sym-
relax. Additional studies have shown that 810 nm and             ptom free. He is deeply appreciative of the care he was
665 nm wavelengths may also be effective, but those              given and continues to enjoy family life which was
specific wavelengths are not able to produce as much             impossible before LLLT. More research needs to be done,
iNOS expression, when compared to 905 nm superpulsed             especially controlled double blind studies to further eva-
technology [6]. An average power for the superpulsed             luate the full effectiveness and possible side effects of
905 nm laser diodes was initially chosen to be 50 mW             using LLLT in the treatment of TBIs and migraines, but
based on personal experience, but further clinical inves-        the latest research has shown that LLLT is an extremely
tigations may uncover more clinically effective average          safe and effective technology for a wide range of neural
power settings.                                                  and muscular skeletal conditions.
   Immediately after the first treatment of only ten min-
utes in duration, the patient reported a 43% reduction in
pain, reporting a VAS of 4/10 from a pre-treatment score
                                                                 REFERENCES
of 7/10. He stated the throbbing and squeezing nature of         [1]   Faul, M.X.L., Wald, M.M. and Coronado, V.G. (2010)
his pain had immediately subsided and that all that was                Traumatic brain injury in the United States: Emergency
left was more of a dull achy pain. He continued with the               department visits, hospitalizations, and deaths. *, **-**.
treatments over the next week and with each new treat-           [2]   Finkelstein E, C.P., Miller T and associates, The Inci-
ment his pain was further reduced. By the end of the                   dence and Economic Burden of Injuries in the United
                                                                       States. Oxford University Press, 2006.
course of 5 treatments, his pain had reduced by over 90%               doi:10.1093/acprof:oso/9780195179484.001.0001
and all that remained was a minor ache that was barely
                                                                 [3]   Sahni, T., et al., (2012) Use of hyperbaric oxygen in
even noticeable. Furthermore, he reported no side effects              traumatic brain injury: retrospective analysis of data of 20
from the treatment except for a slight sensation of warmth             patients treated at a tertiary care centre. British Journal of
over the area where the laser was placed. He was no                    Neurosurgery, 26, 202-207.
longer experiencing constant pain; even his children no-               doi:10.3109/02688697.2011.626879
ticed the difference saying that he looked happier. After        [4]   Naeser, M.A. and Hamblin, M.R. (2011) Potential for
two years, he was finally able to achieve a good night’s               transcranial laser or LED therapy to treat stroke, trau-
rest.                                                                  matic brain injury, and neurodegenerative disease. Pho-


Copyright © 2012 SciRes.                                                                                                     WJNS
W. Stephan et al. / World Journal of Neuroscience 2 (2012) **-**                                3


      tomedicine and Laser Surgery, 29, 443-446.                    [6]   Wu, Q., et al. (2012) Low-level laser therapy for
      doi:10.1089/pho.2011.9908                                           closed-head traumatic brain injury in mice: effect of dif-
[5]   Moriyama, Y., et al. (2009) In vivo effects of low level            ferent wavelengths. Lasers in Surgery and Medicine, 44,
      laser therapy on inducible nitric oxide synthase. Lasers in         218-226. doi:10.1002/lsm.22003
      Surgery and Medicine, 41, 227-231.
      doi:10.1002/lsm.20745




Copyright © 2012 SciRes.                                                                                                     WJNS

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Efficacy of super pulsed 905 nm low level laser therapy (lllt) in the management of traumatic brain injury

