Cannabis Helps PTSD
There has been so much self-medication of sufferers from PTSD with marijuana that this discovery probably comes as no small surprise. The discovery of humans having an entire system within the human body called the endocannabinoid system, some ten years ago, has given rise to many discoveries and many more are going to be forthcoming. It is no surprise that, since the human body is wired and has a built system responding to THC and similar molecules, that marijuana has and will continue to show great promise in medicating human disease and symptoms.
Loss of Sleep = Smaller Brain
A recent study confirmed the general notion that the cognitive abilities of a human are diminished during periods involving lack of normal sleep. It has long been known that a person with diminished sleep will score more poorly on academic and cognitive testing. A more recent finding gives an explanation for the need for sleep – that during sleep the brain and its surrounding tissues and fluids are cleaned and washed. It is therefore no surprise that a recent study (Sexton CE et al. 2014) showed that in humans with reduced sleep, the volume of their brain was found to be diminished.
The significance of sleep or lack of sleep has traditionally been talked about as a relatively unimportant phenomenon that has no lasting or systemic damage to our bodies, but this attitude must and will soon change as the biological and objective damages of disruptive sleep become more and more evident.
Injury to the Cerebellum Equals Autism
The cerebellum, located in the very back of the human brain, has long been thought to mostly be involved with coordination and smooth movement of the human body. More recently, some connections to memory were surprisingly found. Now, a recent study (Wang SSH, et al. 2014) has shown that early injury to the cerebellum in human infants can lead to autism. The breakdown in normal brain development occurs when injury to the cerebellum puts into motion an abnormal course of development of a child’s brain. It was found that infants with cerebellum injury have a 36 times greater likelihood of developing autism than an uninjured child. This, of course, would include prenatal injuries as well.
Using Light in the Brain
Scientist at Massachusetts Institute for Technology, in a study published in Nature, have been able to alter or remove memories in a mouse’s brain using light beams. Negative memories of a mild shock were removed completely by this method. They also found that neurons in the hippocampus area of the brain, involving memory, can be altered to make a bad memory less negative. These breakthroughs will promise in future research involving the origins and treatment of anxiety and depression.
Mild Traumatic Brain Injury and Long Term Consequences
A 2011 study (Komrad, C et al.) followed 33 individuals who had sustained a mild TBI for an average of six years versus 33 healthy controlled subjects. Comprehensive testing was done to assess cognitive and emotional functioning. The results showed that mild TBI victims had significant impairments in cognitive domains compared to the healthy controlled subjects, with the effect being described from medium to large. They noted “MTBI may lead to lasting disruption of neurofrontal circuits not detectable by standard structural MRI and needs to be taken seriously in clinical and forensic evaluation.”
Worsening Symptoms after MTBI
The conventional medical wisdom is that symptoms of a mild traumatic brain injury are at their worst at the time of the trauma and thereafter always get better, not worse. However, studies have shown (Bleiberg, J et al. 1997) that this is not always the case, when they compared normal volunteers with persons suffering from MTBI. The injured group showed erratic and inconsistent performances on follow-up testing, with some subjects showing worsening performance across days. This and other studies are showing that this intolerance to worsening symptoms over time has no medical basis.
Inaccuracy of Mild TBI Diagnoses at ER
Every year, thousands of victims of TBI are failed to be diagnosed with a mild brain injury because of emergency room failure to diagnose. In the study entitled “Accuracy of Mild Traumatic Brain Injury Diagnoses” (Powell JM, et al. 2008) medical documents were reviewed from emergency room examinations resulting in a finding that 56% of those actually suffering from a mild TBI did not have a documented and related diagnoses in the ER records. The greatest agreement between the persons studied and the ER physicians who gave a positive mild TBI diagnoses was for loss of consciousness, with the greatest discrepancy being the symptom of confusion.
This failure and confusion does great harm to those patients who developed enduring or permanent symptoms from MTBI and because of this failure of a baseline diagnosis. Follow up medical providers and especially insurance companies, will tend to disregard a legitimate diagnoses of MTBI.
The Spinal Cord and Vertigo
You usually would not consider damage or problems in the cervical spine to have anything to do with the symptom of dizziness or vertigo. However, research entitled “The Implications of Cervical Spine Degeneration and Traumatic Diseases in the Pathogenesis of Cervical Vertigo and Hearing Loss” (Cobzeanu, MD et al. 2009) showed that there are receptors located in the spinal disc and cervical spine muscles which affect blood flow in the arteries. This causes a disruption in ear blood flow which can bring on hearing loss, vertigo and ringing in the ears (Tinnitus). This could help explain some of the strange and unexplainable symptoms often reported by persons who have suffered a severe whiplash. ENTs need to become aware of this research as soon as possible.
Stress and Brain Development
Stress causes problems in all kinds of human body systems. Stress hormones have been linked to a reduction in brain neurogenesis, or memory cell replacement in the human brain, located in the hippocampus. (Schoenfeld, TJ 2012). Chronic stress can arise after a TBI injury. Other research has shown that when animals are lowered in the pecking order of their society, there is a great increase in stress hormones. TBI victims who lose cognitive ability suffer personality changes, and financial devastation, are commonly and suddenly thrown into a lower societal level. Thus, this additional stress worsens the conditions already present in the injured TBI victim. Studies have shown that TBI victims with more supportive families, obviously, do much better. Perhaps this alleviates some of the stress hormones.
Gene Expression Following TBI
Epigenetics and gene expression are cutting edge concepts which are making their way into the realm of traumatic brain injury. A study (Staffa, K et al. 2012) looked at twelve cases of severe brain injury resulting in death and analyzed whether or not the brain tissue had gene expression different than controls without TBI. They found that several substances were expressed in the cerebellum indicating that the cerebellum is an important target to study further regarding gene expression after TBI. This means that adverse changes in a parent with TBI can be passed to children. (for more see blog article)
Blast Wave Hurt Axon
Further exploration of the effects of a blast wave on the brain continue to shed light. Mice, after being exposed to a blast, showed cognitive and behavioral changes. It was noted that there was a shortening of the axon initial segment (AIS) in the cortex and hippocampus. This increases both the threshold and the ability of the firing neurons to perform normally and supports the conclusion that exposure to a single blast can lead to mild traumatic brain injury (mTBI) with accompanying cognitive impairment and subcellular changes in the molecular organization of neurons.
Barbiturate Coma After Severe TBI
The idea of putting patients into a barbiturate coma after serious TBI in order to reduce the intracranial pressure (ICP) has been around for years. It has been controversial, and a new study (Majdan, M et al. 2012 ) showed that in five European treatment centers, while high dose barbiturates decrease ICP in 69% of patients, it also caused longer periods of pressure instability, which is exceedingly dangerous. The analysis showed no significant effect on outcome at any stage after injury. Probably not worth doing.
Gender Effect on TBI Outcome?
A study utilizing the Chinese head trauma data bank (Gao, GY 2012) studied over 7000 patients to determine whether or not there was a statistical difference between males and females suffering from traumatic brain injury regarding outcome. There was not. Mortality rates and unfavorable outcomes, showed no gender difference.
