Over the past decade this blog has featured several articles addressing the growing recognition that neuroendocrine issues are an often-overlooked consequence of TBIs of all levels of severity, leaving patients with unnecessary chronic symptoms. We have discussed evolving guidance on the best methods to assess these issues (including the importance of “stimulation testing.” ) Unfortunately, outside of major medical centers (and military hospitals) awareness of this issue is not consistent.
As we have discussed, one of the most common neuroendocrine deficiencies is “growth hormone” deficiency. The symptoms of growth hormone deficiency are common following TBI; they include “quality of life” problems including low energy level, increased emotional lability and irritability, and increased social isolation. They also include physical symptoms such as increased fat mass and decreased muscle strength. The good news is that when the cause of these symptoms is injury to the pituitary gland (often the stalk of the pituitary gland, which is particularly vulnerable) treatment may lead to improvement in the symptoms. Growth hormone deficiency may be addressed through regular growth hormone injections. Although this treatment can be expensive and is sometimes required on a permanent basis, the increasing understanding of this issue in the field of neuroendocrinology has made it easier for patients to get insurance coverage. Read More
For more than a decade this blog has covered the growing recognition by policy makers and in the peer reviewed literature that traumatic brain injuries (TBIs) of all kinds should not be treated as a static event from which patients gradually recover over time.
In many cases, the TBI is the beginning of a disease process that can cause symptoms that change over time, in some cases getting better instead of worse, and that can impact multiple organ systems.
In 2009 this led a leading advocacy group, the Brain Injury Association of America (BIAA), to issue a position paper in favor of recognizing TBIs as a “chronic health condition.” The BIAA has continued to advocate this position. The Centers of Medicare and Medicaid Services (CMS), the federal agency that administers Medicare and Medicaid (the latter in cooperation with states) has now adopted this position as well, recognizing TBI as a chronic health condition effective January, 2025. This will lead to both increased public health resources – to address the lifelong impacts of brain injury – and to enhanced benefits from health insurance plans like Medicare and Medicaid. Read More
A recent systemic review of the literature, just published in the Journal of Athletic Training, 2024; 59(1): 49-64, concludes that “vestibular and oculomotor screening are prognostic of time to recovery” from concussion.
Positive findings on these assessments “consistently predict longer recovery.” The authors therefore recommend that vestibular and ocular motor screening be part of the standard of care for assessment of concussion patients. Read the full study.Read More
As reflected in the posts on this blog over the last several years, scientific understanding of “mild traumatic brain injury” (Mtbi) – often referred to as “concussion” – has advanced considerably over the last 30 years. Unfortunately many physicians, including those on the “front lines” for these injuries–in emergency rooms and primary care clinics–have not kept up with this evolving science. In emergency rooms, the focus is typically on ruling out catastrophic injuries. The signs and symptoms of concussion are often missed. Even where the symptoms are recognized, many physicians mistakenly believe, based on outdated information, that the symptoms of mTBI can be ignored and that virtually everyone recovers spontaneously. Compounding this misinformation is inconsistency in the definitions found in the literature, in many cases depending on when the definition was adopted.
In 2019 – to address some of these problems – the mTBI Task Force of the American College of Rehabilitation Medicine (ACRM) Brain Injury Special Interest Group undertook an updating of the 1993 ACRM definition of mTBI – one of the most widely recognized definitions. This work included rapid evidence reviews, an expert survey (to rate the diagnostic importance of various clinical signs, symptoms, test findings, and contextual factors), public and stakeholder engagement, and a Delphi consensus process with an international, interdisciplinary panel of clinician-scientists. The working group included 17 ACRM mTBI Task Force members and an external interdisciplinary expert panel of 32 clinician-scientists from seven countries and various fields such as sports, civilian trauma, and military settings. The new criteria adopted by this group are based on syntheses of current research evidence and went through several rounds of revision until more than 90 per cent of the expert panel agreed with what they were proposing. Read More
A large TRACK-TBI cohort study published in JAMA Network Open finds incomplete recovery at 5 years in 53% of mild traumatic brain injury (mTBI) patients, dictating need for longer term rehabilitation.
A multi-center transforming research and clinical knowledge in TBI (TRACK-TBI) cohort study published March 20, 2023 in JAMA Network Open followed 1196 patients at 18 level 1.0 trauma care centers in the US over five years, including patient with mTBI, patients with moderate-severe brain injury (msTBI) and orthopedic controls. It found persistently elevated rates of incomplete functional outcomes in 53% of mild traumatic brain injury patients and 83% of msTBI patients compared to controls, supporting a need for longer term monitoring and rehabilitation.
A recent study published in JAMA Network Open finds that patients with a history of traumatic brain injury (TBI), including mild TBI (mTBI), are at significantly greater risk of developing chronic cardiovascular, endocrine, neurological and psychiatric disorders. This proved to be true in all age groups, including younger adults (18-40).
This study is important because, as the authors note, “the risks of incident comorbidities in previously healthy patients who sustained mTBI and msTBI (moderate-severe TBI) has not previously been reported.” The most important takeaway of the study is that “patients with TBI in all age groups may benefit from a proactive targeted screening program for chronic multisystem diseases, particularly cardiometabolic diseases.” Read More
As highlighted in prior posts in this blog, TBI research increasingly highlights the importance of providing follow-up care to patients discharged from the ER with a diagnosis of TBI. Put simply, patients with follow up care have better outcomes.
One of the most frequent questions I get from TBI clients in my Vermont law practice is: “Are there alternative therapies I can explore to help support my recovery from a traumatic brain injury without risking further harm?” Physicians practicing “integrative oncology” offer a multi-disciplinary approach to patient care for cancer that implements complementary therapies in collaboration with conventional treatment. Although TBI medicine is not as well organized, the peer reviewed TBI literature does support similar evidence-based complementary therapies for the treatment of TBI. Several have been featured in prior posts in this blog, including yoga and other mindfulness based therapies, exercise therapies, dietary therapies (especially foods rich in ‘polyphenols” found in many fruits and vegetables) and promising supplements including melatonin and curcumin (found in tumeric, curcumin reduces the levels of two enzymes in the body that cause inflammation.)
Another supplement receiving increasing attention in the literature is resveratrol, a “phytoalexin” produced by plants such as the red grape in response to various stresses, which promotes disease resistance. Read More
Victims of mild traumatic brain injury (“mTBI”) commonly report psychological distress, which is not surprising given the impact the injury can have on every aspect of everyday life including but not limited to balance, vision, sleeping, physical discomfort including headaches, and perhaps most significantly thinking clearly. Patients often report that they are not the same person and fear that person will never return.
Israeli study finds that one in four children with mild traumatic brain injury (mTBI) suffer from persistent post-concussive symptoms
In a large multi-center retrospective matched cohort study, Israeli scientists recently found that one in four children (25.3%) who have been discharged from the emergency room after a mild head injury suffered from persistent post- concussive symptoms.
Among the chronic symptoms seen in these children were forgetfulness, memory problems, sensitivity to light and noise, ADHD and even psychological problems. Sadly, many of these children had been misdiagnosed as suffering from unrelated ADHD, sleep disorders, depression, etc. This misdiagnosis, the researchers noted, leads to treatment that is not suited to the problem, thus causing the children prolonged suffering. Read More
