Use of Botox and TMS in treating Traumatic Brain Injuries

- Prajval Albuquerque

Post Traumatic Headache:

Most patients after Traumatic Brain Injuries (TBI) have a headache.
To attribute a headache to Traumatic Brain Injury it should begin within a week from the date of injury.
Depending upon the extent of injury to the brain, the headache can be classified into Mild, Moderate or Severe.
Post Traumatic Headaches can lead to Migraine.
Preexisting Migraines become worse after a Traumatic Brain Injury; an occasional Migraine becomes a daily headache and then a Chronic Migraine.

If the headache persists for more than 3 months, and the patient develops sensitivity to light then the patient is an ideal candidate for Botox treatment.
Insurance companies take time to approve Botox treatment for Headaches
Botox treatment will reduce the number of headaches a person has.
Botox treatment is administered on a 12 weeks cycle. If the Botox treatment is abused then a person may develop antibodies against Botox
Though side effects are rare they include: Skin rash, neck pain, drooping eyebrow, develop antibodies against Botox.
Botox treatment is a continuous treatment and should be included in the healthcare plan. The Botox treatment controls the Migraine from getting worse but there is no cure for it.

History of Traumatic Brain Injury (TBI) is obtained from witnesses and family members.
TBI can be temporary or permanent.
Even mild TBI can develop into Post Concussive Syndrome (PCS).
Not every TBI results in loss of consciousness. Symptoms of TBI include dizziness, depression, headache, sleeplessness etc.
A client suffering from Post Concussive Syndrome (PCS) can suffer from mood swings, depression etc and make the life of an Attorney difficult. If a client displays these symptoms suggest him/her to undergo PCS evaluation and treatment
Post Concussive Syndrome Symptoms:

Migraine and Headache
Light Sensitivity and Photophobia
Dizziness and Vertigo
Depression and Other Emotional Symptoms
Alzheimer’s Disease
Parkinson’s Disease
Chronic Traumatic Encephalopathy (CTE):
Cognitive impairments including memory loss, changes in thinking
Psychological changes including impulsive behavior, depression, aggression, suicidal thoughts
Substance abuse
Speech and language changes or difficulties
Difficulty walking, weakness and tremor
Changes in vision and smell
Dementia

Transcranial Magnetic Stimulation TMS is used after anti-depressants fail. It is not based on guesswork. Initially, a PET scan is performed before administering the TMS Treatment
TMS is moderately effective but it has very less side effects as compared to anti-depressants and other treatments.
TMS is non-invasive, USFDA-approved, and the treatment lasts between 20 minutes to 1 hour.
If within 2 weeks of administering TMS treatment there is no improvement, then a PET scan needs to be performed to check whether the treatment is being administered in the wrong area or verify whether the patient is an ideal candidate for TMS or not.
If a patient has had heavy or moderate dental treatment then the patient is not an ideal candidate for TMS
The average number of sessions required for treating depression with TMS is 35 to 40 sessions.
Headache may be a side effect of TMS, but it has not been conclusively proven.

Enhances brain function recovery by inducing structural and functional changes in the area affected by trauma.
Reduces Post Concussive Syndrome and Depressive Symptoms by 50% post-TBI.
Significant reduction in tinnitus complaint after 5 sessions.
TMS reduces migraine attacks by 50%.
Patients with CRPS experience at least 30% relief after TMS treatment

The contents of this article are based on a session in TBI Med Legal and my experience of reading multiple medical records.