  • 1. World Journal of Neuroscience, 2012, 2, ***-*** WJNS Published Online November 2012 (http://www.SciRP.org/journal/wjns/) Efficacy of super-pulsed 905 nm Low Level Laser Therapy (LLLT) in the management of Traumatic Brain Injury (TBI): A case study William Stephan1, Louis J. Banas1, Matthew Bennett2, Huseyin Tunceroglu3 1 William Stephan M.D., Limited Liability Company (LLC), New York, USA 2 Bennett Health and Wellness, New York, USA 3 University of Buffalo School of Medicine and Biomedical Sciences, New York, USA Email: huseyint@buffalo.edu Received****************2012 ABSTRACT isting symptoms. These symptoms, as described by the National Institutes of Health, range from mild to severe Traumatic brain injury is a major health concern and include: headaches, nausea, vomiting, confusion, and worldwide with massive financial and social impact. blurry vision. Current theory on alleviating the symp- Conventional treatments primarily focus on the pre- toms of TBIs is based on reducing inflammatory and oxi- vention of further damage to the brain parenchyma, dative stress and increasing perfusion to support meta- while failing to address the already existent symptoms. bolic needs [3]. A study by Naeser et al. looked at the use Previous clinical studies have shown that Low Level of Near Infra Red (NIR) light for the treatment of TBI, Laser Therapy (LLLT) can significantly reduce pain stroke, and neurodegenerative disease. Their results were and induce temporary vasodilation in capillaries, very promising, showing that nightly treatments with which the authors hypothesize can be used to improve NIR LED over a period of months to years improved the quality of life in TBI patients by treating their cognitive abilities [4]. Furthermore, they showed that the current symptoms, which are predominately migraine- use of NIR light increased ATP production, caused vaso- like headaches. This case report illustrates the use of dilation, and improved perfusion. We believe that the LLLT in the treatment of a patient with a TBI and superpulsed 905 nm LLLT system employed in this case the great clinical success achieved in the reduction of study operates through similar mechanisms of action and pain, as measured by VAS—achievable within five to support our hypothesis we present a case report of a treatments of 10 minutes in duration. patient with a traumatic brain injury that was treated with the superpulsed 905 nm LLLT system two years after the Keywords: Traumatic Brain Injury; Low Level Laser injury occurred. Therapy; LLLT; Chronic Migraines; Headaches 2. CASE REPORT 1. INTRODUCTION A 25-year-old man with no pertinent past medical history Traumatic brain injury (TBI) typically occurs when there presented as a new patient. His only complaint was is any sudden trauma to the skull that induces damage to chronic debilitating migraines since a traumatic brain the brain. There are many causes of TBIs, but unfortu- injury which occurred in May of 2010. He was attacked nately no documented cures. According to Faul et al., the and repeatedly hit over the head with a lead pipe, cons- annual incidence of TBI in the United States is approxi- quently requiring many sutures and leaving a scar on the mately 1.7 million incidents, which account for 30.5% of brain as evidenced by the MRI performed subsequent to injury related deaths [1]. The direct and indirect costs of the incident. Since the attack, he has been experiencing TBI totaled an estimated 76.5 billion dollars in the excruciating migraines daily which he rates at ranging United States in 2000 [2]. Traumatic brain injuries play a from 7/10 to 10/10 using a Visual Analog Scale (VAS) major role in the health care of our nation, especially in reference and physically describes them as: throbbing, our armed forces, where the men and women serving our squeezing sensations located primarily to the occipital country are at a higher risk to suffer a TBI. region of his skull. He complains of being unable to have Treatment is centered on preventing future insult to the a peaceful night of sleep or to participate in play with his brain, but very little can be done to treat the already ex- four children, the oldest being 9, due to the constant pain Published Online November 2012 in SciRes. http://www.scirp.org/journal/wjns
  • 2. 2 W. Stephan et al. / World Journal of Neuroscience 2 (2012) **-** and agony he experiences. 3. DISCUSSION After undergoing multiple previous treatment modali- Low Level Laser Therapy (LLLT) has been used in many ties, which included: medications, vitamin supplements, acute and chronic conditions, but its effectiveness is yet and chiropractic massage therapies, all of which were to be fully documented by human clinical trials for mi- unsuccessful at alleviating his symptoms, he had all but graine, stroke or TBI. Currently Dr. Michael Whalen, given up hope. Willing to try anything to rid himself of working at Massachusetts General Hospital, is conduct- the chronic pain, he agreed to undergo LLLT treatment. ing controlled studies using a low level laser with the Using a Theralase® superpulsed LLLT medical laser sys- hopes of bringing this new technology into the forefront tem equipped with a multiple probe handpiece (5 × 905 of neuroscience and medicine. This case study gives one nm wavelength @ 0 to 100 mW average power per laser example of how LLLT can be used to treat chronic mi- diode + 4 × 660 nm wavelength @ 25 mW average graines, specifically those that are a result of traumatic power per laser diode), he was given a total of five treat- brain injuries. LLLT has been shown to reduce pain and ments delivered over a two week period, with the 905 nm inflammation, create a state of vasodilation by activating laser diodes set to 50 mW average power. The LLLT was the nitric oxide pathway and further even promote an- targeted to a total of four areas on the scalp for two and a giogenesis. The present theory is that by increasing blood half minutes each: midline occipital region just below the flow to the brain, and subsequently, increasing oxygen lamboidal suture, superior aspect of the nape to target the delivery to the brain, the symptoms of a migraine can be Circle of Willis and over the mastoid processes bilate- mitigated. This case differs from previous studies per- rally. We selected 905 nm wavelength based on a previ- formed using laser therapy to help patients with TBIs in ous scientific study that demonstrated that the 905 nm that the type of laser and the settings used were unique. superpulsed wavelength employed by the system was Specifically, unlike the LED light used by Naeser et al., able to increase inducible Nitric Oxide Synthase (iNOS) the therapeutic laser we utilized only required five treat- expression by 700%, as compared to numerous other ments over two weeks to be effective with immediate re- wave-lengths that showed little or no effect [5]. iNOS sults after the first treatment. has been well documented in numerous clinical studies It is currently unclear whether or not our patient will to cause temporary vasodilation by signaling endothelial need maintenance therapy. He was interviewed at two cells located in capillary walls to become flaccid and weeks and two months post treatment and remains sym- relax. Additional studies have shown that 810 nm and ptom free. He is deeply appreciative of the care he was 665 nm wavelengths may also be effective, but those given and continues to enjoy family life which was specific wavelengths are not able to produce as much impossible before LLLT. More research needs to be done, iNOS expression, when compared to 905 nm superpulsed especially controlled double blind studies to further eva- technology [6]. An average power for the superpulsed luate the full effectiveness and possible side effects of 905 nm laser diodes was initially chosen to be 50 mW using LLLT in the treatment of TBIs and migraines, but based on personal experience, but further clinical inves- the latest research has shown that LLLT is an extremely tigations may uncover more clinically effective average safe and effective technology for a wide range of neural power settings. and muscular skeletal conditions. Immediately after the first treatment of only ten min- utes in duration, the patient reported a 43% reduction in pain, reporting a VAS of 4/10 from a pre-treatment score REFERENCES of 7/10. He stated the throbbing and squeezing nature of [1] Faul, M.X.L., Wald, M.M. and Coronado, V.G. (2010) his pain had immediately subsided and that all that was Traumatic brain injury in the United States: Emergency left was more of a dull achy pain. He continued with the department visits, hospitalizations, and deaths. *, **-**. treatments over the next week and with each new treat- [2] Finkelstein E, C.P., Miller T and associates, The Inci- ment his pain was further reduced. By the end of the dence and Economic Burden of Injuries in the United States. Oxford University Press, 2006. course of 5 treatments, his pain had reduced by over 90% doi:10.1093/acprof:oso/9780195179484.001.0001 and all that remained was a minor ache that was barely [3] Sahni, T., et al., (2012) Use of hyperbaric oxygen in even noticeable. Furthermore, he reported no side effects traumatic brain injury: retrospective analysis of data of 20 from the treatment except for a slight sensation of warmth patients treated at a tertiary care centre. British Journal of over the area where the laser was placed. He was no Neurosurgery, 26, 202-207. longer experiencing constant pain; even his children no- doi:10.3109/02688697.2011.626879 ticed the difference saying that he looked happier. After [4] Naeser, M.A. and Hamblin, M.R. (2011) Potential for two years, he was finally able to achieve a good night’s transcranial laser or LED therapy to treat stroke, trau- rest. matic brain injury, and neurodegenerative disease. Pho- Copyright © 2012 SciRes. WJNS
  • 3. W. Stephan et al. / World Journal of Neuroscience 2 (2012) **-** 3 tomedicine and Laser Surgery, 29, 443-446. [6] Wu, Q., et al. (2012) Low-level laser therapy for doi:10.1089/pho.2011.9908 closed-head traumatic brain injury in mice: effect of dif- [5] Moriyama, Y., et al. (2009) In vivo effects of low level ferent wavelengths. Lasers in Surgery and Medicine, 44, laser therapy on inducible nitric oxide synthase. Lasers in 218-226. doi:10.1002/lsm.22003 Surgery and Medicine, 41, 227-231. doi:10.1002/lsm.20745 Copyright © 2012 SciRes. WJNS