ABSTRACT

This patient demonstrates the benefits of Laser Therapy in the treatment of the neurological problems that typically present at our clinic. It cannot always be accurately determined how much benefit is obtained secondary to Laser Therapy, but in this case, prior to February 2017, the patient’s status had plateaued completely. Subsequent to the initiation of Laser Therapy in February 2017, his ability to speak and the improvement in his visual fields, in view of the absence of other factors, must therefore be attributed to Laser Therapy.

CASE PROFILE:

• Chiari Malformation-Left Temporal Lobe with spontaneous intracranial bleeding episode. (December 31, 2015)
• Emergency Craniotomy. (January 1, 2016)

MEDICAL HISTORY:

The patient is a 22-year-old male, who had been diagnosed with an intracranial arteriovenous malformation in the left temporo-parietal area, diagnosed two years prior to treatment at our facility.

At that time, he had sustained an intracranial hemorrhage with a subsequent rise in intracranial pressure. The situation required an emergency craniotomy in order to evacuate the hematoma in the left posterior temporo-parietal lobe.

An MRI post-surgery revealed a discrete area of encephalomalacia involving the parietal operculum and the posterior temporal lobe extending to the left side of the brain.
As a result of the surgery, the patient continued to have significant visual disturbances, memory loss, cognitive issues and aphasia. His ability to speak was markedly reduced, along with comprehension at many levels. An automated visual field perimetry study performed post-craniotomy revealed a total inferior right homonymous quadrantanopsia, consistent with the cortical damage that had occurred.

PHYSICAL EXAMINATION (February 2017):

Aside from the visual impairment and aphasia, there was a modicum of findings with regard to other abnormalities.
There was a loss of normal curvature of the cervical spine and moderate tenderness over this area.

DIAGNOSIS:

• Chiari Malformation-Left Temporal Lobe with spontaneous intracranial bleeding episode.
• Emergency Craniotomy.
• Visual Field Impairment/Aphasia, along with Moderate Cognitive Impediments

DISCUSSION:

The patient received a total of four Laser Therapy sessions involving the cervical spine, brainstem and cerebellum at the Meditech Rehabilitation Clinic beginning February 21, 2017. As he lived at a distance from the clinic, his caregivers were trained on the utilization of the Home System and continued the treatment subsequently at regular intervals. The areas treated included the cerebral hemispheres and the cervical spine.

After several weeks of treatment, the patient’s attendance at university was resumed.

Six months post-initiation of Laser Therapy, the patient had a follow-up appointment with his ophthalmologist. An automated visual field perimetry study was performed and revealed a 10% decrease in scotoma. The quadrantanopsia did not cross the vertical midline.

Enclosed in this communication are his visual fields prior to starting Laser Therapy and six months after continuing treatment. His ophthalmologist was impressed with the improvement noted considering that the trauma had occurred almost two years prior to initiating Laser Therapy. His initial quadrantanopsia had been considered to be permanent.

As his improvement in speech and vision are continuing to move forward, the patient was advised to continue with both the cranial and cervical Laser Therapy under our supervision.

INTRODUCTION:

For over 30 years, Laser Therapy has been effectively used in the treatment of many medical conditions, including musculoskeletal, dermatological problems, wound healing and more recently, the treatment of neurological conditions.

The technology has been utilized for over 40 years and over the past two decades, has made significant progress. Laser Therapy is a non-invasive, light-based therapy that applies a combination of red and infrared light sourced from red and infrared LED’s and laser diodes.

Photon particles are absorbed by the mitochondria through cytochrome c oxidase, causing a photodissociation of nitric oxide from cytochrome c oxidase resulting in increased cellular ATP levels. The dissociated nitric oxide levels also promote vasodilation and improve arterial perfusion.

Transcranial Laser Therapy has been demonstrated to significantly improve outcomes in patients of all types. Lampl et al wrote that “Although the mechanism of action of infrared laser therapy for stroke may not be completely understood, infrared laser therapy is a physical process that can produce biochemical changes at the tissue level. The putative mechanism involves stimulation of ATP formation by mitochondria and may also involve prevention of apoptosis in the ischemic penumbra and enhancement of neurorecovery mechanisms.”¹

Apart from ischemic heart disease, stroke (CVA) is the leading cause of death worldwide. The current approved treatment is to apply tissue plasminogen activator within 3 hours of onset of a CVA. Although this method is effective in clearing blood clots, the narrow time window that exists for effective treatment limits treatment options for the majority of stroke victims.
Laser Therapy has been investigated as an alternative treatment for CVA and has been shown to have a neuromodulatory and neuroprotective effect, while regulating many biological processes.

MECHANISMS OF ACTION

Photon particles are absorbed by the cerebrospinal fluid and distributed throughout the cranium, including the ventricles. These confer a significant neuromodulation effect. The particles of energy are also absorbed by the arterial, venous and lymphatic systems and are thereby transported to the fluid surrounding the central nervous system and the spinal cord. Additional benefit is transmitted by direct irradiation of the soft tissues and the skeletal system of the area involved.

1Lampl Y. Zivin J.A. Fisher M. Lew R. Welin L. Dahlof B. Borenstein P. Andersson B. Perez J. Caparo C. Ilic S. Oron U. Infrared laser therapy for ischemic stroke: a new treatment strategy: results of the NeuroThera Effectiveness and Safety Trial-1 (NEST-1) Stroke. 2007; 38:1843–1849

Automated Goldmann Visual Fields (December 23, 2016)

• Right Homonymous Inferior Quadrantanopsia
• This is a typical “pie on the floor” appearance in a visual field that conveys involvement of the optic radiation as it traverses the left temporo-parietal lobe. Note complete scotoma of the left lower quarter visual field.

Automated Goldmann Visual Fields (August 18, 2018)

• Right inferior quadrantanopsia
• Scotoma is not homonymous in this visual field. Note 10% improvement in both visual fields with sparing of the central visual field