One of the causes of the failure of clinical trials to successfully treat TBI, the authors contend, is the common classification of TBIs as “mild, moderate or severe.” These classifications do not incorporate newer insights and findings from diagnostic tools such as imaging and biomarkers and therefore do not promote “mechanistic targeting” for clinical trials. The authors support the transition to a more nuanced approach, a precise disease classification model that is based on the precise pathoanatomical and molecular features of the injury. Read More
Defense attorneys often cite “meta-analytic” reviews of neurological studies to make the argument that “mild” traumatic brain injuries (mTBIs) cause no lasting effect beyond three months post-injury. A “meta-analysis” involves a statistical study of multiple studies published in the literature.
Meta-analyses in mTBI are often used to show that persistent symptoms are “neurotic” rather than “organic”
Fortunately, it is generally agreed that the majority of people who suffer mTBIs, sometimes referred to as “concussions”, report full recovery from symptoms within three months of the injury – in fact many recover much faster. A great deal of research over the past few years has focused on the minority of people who do not fully recover within three months, described as having a “persistent post-concussion symptoms (PCS).” These patients are sometimes referred to as the “miserable minority.” The “meta-analyses” are often cited as demonstrating that changes in performance after three months have “limited statistical and clinical significance;” in other words, that persistent symptoms must be psychological or “neurotic” rather than “organic” or neurologic. Read More
Two recent peer reviewed papers support the position statement adopted by the Brain Injury Association in 2009 that “Brain Injury” be treated not as static event from which patients gradually recover over time, but as the beginning of a disease process that that can cause symptoms that change over time, in some cases getting worse instead of better, and that can impact multiple organ systems.
The good news is that most people do, in fact, recover. For those who do not, however, the disease model is more consistent with the evolving research. As McCrea, Iverson, McAllister, et. al. noted in their 2009 Integrated Review of Recovery after Mild Traumatic Brain Injury, brain injury science has advanced more in the last few years than in the previous 50, causing us to change the paradigms we have used to understand both the injury and its consequences. Read More
A recent study published in Neurology found a link between traumatic brain injuries (TBI) and ischemic strokes. Ischemic strokes, a category which accounts for 87 percent of all stroke cases as per the American Stroke Association, are those which are caused by blood clots or other obstructions in the blood vessels which connect to the brain. Read More
Concussion, or mild traumatic brain injury (TBI), typically produces no gross pathology, such as hemorrhage or abnormalities, that can be seen on conventional CT scans of the brain. It does cause rapid-onset neurophysiological and neurological dysfunction that in most patients resolves spontaneously over a fairly short period of time. Studies have shown, however, that approximately 15% of individuals with mild TBI develop persistent cognitive dysfunction and other symptoms. Researchers are starting to make progress on proving mild traumatic brain injury using the biomarkers that underlie such symptoms. Read More
Researchers at the Albert Einstein College of Medicine have just published a study in the peer-reviewed journal Radiology showing that soccer players who “head” the ball with high frequency show abnormalities in the white matter of their brains and poorer memory scores on cognitive tests. Read More
The American Academy of Sleep Medicine has announced the results of a recent study showing that bright light therapy following Mild TBI (concussion) may improve sleep, cognitive and brain function. The study results were presented at the June 3, 2013 meeting of the Associated Professional Sleep Societies LLC and published in an online supplement to the journal Sleep. Read More
The topic of sexual dysfunction after a traumatic brain injury shouldn’t be taboo. Millions of people in the United States live with the physical, cognitive and emotional consequences traumatic brain injury (TBI). Sexuality is often impacted, but not often discussed or addressed. Failure to address this issue can compound the adverse effect of TBI symptoms on important relationships and self-esteem. NeuroRehabilitation: An International Journal recently published a critical review of fourteen studies on this topic. Read More
In the study, NYU medical school researchers measured changes in global and regional brain volume over a one year period in 30 patients with “mild” traumatic brain injuries and typical post-injury symptoms including anxiety, depression and fatigue, and other symptoms such as headache, dizziness and perceived cognitive problems.
The “BRAIN” initiative, which stands for Brain Research through Advancing Innovative Neurotechnologies, is already underway at the National Institute of Health (NIH). And, on April 2, 2013 President Obama announced that his 2014 budget will include $110 million in funding to advance the initiative, which supports human brain research that could be used to treat a range of neurological conditions, including traumatic brain injury (TBI).
I expect the additional funds to elevate the project’s urgency, as it would be a joint effort of the National Institutes of Health, the Defense Advanced Research Projects Agency (DARPA) and the National Science Foundation along with other private and public entities. If this initiative goes forward, it also promises to augment work already underway at other research centers throughout the country.