Hope for Vision Loss Reduction after TBI
A recent study (Sabel BA, et al. 2010) has shown that retinal or cerebral visual injury, long considered irreversible, can be restored with vision rehabilitation techniques. They propose the name “residual vision activation theory” and suggest it can be started at all ages and in all types of visual field impairment after stroke or TBI.
Conflicting Data on Stromal Cell Implantation
In the Journal of Neurotrauma (Bonilla C, et al. 2010) a study tested the intravenous administration of bone marrow stromal cells after traumatic brain injury in rats. After two months of administration the rats were no better at functional abilities. A study of their brains in comparison with the normal group showed no changes in the brains of the mice who received the intravenous stromal cells. However, the same group of investigators in 2009 had implanted the stromal cells, rather than have them administered through IV and found that the rats showed progressive functional recovery and signs of increased brain volume and neurogenesis in the autopsy brains of the rats. This is consistent with earlier studies (Zurita M. 2004) in which the therapeutic effect of transplanted bone marrow stromal cells showed clear and progressive functional recovery of treated animals compared with controls. In that case, new spinal cord tissue was grown bridging the traumatic injury and restoring function.
Surgeons in India have had success with transplantation of stem cells into humans suffering from severe traumatic brain injury and coma. More than one patient in a coma has recovered consciousness and speech after the operation.
In addition, several new drugs and treatments are on the horizon which will give rise to increased neurogenesis or regrowth of brain cells after injury or trauma.
Current Status of Stem Cells for Spinal Cord Regeneration
Many attempts in the last fifteen years have been made to find a method for enhancing spinal cord regeneration after injury. These include use of embryonic or adult stem cells, Schwann cells, genetically modified fibroblast, bone stromal cells, and olfactory ensheathing cells. Out of all the types of cells, a recent study (Sobani ZA, et al. 2010) showed that olfactory ensheathing cells seem to be the most promising, followed by bone marrow stromal cells. However, in the United States direct transplantion of these cells for spinal cord regeneration is not yet out of the experimental stage.
A human trial carried out in Australia had cultured olfactory ensheathing cells transplanted into the spinal cords of six patients with paraplegia. No improvement was noted. However, a quadriplegia patient who was operated on 13 days after a quadriplegia break at C4-5 using cultured bone marrow stomal cells showed gradual improvement in six months following the surgery.
Nerve Repair with Fat Derived Stem Cells Successful
Peripheral nerves (those outside the brain or spinal cord) can often cause ongoing and devastating nerve pain in the extremities. Micro surgery often cannot address all of the cell death involved in some of these conditions. However, combining nerve repair with placement of fat derived stem cells in the dorsal root ganglia showed nerve regeneration and neuro-protection with significant reduction of symptoms. (Reid AJ, et al. 2001).
Important Finding on Coma Decisions
The difficulty in determining the true nature of injury and making what can be horrible choices for patients with vegetative or minimally conscious states is well known. Investigators using resting state EEG (Fingelkurts AA, et al. 2011) show that (1) the EEGs for non survivors were significantly lower than for survivors; (2) there was a higher probability of mostly delta and slow beta waves during first assessment for patients with bad outcome (i.e. those who died within the first six months); (3) patients with a good outcome had higher probability of mostly fast-beta and alpha oscillations. Therefore resting state EEGs may have a potentially prognostic value with regards to outcome from VS or MCS. This will also be potentially helpful in medical-legal end of life decision making.
TRAUMATIC BRAIN INJURY AS CHRONIC DISEASE
A review of 25 years of treating survivors of brain injury in a university of Texas medical school study, shows that brain injury is a chronic ongoing process rather then a one time injury, as traditionally thought. The researchers hope to reclassify traumatic brain injury as a chronic disease, which will help researches with additional funding to investigate potential cures. They stress that neurological disorders can decrease life expectancy through sleep disorders, cardiac arrhythmia, or epilepsy. The disorders lead to gradual decline in cognitive functioning, hosts of endocrine disorders, and psychiatric and psychological diseases.
TRAUMATIC BRAIN IN JURY COMMON AMONG HOMELESS
A study of more than 900 homeless men and women in Toronto showed that an astonishing 58% of the homeless men and 42% of the homeless women have a history of traumatic brain injury. For many people, the first instance of brain injury occurs at a young age, suggesting that it could have set off a chain of events leading to homelessness. The study again highlights the seriousness of brain injury to a life as a successful human being.
SOLDIERS WITH BRAIN INJURY HAVE HIGHER EPILEPSY RISK DECADES LATER
New research in the publication Neurology, showed that 13% of post traumatic epilepsy reported in head-wounded veterans did not show up until more than 14 years after the brain injury. A study found that the types of seizure changed over time, often becoming more severe.
MILD HEAD INJURY INCREASED RISK OF SLEEP DISORDER
A study (Ayalon, L 2007) showed that as many as 40% to 65% of people with mild traumatic brain injury suffer from insomnia.. The head injury patients underwent numerous sleep studies and found that 15 of 42 patients or 36% had circadian rhythm sleep disorder (CRSD) it was noted that these disorders can lead to psychological and cognitive problems and can interfere with rehabilitation.
MORE EVIDENCE OF PROGESTERONE AS TREATMENT FOR TRAUMATIC BRAIN INJURY
Researchers at Emory University (Stien, D.G. 2009) found that progesterone can protect damaged cells in the central and peripheral nervous system following traumatic brain injury. They found it can reduce swelling and the restriction of blood supply after an injury. It also protects neurons from dying after trauma. Because of its known safety, low costs and ready availability, progesterone should be widely used very soon.
SLEEP APNEA AND HEAD INJURY A NEW RISK
It is well known that a large percentage of those with mild or moderate brain injury can suffer from sleep apnea. I has also been observed that people with obstructive sleep apnea have a marked increase in the risk of severe motor crashes. A group of sleep apnea sufferers suffered 250 crashes over 3 years compared to 123 crashes in the group without sleep apnea.
TREATING SLEEP DISORDERS IN TBI DOES NOT ELIMINATE SYMPTOMS
Sleep disorders are common with TBI, but a recent study showed that after three months treatment with continuous positive air pressure (CPAP) reduced the severity of obstructive sleep apnea significantly. The participants suffering from TBI experienced no significant changes in the quality of life or cognitive performance after the treatment. Researchers believe that the other problems associated with traumatic brain injury may be continuing to effect the individuals even when obstructive sleep apnea is largely eliminated. This is bad news for sufferers associated with TBI.
PINPOINTING THE SOURCE OF EPILEPSY
Scientist are using a new kind of scan called magnetoencephalopathy (MEG) in association with MRI to generate a detailed map that allows them to locate precise areas of the brain dysfunction and have them removed to stop epilepsy. Chronic epilepsy can be fatal and the ability of MEG to pinpoint the source of the seizure more accurately than the traditional method of EEG is a breakthrough that should help many patients with chronic epilepsy. The costs benefit analysis of doing brain surgery for epilepsy is now greater on the benefit side.
BIOMARKER IN BRAIN FOUND FOR IDENTIFYING POST TRAUMATIC STRESS DISORDER
Seventy-four U.S. vets who were diagnosed with PTSD were scanned by a magnetoencephalopathy (MEG), a new non-evasive type of brain scan with more than 90% accuracy. Researchers were able to differentiate PTSD from health control. In addition, the MEG can show how badly the patients are impacted by the PTSD, possibly opening up the door to showing how badly patients are impacted by other brain disorders.
