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Jack Sisson's TBI Blog

A hug is duct tape for the soul.

 
The C.D.C. has begun funding studies of TBI's in prisons, another of Jack's interests. He has long believed that all prisoners should get a neuro-psych evaluation as part of their exit routine before being released. The prison environment is ripe for TBI's, and it's also probable that a fair percentage of inmates had a TBI long before being sentenced. (Remember that one of Jack's doctors, Jonathan H. Pincus, in his 2002 book (Base Instincts: What Makes Killers Kill?) theorized, "It is the interaction of childhood abuse with neurologic disturbances and psychiatric illnesses that explains murder.") TBI's fall under the classification of neurologic disturbances, and it makes sense to study their prevalence in the prison population.

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According to the BBC News, "Failure to control type 2 diabetes may have a long-term impact on the brain, research has suggested."

Severe hypoglycaemic episodes - hypos - occur when blood sugar levels drop dangerously low. A University of Edinburgh team found they may lead to poorer memory and diminished brain power. The study, based on 1,066 people with type 2 diabetes aged between 60 and 75, was presented at a conference of the charity Diabetes UK.

The volunteers completed seven tests assessing mental abilities such as memory, logic and concentration. The 113 people who had previously experienced severe hypos scored lower than the rest of the group. They performed poorly in tests of their general mental ability, and vocabulary.

Lead researcher Dr Jackie Price said: "Either hypos lead to cognitive decline, or cognitive decline makes it more difficult for people to manage their diabetes, which in turn causes more hypos.

"A third explanation could be that a third unidentified factor is causing both the hypos and the cognitive decline."
We will continue tracking this research. Because diabetes affects so many people, a direct correlation between it and brain function has staggering implications:
Diabetes now affects nearly 24 million people in the United States, an increase of more than 3 million in approximately two years, according to new 2007 prevalence data estimates released today by the Centers for Disease Control and Prevention (CDC). This means that nearly 8 percent of the U.S. population has diabetes.

In addition to the 24 million with diabetes, another 57 million people are estimated to have pre-diabetes, a condition that puts people at increased risk for diabetes. Among people with diabetes, those who do not know they have the disease decreased from 30 percent to 25 percent over a two-year period.
Read BBC article.

Read more on diabetes.

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The U.S. has some catching up to do. In England, "the Children's Trust wants to raise awareness of acquired brain injury (ABI) among parents and teachers because the effects can be misdiagnosed or just seen as bad behaviour." In launching their campaign, they stated that "some bad behaviour may be a result of an undiagnosed brain injury...the effects can be more noticeable at times of stress, like the move from primary to secondary school. It can affect a child's memory, alter their personality, affect physical skills and reduce their ability to concentrate in class or to develop relationships with peers and teachers."

I'm not aware of any program in the U.S. that seeks to identify ABI or TBI in schoolchildren, although, according to a 2006 CDC study, "The two age groups at highest risk for TBI are 0 to 4 year olds and 15 to 19 year olds." Surely someone has thought of this and there's a program out there that I just haven't heard about. But maybe not. We're only now getting serious about studying TBI in our military (due, of course, to the large number of TBI victims returning from the Iraq War) and in our prisons, two populations obviously at risk.

Where TBI is concerned, seems like we've been content with merely reacting, rather than taking a proactive approach.

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From the Brain Injury News and Information Blog:
Congratulations to New York City's Mount Sinai School of Medicine for being designated by the Centers for Disease Control and Prevention (CDC) as its newest Injury Control Research Center (ICRC). The new center will conduct research on persons with traumatic brain injuries in order to better understand the consequences of their injury and to help enhance the quality of their lives.

CDC’s Injury Control Research Centers (ICRC) are located at 13 universities throughout the United States. At each ICRC, scientists from a wide spectrum of disciplines focus upon discovering how to prevent and control injuries more effectively. They also work to identify critical knowledge gaps in injury risk and protection and also conduct research to address these gaps.
Keep reading.

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$1.7 million NIH grant to UC Scientists

Cincinnati Business Courier - July 6, 2007, The National Institutes of Health has awarded $1.7 million to a University of Cincinnati scientist to do molecular research that could lead to better treatments for brain injury patients.

Kenneth Strauss will study two types of molecules known as eicosanoids, which are created by injured brain cells, to confirm that they can protect healthy brain cells from further damage.

If successful, Strauss's research could lead to a new class of drugs designed to enhance the levels of these helpful molecules, and thereby improve outcomes in patients who have suffered traumatic brain injury.

Traumatic brain injury is the leading cause of death and disability among people aged 16 to 45.

Read it here.


Diagnoses, treatments have changed
for some veterans' health problems


The Herald-Mail Online, Monday July 9, 2007,
Of approximately 686,000 troops who had returned from Iraq and Afghanistan and left the military, about 229,000 had gone to Veterans Affairs facilities as of April for health care, whether it was a veteran getting a flu shot or a quadriplegic receiving perpetual care, said VA spokesman Phil Budahn in Washington, D.C.

Budahn said he didn't have specific statistics for injuries caused by IEDs, but the VA was treating about 400 people for traumatic brain injuries. Such injuries could range from subtle symptoms such as loss of concentration all the way up to extreme personality changes and short-term memory loss.

In the past, everyone thought they understood the risks of traumatic brain injury to be obvious physical injury such as shrapnel, so traumatic brain injury wasn't always properly diagnosed, Budahn said.

