Report: Trauma
Neurorestoration Following Traumatic Brain Injury
Gerald Grant, MD, is working to build a comprehensive center for neurorestoration following traumatic brain injury (TBI).
Plans include partnering with TBI research collaborators at other centers, developing a biobank and creating trials that will follow patients throughout their recovery process, and improving the continuity of care for TBI patients to improve quality of life.
Duke recently was invited to join the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) consortium, a select group of institutions partnering to conduct clinical trials across the spectrum of traumatic brain injury. Neurosurgeon Jordan Komisarow, MD, in collaboration with anesthesiologist Vijay Krishnamoorthy, MD, have published numerous trials with this well-curated and nationally representative data set.
In the laboratory, Grant and team are focused on blood-brain barrier research with two distinct goals: the delivery of targeted agents to brain tumors and the healing of injury.
“We know the blood-brain barrier opens up for a period of time after trauma, which may impede the patient’s healing process,” said Grant. “My team is working on ways to restore the blood-brain barrier integrity that may improve neurological function and lower a patient’s vulnerability to future concussions.”
Collaboration is Advancing Peripheral Nerve Repair
Two Duke surgeons are combining surgical reanimation with nerve restoration therapy in one of the first practices of its kind in the Carolinas. Neurosurgeon Brandon Smith, MD, and orthopedic surgeon Neill Li, MD, collaborate to treat patients with brachial plexus and peripheral nerve injuries that occur at birth or in adulthood as well as upper motor neuron injuries following brain or spine injuries or stroke.
Peripheral nerve surgery has improved significantly in the past decade through the development of nerve transfer procedures alongside improved nerve grafting techniques.
“We had a vision for a single-visit clinic during which a patient can see a neurologist, a pain specialist, a neurosurgeon, and an orthopedic surgeon at the same location, with a holistic focus on the patient’s overall health,” said Smith. Physiatrists and occupational therapists are also part of the care team.
The collaborative clinic will offer nerve tumor surgery, brachial plexus and nerve reconstruction, tendon and free functioning muscle transfer. In addition, the specialists will offer treatment for spasticity, including hyperselective neurectomies, tendon lengthening and transfers, as well as nerve stimulator therapy for pain.
RESEARCH HIGHLIGHTS
Study Explores Spinal Cord Stimulation for Patients with Spinal Cord Injuries
Duke is investigating the efficacy of spinal cord stimulation as a treatment for individuals who have experienced traumatic thoracic spinal cord injury.
Nandan Lad, MD, PhD, is principal investigator of the NIH-sponsored trial, which involves the use of implanted devices that deliver electrical impulses to the spinal cord, targeting specific areas to alleviate pain and restore motor, sensory, and bowel/bladder function.
"The potential impact of this study is immense," said Lad. "Our goal is to provide individuals with spinal cord injuries a renewed chance at achieving pain relief, regaining control over their lives and redefining their future."
Epigenetics of Spine Trauma
Duke has joined TRACK-SCI, a consortium of major medical centers researching spinal cord injury (SCI). “By being part of this study, we’re not only treating patients with the standard of care for SCI, but also tracking our work by getting patient samples, blood and tissue, prior to and after surgery, and matching those up with outcomes,” said Deb Bhowmick, MD.
The objective, according to Bhowmick, is to learn what can affect outcomes at the molecular level. “What are the environmental factors and life experiences that affect what genes are expressed, and what is the effect on recovery from spine trauma?” he said. “And are their interventions that can affect recovery?”
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