EEG SCREENING FOR ONSET OF ALZHEIMER’S
Using a non-evasive and relatively inexpensive EEG analysis and software, scientists have shown that an accurate diagnosis of early Alzheimer’s can be made. A seven year NYU study revealed the program is 95% accurate in predicting cognitive decline. A brain wave called Theta was much more prominent in people likely to decline and was especially abnormal in the frontal regions of the brain. Especially the hippocampus.
NEW TREATMENT FOR ACUTE BRAIN INJURY
Researchers at Clemson University in South Carolina have developed a gel, made partially of stem cells, that they are injecting into the brains of injured patients. People with combat wounds, car accident or gun shot wounds have been injected with the gel which has been shown to promote healing and limit the amount of secondary injury from the trauma. This is an exciting new method of reducing injury and improving outcome that has never been available before. The gel is expected to be ready for testing in humans in about three years.
TEN YEAR RECOVERY FROM TBI: CHILDREN AND YOUNG ADULTS
A Swedish study (Horneman, G. 2009) followed 165 survivors of TBI and tested them 10 years after injury. The results showed poor performance in intellectual function, low results in verbal tests and tests of verbal learning and memory, visual ability and executive functioning. When compared to healthy controls, these deficits persisted. It again noted that it is difficult to predict the outcome in children and young adults until years after the injury.
NEW MARKER FOR TBI
Yet another biological marker for the presence of traumatic brain injury has been found. In a Chinese study (Huang, M. et al. 2009) the changes in plasma micro particle procoagulant activity in patients was correlated with brain injury and is thought to contribute to the inflammatory reaction after trauma. The higher presence of this substance is associated with poorer clinical outcome.
CONTINUED DEBATE OVER THERAPEUTIC HYPOTHERMIA
For the past ten years the topic of whether or not lowering the body temperature of a recent victim of brain trauma, is or is not clinically helpful. This latest study (deDeyne, C.S. 2010) suggests that the clinical advantages of this procedure are not necessarily outweighed by the negative effects of cooling and re-warming a patient who has been severely injured. The battle goes on and it is unclear where this one will end. Families of the patients who were offered this procedure need to make their own informed decision.
CAREFUL ABOUT SLEEP MEDICATIONS
The Journal of Head Trauma Rehabilitation reported in 2010 (Larson, E.B.) that a negative effect on cognition was reported for TBI patients who were treated for insomnia with Benzodiazepins after injury. Furthermore, GABA agonists were found to possibly interfere with neuro-rehabilitation after injury. These types of medications should be avoided in the recovery phase of TBI. Pharmaceutical help in aiding sleep should be tailored to avoid these families of medications.
THE PSYCHIATRIC INJURIES OF TBI
Although it is generally held that psychiatric conditions can be created or aggravated after TBI, there is a lot of research going on at the present time to quantify this. In the American Journal of Psychiatry, (Bryant R. A. et al. 2010) a study involving patients who had suffered mild traumatic brain injury (MmTBI) was designed to see if new psychiatric disorders occurred after injury. Measurements three and twelve months post injury showed that 22% of the patients developed a psychiatric disorder they had not experienced before injury, the most common being depression 9%, generalized anxiety disorder 9%, post traumatic stress disorder 6% and agoraphobia 6%. Other studies have shown higher rates.
GENETIC ASSOCIATION WITH TBI OUTCOME
It remains a mystery why certain individuals who suffer a mild or moderate TBI can have an excellent outcome, while others can suffer devastating effects. Comparing MRI or CT scans between patients offers little to support the differences. Studies are now (Dardiotis, E. et al 2010) starting to accumulate evidence which implicates various genetic elements in the injury and recovery process of brain trauma. They note that “the extent of brain injury after TBI seems to be modulated to some degree by genetic variance.” Further research on this important issue will be forthcoming. Patients should take comfort in these studies in cases where hope for recovery does not occur, because it is in some instances beyond the patients control.
DATA ON DECOMPRESSIVE CRANIOTOMY
The benefits of decompressive crainotomy (DC) in the treatment of traumatic brain injury patients with increased intracranial pressure (ICP) is controversial. A recent study Williams R. F. et al. 2009, showed that DC resulted in good functional outcome in over 50% of patients with severe TBI. The maximum benefit was observed in younger patients. They had demonstrable reduction in ICP after decompression. These are factors to consider when the choice of DC arises after injury.
PROBABILITY OF LATE ONSET SEIZURES
Late onset seizures following moderate to severe brain injury are of great concern. They can emerge a year or two or more after the initial injury. A study (Englander, J. et al. 2003) showed that the highest probability for post traumatic seizures included biparietal contusions (66%), dural penetration with bone and metal fragments (62.5%), multiple intracranial operations (36%), multiple subcortical contusions (33%), subdural hematoma with evacuation (27%), or midline shift greater than 5mm (25%). The initial Glasgow Coma Scale was associated with the following probabilities for developing late post traumatic seizures at 24-months: a score of 3 to 8, 17%, a score of 9 to 12, 24%, a score of 13 to 15, 8%.
NEW IMAGING HELPFUL IN CHILD BRAIN INJURY CASES
Two new types of MRI of the brain – Diffusion Weighted Imaging (DWI) and Consequent Apparent Diffusion Coefficient (ADC) have been used as predictors of outcome in adults, and a recent study (Galloway, NR 2008), shows that these tools have excellent predictive capability in regards to children with traumatic brain injury. The study found that ADC values in the peripheral white matter were significantly reduced in children with severe TBI with poor outcomes compared to those with severe TBI and good outcomes. They also found that the total brain ADC value alone had the greatest ability to predict outcome and correctly predicted outcome in 84% of cases. Thus, early identification of children in high risk for poor outcomes can be obtained using these tools and can assist in aggressive clinical management of these patients.
FACE RECOGNITION IMPAIRMENT WITH TBI
A review of the literature done in the journal Brain Injury (Radice-Meumann, D. et al 2007) shows that the TBI population often suffers from an impairment of their ability to determine the emotion of others from facial expressions. The results of this deficit result in poor interpersonal skills, which can affect social relationships, marriage, and rehabilitation. They suggest treatment approaches similar to those previously designed for autism to be considered with PT.
NO MALINGERING DETECTION IN WISCONSIN CARD SORT TEST
A large test of patients with mild traumatic brain injury and uninjured controls (Grebe, KW, 2009) showed that the widely used neuropsychological battery instrument tests, the “Wisconsin Card Sorting Test,” failed to detect patients who intentionally performed below their ability on the tests. The scores were ineffective in discriminating malingering from non-malingering mild TBI patients.
STUDIES ON POST CONCUSSIVE SYMPTOMS
Study in Norway (Siqurdardottir, S. 2009) studied post concussive symptoms from 3 to 12 months post injury in adults with TBI. Of the whole sample, 28% of cases developed those concussive syndromes at 3 months and 24% at 12 months post injury. The mild and moderate group showed a decline of symptoms over time in contrast to the severe TBI group. Greater levels of anxiety at 3 months, as well as shortness of post traumatic amnesia duration were found to be important predictors of the severity of these symptoms at 12 months. Interestingly, one year after injury, no differences were found between the TBI groups mild, moderate and severe on the presence of post concussive symdrome (PCS).
