Breaking News About TBI

Dr. Ron Stram, a specialist in integrative medicine in Albany, N.Y., has developed a handheld device for treating migraines and nerve pain in patients who have sustained head injuries such as soldiers exposed to blast forces in Iraq or Afghanistan. The device emits changing frequencies of electric current through the skin and teaches the nerves to handle many different kinds of stimulation. This has the effect of reducing the hypersensitivity of the nerves along with the frequency of migraines or nerve pain.

TBI support groups are invaluable psychologically because so many people living with TBI feel isolated and misunderstood until they have the opportunity to meet regularly with others in their shoes. That’s when they get the understanding and social support they have been craving. But TBI support groups can do even more. If they are run by a speech-language pathologist they can help each group member improve his or her communication skills including pragmatics (the ability to use speech appropriately in a social context to productively interact with others). Support groups can also help with community re-integration by doing fundraisers or volunteer work in the community. The vast potential of support groups has yet to be tapped.

Lithium has been used for decades to treat mania. Psychiatrists believe that lithium controls mania in part by decreasing the activity of the excitatory neurotransmitter glutamate. Following TBI some brain cells release excessive quantities of glutamate which damages or kills other brain cells. Fengshan Yu and colleagues at NIH and the University of Health Sciences have explored the effect of lithium on acute TBI in mice. They devised an experiment in which some of the mice given a TBI under anesthesia were treated with lithium for 3 days and the others were treated with a placebo

The key results of the study include: lithium chloride at 1.5 to 3.0 mEq/kg reduced brain lesion volume compared to control; lithium chloride reduced post-trauma related anxiety behavior during the outcome monitoring; lithium chloride reduced breakdown of the blood-brain barrier; and short-term and long-term motor coordination was better in the lithium group of mice. The researchers would like to try out lithium in a clinical study on human beings with TBI in the future. Their results were published in the Journal of Neurotrauma.

Some of the soldiers returning from Iraq and Afghanistan with TBI are displaying the dual problem of seizures and migraine. Two University of Utah researchers (K.C. Brennan, M.D., assistant professor of Neurology, and Edward Dudek, Ph.D., professor and chair of the Department of Physiology) are teaming up with the Department of Defense to investigate this phenomenon. They suspect that seizures and migraine both arise from over-excitation of the brain due to TBI, and they are collaborating on a study to see if there is a common mechanism and a common method of preventing these very serious, long-term consequences of TBI.

NeuroVive Pharmaceutical, AB is a Swedish drug development company. Working with NeuroStat it has developed a mechanism for delivering drugs directly to the brain through the blood-brain-barrier which normally screens out large molecules. In recent tests NeuroVive has shown that cyclosporine A, a drug used to help organ transplant recipients avoid immune rejection, helps victims of severe traumatic brain injury by revving up the shocked mitochondria in their brain cells. Mitochondria are the part of cells that produce the vital energy needed for all cellular processes including cellular respiration, repair, and reproduction. NeuroVive continues to work on this new treatment, and it has just received a large grant from the Swedish government to use cyclosporine to treat acute stroke.

PTSD (post-traumatic stress disorder) can co-occur with TBI from the same event or occur on its own. Either way PTSD can cause serious emotional suffering and disability from work. A recent study on PTSD prevention by Joseph Zohar, M.D., of Tel Aviv University and Hagit Cohen, Ph.D., from Ben-Gurion University showed that traumatized patients who received a single injection of cortisone within a few hours of the event were more than 60% less likely to develop PTSD.

The researchers said the current prevention therapy using diazepine tranquilizers like Valium or Xanax to calm the traumatized patient down has not worked. They speculate the reason is that diazepines block the release of cortisol (which is made from cortisone). Why would blocking cortisol increase the likelihood of PTSD?

Cortisol increases blood sugar which reduces memory formation. Diabetics (who have high blood sugar) have poor cognitive function including poor memory. It may be that giving a shot of cortisone increases the material needed for cortisol synthesis which raises blood sugar and reduces memory of the event. Whatever the reason, the two researchers have been given a grant to continue studying the underlying mechanism(s).

In the October 2011 issue of the journal Trauma epidemiologist Eric B. Schneider, Ph.D., of the Johns Hopkins University School of Medicine reported that older patients who happened to have been taking cholesterol-lowering statin drugs when admitted to the hospital with serious head injuries were 76% more likely to survive than those not taking the drugs, according to results of a Johns Hopkins study. Those taking statins also had a 13%greater likelihood of achieving good, functional recovery after one year. Dr. Schneider suspects these effects are due to the anti-inflammatory properties of statin drugs which would prevent masses of white cells from moving into areas of traumatized brain tissue and killing them. He plans to do a clinical trial that would involve giving statins to in the ICU to seriously brain injured patients who had not previously taken statins.

Science writers Linda Carroll and David Rosner have just published an important book called “The Concussion Crisis: Anatomy of a Silent Epidemic” to dispel the myth that a concussion is not really serious and does not involve actual damage to the human brain that can produce long term symptoms with subjective misery and (in some cases) objective disability from employment.

Librarian Angela Hunt of Carver, MN tripped and struck her face on the sidewalk en route to work causing a TBI with loss of consciousness for about 20 minutes. When she attempted to return to work she had difficulty speaking, was unable to use a computer and no longer recognized long term library patrons. Hunt helped rehab herself by writing poetry. She found that the physical act of writing helped her brain make connections with language. Writing poetry helped her recover language skills and vocabulary. It was also an outlet for expression and integral to regaining her emotional equilibrium. Hunt has published a book for TBI survivors titled “Am I Still Me? A Group of Words with Fundamental Questions for Those Struggling to Recover Themselves.”

Although there is no one definition of mild traumatic brain injury (MTBI) agreed upon by all physicians, here is a good one from Neil N. Jasey, M.D., director of brain injury rehabilitation at the Kessler Institute for Rehabilitation in West Orange, New Jersey:
“A brain injury occurs when a blow or jolt to the head or body disrupts normal brain function, typically causing a change in mental status or consciousness. While radiographic evidence of a brain injury may not be apparent, long-lasting cognitive and behavioral effects can result.” Dr. Jasey cautions that: “Unlike physical injuries, such as a sprain or broken bone, the signs of a [mild] brain injury may not present themselves immediately. Initial symptoms may include confusion, disorientation, headache, nausea and extreme fatigue. Over time, other symptoms, including irritability, difficulty with memory or concentration, and even depression, may appear along with impaired judgment, behavioral issues and personality changes.” Remember that MTBI is substantially equivalent to a concussion, that it does not require coma or any complete loss of consciousness (however brief), and that it can be caused by whiplash alone with blunt head trauma.