But in 2003, a study out of the Tampa, Fla., VA hospital pointed out that people could experience a closed head trauma, or concussion, with no visible wounds, just from being close to a bomb going off, said Dr. John Sentell, chief of Mental Health Service at the Martinsburg VA Medical Center.

The brain can get injured from an IED blast without visible blood; even from the brain being jostled in the skull from the blast, Sentell said. These less obvious traumatic brain injuries are more common in today's wars and often make diagnosis difficult.

Read it here.


Illinois program first in the nation to provide
TBI screening for state’s returning Iraq and Afghanistan Veterans


July 3, 2007 -- CHICAGO – On the eve of Independence Day, Illinois Governor Rod R. Blagojevich was joined by Tammy Duckworth, Director of the Illinois Department of Veterans’ Affairs (IDVA) to announce a first-of-its-kind program to screen every returning Illinois National Guard member for traumatic brain injury (TBI), offer TBI screening to Illinois Veterans, and 24-hour toll-free psychological assistance for Veterans suffering from PTSD. The program increases health care benefits for Veterans and will later become part of the Governor’s Illinois Covered insurance plan.

The program will work in two parts: The TBI portion will mandate screening for all Illinois National Guard members returning from deployment and offer free screening to all Illinois Veterans, especially those returning from Operation Enduring Freedom and Operation Iraqi Freedom. The PTSD portion will offer 24-hour, toll-free psychological assistance to give Veterans suffering from PTSD a place to turn, day or night, for help.

Read it here.



Integra LifeSciences Supports Newest Edition
of Brain Trauma Foundation's Guidelines for
the Management of Severe Traumatic Brain Injury


CNN MONEY.com, PLAINSBORO, N.J., June 28, 2007
-- Integra LifeSciences Holdings Corporation (Nasdaq:IART) announced today its support for the third edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury (Guidelines). The Guidelines are nationally recognized and referenced by many of the leading trauma centers in treatment of patients with traumatic brain injury. They are available for viewing at www.braintrauma.org.

The Guidelines were developed by the Brain Trauma Foundation (BTF) in association with the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), and the AANS/CNS Joint Section on Neurotrauma and Critical Care, and incorporate the latest published research findings relevant to the diagnosis and treatment of severe traumatic brain injury.

Read it here.

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These are some TBI clinical trials now recruiting:

*Enhancing Performance of Persons With TBI

*Efficacy of Pharmacological Treatment of Working Memory Impairment

*Pharmacological Intervention in Depression After TBI

*Antidepressant Maintenance in Traumatic Brain Injury

Here's a link to the complete list.

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New York Times, May 31, 2007 --
The rate of diagnosed clinical depression among retired National Football League players is strongly correlated with the number of concussions they sustained, according to a study to be published today.

The study was conducted by the University of North Carolina’s Center for the Study of Retired Athletes and based on a general health survey of 2,552 retired N.F.L. players. It corroborates other findings regarding brain trauma and later-life depression in other subsets of the general population, but runs counter to longtime assertions by the N.F.L. that concussions in football have no long-term effects.

Later in the article:
While consistently defending its teams’ treatment of concussions and denying any relationship between players’ brain trauma and later neurocognitive decline, the N.F.L. has subsequently announced several related initiatives. The league and its players union recently created a fund to help pay the medical expenses of players suffering from Alzheimer’s disease or similar dementia. Last week, N.F.L. Commissioner Roger Goodell announced wide-ranging league guidelines regarding concussions, from obligatory neuropsychological testing for all players to what he called a “whistle-blower system” where players and doctors can anonymously report any coach’s attempt to override the wishes of concussed players or medical personnel.

Mr. Goodell said last week that the league’s concussion committee had just begun its own study “to determine if there are any long-term effects of concussions on retired N.F.L. players.”

Dr. Casson, the committee’s co-chair, said that players who retired from 1986 through 1996 would be randomly approached to undergo “a comprehensive neurological examination, and a comprehensive neurologic history, including a detailed concussion history,” using player recollection cross-referenced with old team injury reports. He said that the study would take two to three years to be completed and another year to be published.
Read the complete article here.

Also, don't miss this site for more information about head injuries and football (from youth ball to the NFL).

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News about brain injuries in Iraq doesn't stop:
Frontline combat troops in the Iraq war have at least a one in five chance of coming home with a brain injury, according to Chris Elia, a Veterans Affairs psychologist who spoke Friday about traumatic brain injuries in veterans at the second annual Black Hills Brain Injury Conference in Rapid City.

“And I suspect it’s a much higher chance than that,” Elia said, presenting an array of statistics about what has become the “signature wound” of the wars in Iraq and Afghanistan.

Of the 23,000 U.S. soldiers, marines and other military personnel who have been wounded in Iraq and Afghanistan since 2002, more than 6,500 have been diagnosed with traumatic brain injury, according to military figures. Elia said those numbers are probably low, given what today’s war is still teaching medical experts about blast injuries.
What a shame that it's literally taken a war to bring TBI front and center. Hardly a day goes by now that TBI is not in the news, and word of advances in TBI research hits the media with unusual frequency. Advocates for brain injury research have wanted this for a long time, but who could have forseen that a war would be necessary to accomplish it? The universe does indeed work in mysterious ways, but I can't imagine anyone who'd have chosen this route to brain-injury awareness.

Read the complete article here.

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