The second Norwegian study (Roe, C. et al. 2009) found that post concussive syndrome cognitive difficulties persisted for 12 months in a large percentage of the patients and that the cognitive symptoms persisted and were considered a significant problem even one-year after injury.
COOLING PROTECTS BRAIN IN INJURED CHILDREN
This is a well known phenomenon, a Chinese study from 2009 showed that moderate hypothermia (lowering the core temperature of the patient 10-degrees or so) showed improvements in intracranial temperature, intracranial pressure and other markers after severe brain injury. The temperature lowering was done for 72 hours after admission to the hospital and was considered safe in that clinical setting and successful.
Another study from 2009 shows that hypothermiawhen used with children suffering from brain injury hypothermia reduces the damage caused to the brain post accident. Damage caused by “oxidative stress” is a secondary form of injury that goes on in the brain following traumatic injury and which could have severe effects. The lowering of the temperature lowered the rate at which oxidated stress occurred and thus resulted in a better outcome for those treated with hypothermia.
BLAST VICTIMS AND VISUAL IMPAIRMENT
The study following Iraq veterans suffering from TBI from blast injuries showed ongoing visual problems in a significant number (over 80%) following injury. The visual dysfunctions included problems with convergence, accommodative and ocular motor dysfunction, visual field defects and night vision. The study is important in that it validates, in a group which no one can attack, the presence of these troubling visual problems often found in non-military brain injury settings. Insurance companies commonly scoff at these types of complaints, which are very real and objective.
THE BENEFITS OF ALPHA LIPOIC ACID IN TBI
A Turkish study from 2009 showed that the ingestion of alpha-lipoic acid (LA) produced inflamation and other symptoms after brain injury. It also reversed swelling due to increased water content. It is thought to exert its influence by helping preserve the brain blood barrier permeability and by its antioxidant properties.
BLOOD TEST PREDICTS BRAIN INJURY OUTCOME
A team at University of Pittsburgh has found that measuring the initial blood magnesium level of patients with brain injury indicated an expected outcome from the injury. They found that patients who had a low magnesium level upon arrival at the hospital had significantly worse outcome than those with a normal magnesium level. It is hoped that more hospitals will begin to take this important measurement in the future.
POSITIVE EFFECTS OF HEMOGLOBIN SOLUTION
It has been noted that resuscitation with a special hemoglobin oxygen-carrying solution may reduce the effects of secondary brain injury in patients who have had traumatic brain injury and bleeds. The solution called HBOC-201 is a salt solution that increases oxygen delivery to tissues. The studies on human should be available soon.
THE DRUG USEFUL FOR AGGRESSION
A pallet study for the use of Quetiapine for treatment of aggression secondary to traumatic brain injury showed that it was effective in reducing irritability and aggression in such patients. Patients also reported an associated improvement in cognitive functioning.
ACCELERATED DAMAGE IN ELDERLY
The destructive cellular action known as Excitotoxicity occurs after TBI and results in brain cell death. A recent study in rats showed that older animals showed earlier onset of damage in wider areas then younger rats. This study shows, along with many others, that the effects of TBI on the elderly are often more significant than an equivalent injury in a middle aged person.
MOOD DISORDERS AND THE HIPPOCAMPUS
It was found that patients who developed mood disorder following traumatic brain injury have significantly lower hippocampal volume than patients without mood disturbance. Reduced hippocampus volumes were associated with poor vocational outcome in one year follow-up. The findings are consistent with the “double-hit” mechanism by which neural and glial elements affected by trauma are further damaged by the neuro-toxic effects of increased cortisol found in association with mood disorders. The need for volumetric studies of the hippocampus following moderate to severe brain injuries is becoming more and more important.
SELECTIVE BRAIN COOLING PROTECTS AGAINST TBI
Therapeutic hypothermia is a promising treatment for patients with severe TBI. Using a head cap and neck band filled with cooling material, patients who underwent such cooling after admission, had a far higher rate of good neurological outcome than those who did not. The non-evasive procedure is a safe method of improving the prognosis in severe TBI patients and hopefully this treatment will begin to be offered in the United States soon.
MILD TBI CELL DEATH
The presence of apoptotic cell death after mild traumatic brain injury in rats has been established. Selective neuronal cell loss was evident in several regions of the brain and the data suggest a biological basis for the permanent symptoms found in some mild TBI patients. (Raghupathi, R et al. 2002).
LONG TERM OUTCOME FOLLOWING MILD TBI
Following patients who reported mild TBI for an average of eight (8) years post injury, revealed that “MTBI can have adverse long term neuropsychological outcomes on subtle aspects of complex attention and working memory.” (Danderploeg, RD 2005).
MILD TRAUMATIC BRAIN INJURY, LONG TERM SYMPTOMS
A European study from 2006 followed the progression of victims of MTBI. The results of follow-up neuropsychological testing showed “the idea that MTBI can have sustained consequences, and that the subjectively experienced symptoms and difficulties in every day situations are related to objectively measurable parameters in neuro-cognitive function.” (Sterr A, et al. 2006).
VISUOSPATIAL ATTENTION DEFICIT AND EXECUTIVE FUNCTIONS PROBLEMS AND MTBI
A group of patients who had suffered mild traumatic brain injury were given a battery of tests to determine the nature and rate of their recovery. The researchers noted “these findings indicate that the regions of the brain associated with orientating and executive components of visuospatial attention may be the most susceptible to neuro damage resulting from MTBI. Moreover, the lack of recovery in the executive component indicates that the degree and time course for recovery may be regionally specific.” The findings show the deficits in executive functioning existed one month after trauma.
MILD TRAUMATIC BRAIN INJURY EQUALS PERMANENT DEFICITS IN MICE
Researchers tested mice following mild traumatic brain injury for up to 90 days post injury. Their findings showed “these results demonstrate that persistent deficits in these tests of cognitive learning abilities and emergence of depression-like behavior in injured mice are similar to those reported in human post-concussion syndrome.” (Milman A, et al. 2005).
DIFFUSION TENSOR IMAGING (DTI) ADVANCES
The type of MRI now being utilized, known as Diffusion Tensor Imaging, promises to be more sensitive than normal MRI, especially in detection of white matter brain injury. It has the ability to see and is more sensitive to diffuse axonal injury and the effects of stretched neurons. Persons with ongoing TBI symptoms in the face of normal MRI should consider DTI to rule out more subtle damage. (Wilde EA et al. 2006).
INCREASED AGE MEANS POORER OUTCOME
A Japanese study (Tokutomi, T., et al. 2008) has shown again what has been known for years. All other factors being equal, victims of TBI who were elderly have a worse outcome. One hypothesis is that cognitive reserve in older patients is lower and thus their recovery from brain trauma is diminished compared to younger persons who have not suffered brain atrophy through aging.
UNEXPECTED PROTECTION FROM TBI
A study in Hawaii (O’Phelan, K., et al. 2008) found, unexpectedly, that the survival rate of TBI victims who tested positive for alcohol and methamphetamine was higher than those who tested negative for any drugs in their system. It is speculated that these substances, as well as cannabis, may provide some neuro-protective mechanism to the brain after trauma.
CONTINUED DEBATE OVER CEREBRAL PERFUSION
It has long been understood that low cerebral blood flow (also called cerebral perfusion pressure – CPP, the rate at which oxygenated blood is flowing through the brain) is associated with poor outcome after TBI.. This has lead to studies trying to present with an agreed target to achieve in patients with brain trauma. An attempt to regulate at 70mmHg showed complications and a goal of 60mmHg is now recommended, although the debate continues.
APOE4 AND OUTCOME OF TBI:
For the past ten years research has shown, then not shown, an association between comparatively worse outcome in patients with TBI who harbor the APOE4 gene. A meta-analysis (Zhou, W., et al. 2008) showed that the APOE4 gene was significantly associated with poor outcome of TBI six-months after injury, but was not associated with the initial severity of brain injury following TBI. There are many difficulties in showing this in the litigation context since genetic testing for this purpose is not well received by treating physicians and many facilities are unwilling to do this type of genetic testing. However, brain injury litigators need to keep trying to screen for this, especially in cases where the patient has a comparatively bad outcome which is being contested by the insurance company.
BRAIN INJURY AND CHRONIC PAIN
The Journal of the American Medical Association in 2008 explored the association between TBI and chronic pain syndromes. After ruling out other factors, such as PTSD and depression, it was found that “chronic pain is a common complication of TBI. It is independent of psychologic disorders such as PTSD and depression and is common even among patients with apparently minor injuries to the brain.” Thus, complaints of pain which complicate recovery from TBI need to be taken seriously and addressed in the proper methods.
EXCITING NEW DRUG
Researchers have shown that a single dose of COG1410, a small molecule derived from the APOE receptor region of the brain, improves outcome following TBI. In these early animal tests, significant improvement was found after administration of this drug, speculating that the drug appears to block the development of significant behavioral deficits and reduces tissue loss associated with TBI.
TBI AND CEREBRAL ATROPHY
It is well known that one of the consequences of a moderate to severe TBI is atrophy or shrinking of the brain due to the injury to millions of cells. High speed velocity change injuries (motor vehicle accident or fall from a height) can give rise to acute Diffuse Axonal Injury (DAI), which is widespread damage to the axons of the brain. This study (Ding, K. et al. 2008) showed the relationship between imaging studies which showed DAI in the acute phase, and whether or not at the chronic phase (more than six-months later) there was correlation to brain atrophy. They noted that acute axonal lesions measured by flare (MRI) imaging are strongly predictive of post traumatic cerebral atrophy. ? In other words, the more white matter damage found early by MRI flare or DTI, the more likely there would be pathological brain shrinkage with the passage of time.
SUCCESSFUL NEW TBI TREATMENT
Studies are starting to mount which indicate a high beneficial course of treatment for those suffering from TBI. A combination of therapy of simvastatin and bone marrow stromal cells (MSCs) showed improved functional outcome in rats after traumatic brain injury. The improvement was long lasting and showed that the stromal cells had permanently attached themselves in the injured brain of the rats, leading to increased healing. These two treatments used together will hopefully be available to human patients within two or three years and should improve the functional outcome of all patients after TBI.
COMMON PILL AIDS TBI RECOVERY
Progesterone, a component of birth control pills, has been shown to improve the neurological outcome for patients with severe head injuries according to The Journal of Critical Care. A Chinese study treated similarly injured patients for three to six months after severe brain injury. Significantly more patients given Progesterone had favorable outcomes. Exactly how the compound works is not yet fully understood, but its wide adoption in emergency rooms across the United States should occur quickly.
NEW IMAGING STUDY SHOWS MILD TRAUMATIC BRAIN INJURY
Diffusion tensor imaging (DTI), which can be done on an MRI scanner with special software, has been shown to show structural changes in the white matter of the brain even in patients with mild traumatic brain injury. Dr. Marilyn Kraus noted “even in patients with mild TBI – those identified as having minimal or no loss of consciousness – there were structural deficits.” Thirty-seven TBI patients underwent the imaging study as well as neuropsychological testing to evaluate memory, attention and executive functioning. Researchers found that the structural changes in the white matter correlated to the observable cognitive deficits related to thinking, memory and attention.
STEM CELLS REPAIR TBI
Scientists in many parts of the world are looking towards stem cells to help repair brain damage from TBI. The limited capacity of self repair for the brain following TBI requires cellular transplantation of stem cells to replace those lost in trauma. Cellular transplantation has begun to be evaluated in several models with animals with promising results.
Because this treatment has not yet been approved for humans in the United States, several doctors and companies have been set up in other countries, in which the patients with TBI can receive stem cells through intravenous transfusion. (The company Medra working out of the Soviet Union, Germany and the Dominican Republic has significant anecdotal success with patients but they are still fighting a battle to be accepted by the medical community).
There appears to be some basis for this treatment in The Journal of Neurosurgery (Mahmood A. 2004), it was shown that marrow cell transplantation after traumatic injury showed increased cellular growth in rats. In another study in the Henry Ford Health Center in Detroit, intravenous bone marrow stromal self therapy reduced “apoptosis” and promoted cell growth in rat brains. “Apoptosis” is a method by which brain cells die after trauma. These and other studies give great hope that bone marrow or fetal stem cell transfusion holds great promise.
PROOF OF MILD TRAUMATIC BRAIN INJURY IN MICE
Because it is unethical to produce traumatic brain injury in humans, many of the most cutting edge experiments are done on mice. Although this is unfortunate, studies show that mild traumatic brain injury, when induced in mice, shows signs of apoptotic cell death in the brain. “Apoptotic cell death” is a fancy word for programed cell death. All of the cells in our body have the ability to regulate their population, if needed. In addition to this internal balance in the body, it has been discovered that traumatic brain injury can give rise to disregulation of brain chemicals, and can thus lead to apoptotic cell death in brain cells. This study at the University of Pennsylvania found objective signs of apoptotic cell death following mild traumatic brain injury to rats. Findings of this occurring as a result of mild traumatic brain injury helps explain why, in some cases, mild traumatic brain injury has long standing and profound effects.
A second study on mice published in the Journal of Neurotrauma showed mice with induced mild traumatic brain injury suffered long lasting cognitive defects, emotional difficulties and behavioral disturbances. Again, the prejudice against those who complain of ongoing symptoms after mild traumatic brain injury is increasingly misplaced. These studies show not only objective signs of brain injury after a mild trauma but that long term symptomology is shown in mice similar to those reported in humans with post concussive syndrome.
BRAIN REPAIR AFTER ALCOHOL DAMAGE
MRI scans used to measure the volume of the brains of alcoholics has shown hopeful evidence that brain volume showed an increase of 2% in size 38 days after stopping the intake of alcohol. The study also showed better performance on tests. Thus, the long known symptom of chronic alcohol abuse, namely a reduction in brain volume (mild to moderate brain atrophy) can be somewhat reduced in a recovering alcoholic.
FOOTBALL STUDY CONSISTENT WITH CAR ACCIDENTS
Researchers outfitted college football players helmets with devices to measure the speed, direction and force at which their heads were struck during a game. Surprisingly, the data failed to predict which hit would or did cause a concussion or brain injury.
This is consistent with the real world, wherein it is difficult to determine who might walk away from a trauma without a brain injury and who might suffer an injury. Factors such as the positioning of the head, the exact line of force, heredity and other unknown variables all must come into play. Some individuals can simply have an increased susceptibility to traumatic brain injury, for reasons we do not fully understand.
DEPRESSION IN NFL PLAYERS TIED TO CONCUSSION
A study by the University of North Carolina, in a health survey of over 2500 retired NFL players, showed that 20% of those who reported sustaining three or more concussions on the football field suffered from depression. That was three times the rate of players who did not sustain concussions. While the findings are consistent with previous research on elevated depression rates on those having suffered a TBI, the NFL and some experts have attacked the study as being inconclusive. Further studies are upcoming.
CENTER FOR DISEASE CONTROL DEFINITION OF MILD TRAUMATIC BRAIN INJURY
The Center for Disease Control (CDC) in 2003 published the following:
Recommended definitions for mild traumatic brain injury.
Incident cases of MTBI
The conceptual definition of MTBI is an injury to the head as a result of blunt trauma or acceleration or deceleration forces that result in one or more of the following conditions:
Any period of observed or self reported:
- transient confusion, disorientation, or impaired consciousness;
- dysfunction of memory around the time of injury;
- loss of consciousness lasting less than 30 minutes.
Observed signs of neurological or neuropsychological dysfunction, such as:
acute seizures following injury to the head;
symptoms among older children and adults such as headache, dizziness, irritability, fatigue or poor concentration, when identified soon after injury, can be used to support the diagnosis of mild TBI, but cannot be used to make the diagnosis in the absence of loss of consciousness or altered consciousness. Research may provide additional guidance in this area.
MEMORY/PROBLEM SOLVING CONTINUE TO IMPROVE AFTER TBI
In a study (Hammond FM et al., 2004) patients who had suffered TBI were tested between the years one and five post injury. The greatest amount of improvement noted was observed in memory and problem solving (34%) which was higher than previous studies had indicated.
The greatest amount of decline was observed for social interaction, which was consistent with previous studies.
These results are more hopeful for victims of TBI than the previous idea that little, if any, cognitive recovery occurs after one or two years post injury.
AMBIEN WAKES COMA PATIENTS
Several instances of partial or significant recovery from coma or vegetative state have been published in the last year, which were caused by the administration of Ambien. The commonly prescribed sleeping pill (Zolpiden) was featured in a BBC documentary aired in October 2007, entitled “The Waking Pill.”
It is thought that Ambien may activate receptions in the brain which are usually reserved for the neuro-transmitter gamma aminobutyric acid (GABA). Researchers believe that brain injury may alter GABA receptors, causing regions of the brain to remain dormant. They speculate that Ambien could possibly temporarily reverse this change.
Several patients have undergone PET scans to show the increase level of activity in the brain following the administration of Ambien, and such activity was indeed shown.
MILD BRAIN INJURY AND SLEEP PROBLEMS
It has long been established that brain injury can cause profound disruptions in sleep which have a significant negative impact on patients. Half the patients in this study were found to have a delayed sleep phase syndrome. Problems included falling asleep, waking up and irregular sleep patterns.
This study, along with previous studies, points to sleep difficulties as one of the under appreciated and understudied aspects of traumatic brain injury.
PROGESTERONE: Treatment for Severe TBI.
The female sex hormone progesterone has been successfully used to treat severe traumatic brain injury, as recorded in the Annals of Emergency Medicine. A hundred patients with blunt traumatic brain injury showed a higher survival rate in those patients who were treated with intravenous progesterone within the first thirty (30) days after injury.
EXTRAORDINARY HOPE FOR SEVERE BRAIN INJURY
In a landmark study published in the Journal, Nature, doctors described reviving a patient in a minimally aware coma by implanting tiny electrodes in the brain. Scientist believe that the process, which is now used in Parkinson’s patients, amplifies the electrical activity of the diminished injured brain resulting in increased awareness and function. The man could only say yes or no; however, after therapy, with the new system, was able to repeat the Pledge of Allegiance and is much more fully aware. This provides possible hope to the 100,000 to 300,000 minimally conscious patients now in the U. S., most of whom are in nursing homes. The doctors caution that those with more severe brain damage may not see such dramatic results. People interested in this procedure should search for facilities that advertise “deep brain stimulation for Parkinson’s rehabilitation.”
WARNINGS ABOUT OBESITY SURGERY
Doctors warn that Bariatric surgery (shortening of the intestines to prevent obesity) can result in Wernicke’s Encephalopathy, which is caused by a thiamine’s deficiency or lack of Vitamin B1. Patients were urged that if they showed symptoms of confusion or poor coordination to seek immediate help and get injections of thiamine as early as possible.
COCOA COULD IMPROVE BRAIN FUNCTION
Several recent studies suggest that some types of cocoa contain substances that could enhance blood flow in the brain and improve brain function. Although it is a little distressing that the conference at which this breakthrough was discussed was sponsored by Mars Incorporated, the candy maker, it did point to compounds known as Flavanois as to their ability to keep the brain healthy and prevent cognitive decline and dementia. Scientists in England believe that drinks containing this compound could be used to treat vascular impairments in the brain. After consumption of the liquid, it was noted that there was increased blood flow to the gray matter for two to three hours.
FEMALE HORMONE SAVES TBI LIVES
Promising new treatment for severe brain injury has emerged in a recent Atlanta study. 77 patients were given the female hormone, Progestin (which is a steroid and also protects brain cells but has no effects on males from hormone stand point). The percentage of patients who died who were not given the Progestin was 30% and only 13% of those given a Progestin died from a head injury. Follow-up studies are underway and they hold great promise.
Studies linking the onset of migraines to certain food such as chocolate, red wine, and aged cheese have not proved to be related. In a recent study, 90 of 100 people self-diagnosed sinus headaches were found to have migraines. They feel most “sinus” headaches are really migraines. Things that actually caused or aggravated migraines included positive or negative stress, weather changes, estrogen withdrawal, fatigue and sleep disturbances, as well as overuse of over the counter pain medication.
DEPRESSION IS A COMMON LONG-TERM OR EVEN LIFETIME PROBLEM THAT OFTEN FOLLOWS TRAUMATIC BRAIN INJURY
Earlier studies have shown that persons with traumatic brain injury induced depression are more difficult to treat than those with other types of depression. A couple of studies published in the archives of general psychiatry show promise in treating 18 chronically depressed men and women with a drug Ketamine which is not yet approved for depression and is commonly used as an animal tranquilizer. It is doubtful Ketamine will be able to be prescribed for depression for at least a year or two but please consult your treating physician.
OUTCOME 3 TO 5 YEARS AFTER MODERATE TO SEVERE TBI
Investigators (Dikmen, SS 2003) followed persons with moderate to severe TBI for three to five years noting the degree of recovery. Unfortunately, significant functional limitations were observed in all areas. In 65% of cases, there was recovery to pre-injury levels in personal care, 40% recovered in regard to cognitive competency, major activity, leisure and recreation. How long the patient was unconscious appeared to contribute to the outcome more than damage seen on MRI.
EFFECTS OF AGING ON TBI RECOVERY
Researches at the Mayo Clinic (Testa JA et al. 2005) confirmed again what was previously known – that age adversely affects recovery from TBI. Findings show that older patients with TBI have a greater likelihood of becoming physically and financially dependent on others. Older TBI patients were more likely to have changes in employment status compared with younger patients. An earlier study had compared TBI patients over 60, and limited to patients with only mild TBI, they showed the same improvement and functional status as the patients under 60. Therefore, the age difference appears to be more significant as the injury goes from mild into the moderate and severe categories.
LONG TERM OUTCOME FOLLOWING MILD TBI
Patients, on an average of 8 years post TBI, most in the mild range, were given follow-up neuropsychological testing and compared with normals who were in motor vehicle accident without TBI. Those who suffered the mild TBI continued, an average of 8 years later, to have problems with aspects of attention and working memory. The study’s conclusion was that it showed “that MTBI can have adverse long-term neuropsychological outcomes on subtle aspects of complex attention and working memory.”
FATIGUE AND MILD TRAUMATIC BRAIN INJURY
Although fatigue is one of the most reported symptoms after TBI, there have not been many studies on its effects. A group in the Netherlands (Stuleneijer, M et al. 2006), studied approximately 300 patients with MTBI. The study found that one-third of the patients experienced severe fatigue six months after injury and that the type of fatigue is associated with limitations in daily functioning. Severe fatigue was highly associated with the experience of other symptoms and limitation and did not stand alone.
LONGER AMNESIA PREDICTS MORE BRAIN ATROPHY
Post-traumatic amnesia (PTA) has long been used as a predictor of outcome in those with TBI. A recent study (Wilde, EA, Bigler, ED et al. 2006) showed that a correlation between the duration of PTA in the existence of atrophy of brain tissue following an accident exists. The longer the period of PTA the higher the rate of brain tissue atrophy following an injury.
RELIEF FROM CHRONIC PAIN?
Persons suffering from intractable chronic pain have found relief in monitoring their own brain waves on a functional MRI scanner. After some training, the volunteers were able to make changes in the way their brains processed the pain signals and reported feeling less pain. The Stanford University study physicians caution that much is yet to be done but a company called Omneuron is trying to develop the equipment for commercial use.
CURE FOR COCAINE HABIT?
Because many who suffer traumatic brain injury can develop addiction problems, a recent finding could provide some help. Cocaine addicts, who were hospitalized, were given a supplement known as NAC (N-acetylcysteine), which appeared to lessen the desire for the drug. MRI’s taken of the patients’ brains saw a difference associated with the supplement.
MOLECULAR DAMAGE FROM TBI ONGOING FOR YEARS
In a recent paper further evidence of secondary or delayed cell death following TBI was shown. The diffuse and widespread damage was progressive and prolonged for months or years after the initial insult. Areas that continued to be vulnerable to such ongoing destruction are the cortex, hippocampus, thalamus, striatum and subcortical nuclei.
DEPRESSION AND TBI
Several recent studies continue to solidify the relationship between depression and traumatic brain injury. A multicenter study (Seel RT 2003) showed that patients with TBI are at “great” risk for developing depressive symptoms. Unemployment and poverty may also be substantial risk factors in the development of depressive symptoms. A study tracking the psychiatric illnesses following TBI (Fann JR 2004) found that 34% of those with mild TBI had a high initial and ongoing risk of persistent psychiatric illnesses.
PEDIATRIC TBI EQUALS WORSE OUTCOME
An experiment, with one-week old rats who sustained TBI, has clearly shown that the trauma triggered cell death (apoptosis) in the brains of the very young rats was far greater than those in older rats. These results help explain the unfavorable outcomes of very young pediatric head trauma patients and outlines again the importance of trying to prevent secondary cell death following head trauma.
SPECT SCAN VALIDATED IN TBI
SPECT scanning of the brain, which has received increasing recognition in the past five years, has again shown to be sensitive to TBI. In a variation known as Proton Magnetic Residence Spectroscopy (1 H-MRS) the relationship of brain chemicals in the brain following trauma, are now seen to be markers for diffuse axonal injury. The levels of chemicals have a significant correlation with the functional status of the patient. Thus, localized 1H-MRS has the potential to be used for detecting diffuse axonal injury (DAI) in TBI patients and can be useful as a guide to future rehabilitation.
EARLY SYMPTOMS OF TBI LINKED TO OUTCOME
Mild traumatic brain injury patients’ symptoms were used to predict severity of post traumatic complaints six-months after injury. It was found that the patients complaining of headache, dizziness, or nausea at the emergency room after mild traumatic brain injury strongly associate with the severity of symptoms six-months after. Patients at the emergency room without headache, dizziness, nausea did much better at six-months following injury than those who had these complaints (R deKra 2002)
WATCH YOUR PITUITARY
Pituitary gland function and levels of growth hormone can be adversely affected by TBI. A recent study (Aimaretti, G. 2004) suggest that careful screening of the pituitary function should occur following TBI. Keeping these systems in chemical balance will speed TBI recovery.
MAGNETIC FIELDS MAY REDUCE DEPRESSION FOLLOWING TBI
Many patients have depression following brain injury which does not respond to antidepressant drugs. The authors of the study contend that there may be subclinical, partial complex seizure activity which continues for months or years after “recovery”. Four patients who had such an injury showed significant improvement of depression after having burst-firing magnetic fields across their temporal lobe once a week for five weeks. (Baker-Price L.A. 1996).
NEW WAY OF DETECTING HEARING LOSS
Because many persons with traumatic brain injury are in a coma or otherwise unable to communicate their problems, it is often a bit difficult to determine if hearing loss is part of the injury. A recent study (Lew H. L. 2004) showed encouraging results by having the individual undergo brain stem auditory evoked potential. They follow this test up with CT scan of the bilateral temporal bones. Use of these two tests may prove valuable in ruling out hearing loss in those with severe TBI.
It has been found that treadmill activity, forced limb movement, and other physical activities help promote brain plasticity (ability to repair). A pattern of exercise before an injury promotes a defense against cell death. It is thought that, in the chronic stages after brain injury, an exercise program might reactivate the mechanism of healing, and thus it is recommended to keep victims as physically active as possible. In a related study, recreational therapy was found to improve rehabilitation.
Effects of trauma induced brain injury can possibly be reduced, post-accident, by giving the patient a vaccination of Cop-1, a synthetic co-polymer used to treat MS. Such a vaccine may be available soon, and would be ideal for use at trauma centers and emergency room facilities. Do not expect this vaccination until, at least, 2005.
NEW WONDER DRUG?
Mifepristone, also known as the abortion pill, may have a wonderful side effect in that it protects brain cells. Experiments in mice have shown that the drug extends the life of neurons and protects against the cellular destruction which occurs in traumatic brain injury (and for other reasons) in a process called apoptosis.
BETTER NEUROLOGICAL OUTCOME
Trial studies of the drug, dexanabinol, were briefly conducted in cases of severe head injury. Patients treated with the drug had increased positive blood flow after injury without dangerously low blood pressure. Overall the patients treated with the drug had faster and better neurologic outcome.
MAGNETIZATION TRANSFER RATIO (MTR)
Research into new MRIs have shown promise into showing, more sensitively, brain damage due to trauma. The type of MRI known as Magnetization Transfer Ratio (MTR) has shown to be effective in detecting abnormalities in the white matter of the brain following trauma. These abnormalities were looked at in the splenium of the corpus callosum in the brain stem. (Sinson, G. 2002).
PROMISING NEW DRUG
Researchers at the University of Florida are working toward a treatment to curtail the secondary cell death which follows severe brain trauma. Early signs show that administration of the common chemotherapy drug Cyclosporin A within 12 hours of injury interrupts the chain of events that can lead to worsening of brain injury in the first day or two following trauma. Tests on animals show great promise in reducing swelling and regulation of calcium induced damage.
SAY NO TO HERBAL REMEDIES
The use of herbal supplements is common in the U.S. However, following a brain injury, remedies such as St. Johns Wort and Ginko Giloba, SHOULD BE AVOIDED. Studies show that they may induce mania in TBI patients. If you feel that you must take supplements, make sure you clear them with your doctor, especially if taken in conjunction with prescription medication. (Spinella M., 2002)
MRI USED FOR DIAGNOSIS OF MENTAL ILLNESS
Several hospital centers across the U.S. are beginning to use MRI (MRS) to diagnose mental illness such as depression and panic disorder. Changes in metabolic activity can clearly correlate with certain disorders. For example, evidence of bipolar disorder in the frontal lobes can be seen and changes associated with ADD in children can be gleaned through changes in brain volume.
DRUG FOR SEVERE BRAIN INJURY
A recent study confirmed the safety and usefulness of intravenous dexanabinol (HU-211), in cases of severe head injury. Patients experienced excellent control of intra-cranial pressure, a common deadly side effect of brain injury. Patients on HU-211 also experienced faster and better neurologic outcome. (Knoller N., 2002)
Long Term Depression with TBI
A long term follow-up study on head injured veterans reported in the archives of general psychiatry showed that concussions and other head injuries in early adulthood may significantly raise the risk of depression decades later. This is consistent with earlier studies that show that head injured patients may be prone to depression shortly after the head injury. The study suggested that the risk of depression persists even fifty years after the injury. (Keep in mind that the study by McCallister and Flashman in 1999 concluded that 20% to 30% of mild TBI patients show major depression in the first year post injury) (T. Holsinger 2002).
QUANTITATIVE MAGNETIC RESONANCE
Dr. Erin Bigler of Brigham Young University and others are examining ways in which MRI studies can show demonstrable reductions in the volume or surface area of the brain after traumatic injury. The “atrophy” or shrinking of the brain after traumatic injury, has been shown to be consistent with the aftermath of diffuse axonal injury (DAI) and focal brain injury. Following the early stages, this method of imaging the brain holds great promise in proving injury. (Bigler E. 2001)
The Annals of Neurology has found that creatine, a common food supplement administered to rats after traumatic brain injury, increased the repair of cortical tissue by 30% to 50%. (Sullivan P.G. 2000)
TREATMENT FOUND NOT EFFECTIVE
The New England Journal of Medicine in February 2001, reported that a hopeful therapy for brain injury, hypothermia, was not shown to be effective in reducing residual brain injury symptoms, as previously thought.
The Journal of Brain Injury recently reported that patients in the slow-to-recover subset of severe TBI, may benefit from longer trials of rehabilitation, with functional recovery continuing to improve months or years after injury. (Grey D.S. 2000)
CHILDREN AT GREATER RISK
A French study further confirmed that the “Kennard Principal” (that recovery from injury is greater in children that adults) appears to be false, especially in diffuse injuries. They recommended that final assessment of childhood outcome for TBI should be done only after several years. (Laurent-Bannier A. 2000)
A study in Norway found that post injury TBI patients had a highly increased percentage of involvement in driving accidents and recommended special assessment for driving post injury. (Mosberg A. 2000)
In a study of paid attendant care to victims of TBI the main benefit was found to be that of friendship to the victim, and the study recommended further training to stress this important component of care. (McCluskey A. 2000)
A study from this year in the Journal of Nervous and Mental Disorders found the rate of Post Traumatic Stress Syndrome in cases of severe traumatic brain injury to be 27% and recommended rehabilitation efforts to take this into account.
LOSS OF CONSCIOUSNESS
The study of brain injured athletes showed no relevant distinction in the outcome between athletes who lost consciousness and those who did not at the time of injury. (Lovell M.R. 1999)
CHILDREN MORE AT RISK
A study in rats showed that neuro-degeneration after trauma was worse in immature versus mature individuals, and cited as the cause Apoptotic Degeneration.
In the studies that support the findings supporting the use of MRS, protein markers consistent with traumatic brain injury were found in injured patients. This was consistent with the follow-up outcome of neuropsychological testing. (Ingebrigtsen T. 1999)
Secondary damage after traumatic brain injury via lipid peroxidation (LPO) was found in patients within twenty-fours hours post injury. Treatment with natural or synthetic antioxidants was recommended. (Sutkovoi 1999)
HOPE FOR EPILEPSY
Widespread use of nerve stimulators in patients with severe epilepsy has shown a good to moderate reduction in reducing seizures in 66% of patients. Patients undergo a one to two hour surgery to implant a stop-watch size device in the chest. The procedure, covered by most insurance, costs approximately $20,000.00.
LEAD POISONING FINDINGS
The recent study showed that lead concentrations in blood were much lower than previously thought, and were associated with declines in cognitive and academic skills. Decreases in performance occurred in children having a blood level less than 5 micrograms per deciliter (ug/dL). These finding would indicate that the current blood level concentration cut off of 10 ug/dL is incorrect and would have to be lowered. (Lanphear 2000)
Ringing in the ears (Tinnitus) is a common and often terrible symptom of brain injury. Previously, there was no test to objectively determine the existence or non existence of this complaint. However, a recent study indicates that changes in the inner ear leading to Tinnitus may be detectable on MRI imaging of the ear. (Meriot 2001)
MRI imaging technology continues to be refined and improved. Adding magnetization transfer imaging (MTI) and contour plot analysis to MRI studies greatly adds to the sensitivity of the imaging in detecting signs of traumatic brain injury (McCowan J.C. 2000)
There are apparently far more visits to the emergency room in the United States for traumatic brain injury than previously thought. A re-analysis of data from the calender year 1995 to 1996, showed one million visits, much higher than previously thought. (Guerrero 2000)
A long term follow-up of victims of childhood brain injury showed continuing vocational problems at age 21. Again showing that children are not more immune to brain injury than adults. (Nybo 1999)
This study, among others, has confirmed that there is a direct relationship between traumatic brain injury and the emergents of sleep disorders. The severity and impact of chronic sleep disorder is just now beginning to be understood, and is far more of a problem than previously thought. (Beetar 1999)
In this older study, reconfirmed by more recent studies, 686 victims of mild traumatic brain injury were examined and found to have completely normal neurological exams. The patients then underwent imaging studies and 18% of the patients were found to have lesions in the brain. (Stein 1993)
Contrary to what was previously thought, cognitive decline in patients suffering from diabetes and hypertension starts at middle age rather than old age. (Knopman 2001)
MAGNETIC RESONANCE SPECTROCOPY (MRS)
Yet another study confirms the exciting possibilities of this new diagnostic tool, which measures the relationship of brain chemicals utilizing MRI. The finding of certain relationships is consistent with the diagnosis of brain injury. (Brooks W.M. 2001)