TBI is Consequential. It Causes Homelessness.

Dr. Jane Topolovec-Vranic, a clinical researcher in neuroscience at St. Michael’s Hospital in Toronto, announced that nearly half of the 111 homeless men she studied had suffered at least one traumatic brain injury, and that 87% of them had their brain injury before becoming homeless. The study was published in Open (a journal of the Canadian Medical Association) on April 25, 2014. This study is one of many which refutes the comment I have heard often by defense lawyers in brain injury litigation that brain injuries aren’t serious – just a bump on the head. The fact is that traumatic brain injuries are serious and can be permanently life-altering for the worse.

How To Prevent Seizures After Severe Traumatic Brain Injury

Between 10 and 20 percent of all cases of epilepsy result from severe traumatic brain injury. A team of researchers from multiple universities led by integrative biologist Daniela Kaufer of UC Berkeley has demonstrated why this happens and how to prevent seizures consequent to TBI. Using MRI they observed that the blood-brain-barrier in rats breaks down for a period of several weeks after a severe head injury. This permits the blood protein albumin to leak into the brain which sets off an inflammation process leading ultimately to the development of a permanent seizure disorder. They also found that a safe, FDA approved blood pressure drug called losartan (Cozaar) blocks albumin from activating a specific receptor in the rat brain that is responsible for inflammation. Without losartan 100% of the rats given a severe TBI developed seizures, but with losartan only 40% did. This very promising bit of research was published in the April 2014 issue of the Annals of Neurology.

Hopefully human trials using losartan can begin within the next few years. Giving people a harmless blood pressure drug to prevent seizures is a huge improvement over waiting for seizures to start after brain injury and then giving people very expensive drugs with lots of side effects to stop the seizures.

State Bans on Texting While Driving Not Universal Yet

There are horror stories from across our nation involving distracted drivers who plow into an innocent person while texting or chatting on their hand-held cell phone. Sometimes the driver or passenger of the car they hit winds up with a permanent, traumatic brain injury. This what happened to a young man named D.W. Flanders in Massachusetts. Just ask his father newspaperman Ray Duckler at rduckler@cmonitor.com There is no excuse for any state to fail to adopt and strictly enforce a legal ban on this activity behind the wheel.

Right now only 12 states prohibit all drivers (including experienced drivers) from using hand-held cell phones while driving. Other states only prohibit novice drivers from doing so. Washington was the first state to pass a texting ban in 2007. Currently, 43 states, D.C., Puerto Rico, Guam and the U.S. Virgin Islands  ban text messaging for all drivers.  If you want to  find out what the laws are in your state or keep tabs on what is going on nationally click on http://www.ghsa.org/html/stateinfo/laws/cellphone_laws.html

Post-Traumatic Headache More Common After Mild TBI

Dr. Sylvia Lucas a professor of neurology at the University of Washington in Seattle reported at the annual meeting of the American Headache Society in August 2012 that the likelihood of headache following brain injury is 70% greater in the mild TBI group than in the moderate or severe group. Dr. Lucas and her colleagues followed 220 patients with mild TBI who were enrolled at one center within a week of injury and a seven-center cohort of 378 patients with moderate to severe TBI who were admitted to various inpatient rehabilitation facilities.

Prior to injury all groups of TBI sufferers had an average incidence of headache of 17%. But following injury the mild TBI group had a significantly higher incidence. As to why this is so, Dr. Lucas and her colleagues say it remains a mystery. They noted that the most prevalent type of headache in all 3 groups following brain injury is the migraine type involving blood vessels inside the head. The second most prevalent was the tension headache involving the scalp muscles. And the third most common was the cervico-genic type involving chronic contraction of the neck muscles. So clearly it is not the whiplash of the neck muscles that causes more headaches, but something else yet to be indentified. Right now the doctors are speculating that that mild TBI irritates a pain generator in the head whereas moderate to severe TBI turns it off.

New Method To Stop Cerebro-Spinal Fluid Leaks After TBI

Cerebro-spinal fluid (CSF) is the sterile fluid that bathes the brain and spinal cord and cushions them from trauma. Approximately 80% of all cases of leakage of CSF are caused by trauma with the rest occurring as a consequence of surgery. On March 23, 2014, Cook Medical (a medical products company headquartered in Bloomington, Indiana) announced the FDA had approved the use of its biomaterial to stop leakage of CSF from any cause. The device (known as the Biodesign® Dural Graft) is made from the lining of pig intestines which is sterilized and treated, leaving a paper-thin sheet with the ability to promote tissue regeneration wherever it is inserted. In time, the biomaterial is absorbed by the body.

Differences in How Teens Experience Concussion

At the University of Kentucky neuropsychologist Dan Han, an expert on concussions, and psychologist Lisa Koehl, joined forces to study how concussions cause and are complicated by emotional effects in a group of 37 student athletes age 12-17. What they found is that 22 of the 37 students showed chronic post-concussive symptoms. Of those, 23 percent were sensitive to light while 14 percent were sensitive to noise. In comparison, of the 15 teens without emotional symptoms, 13 percent were sensitive to light and no teens were sensitive to noise. Teens in the study who reported anxiety were 55 percent more likely to experience attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability.

There were no differences between the two groups in factors such as what percentage experienced loss of consciousness, amnesia, nausea and/or headaches, indicating that the groups were likely comparable in the level of severity of concussion.

According to the researchers their findings demonstrate a bidirectional relationship between both emotional symptoms developing in conjunction with physical symptoms, and also emotional symptoms developing because of the physical symptoms. They hope the data can be used to plan more effective treatment for people with concussions.

What Role Does Tau Play in Traumatic Brain Injury?

Axons play two critical functions in the brain. They release neuro-chemicals from brain cells to other brain cells, and they transport nutrients from the environment into the brain cell to keep it alive. Axons are held together by structural supports called microtubules which can flex without breaking when force is applied slowly to the brain. But when force is applied too rapidly the axons are sheared (i.e. snapped in half) and the brain cell dies. Why does this occur?

The protein tau (which is best known for clumping up axons in the brains of patients with Alzheimer’s disease) is a key factor in how this process occurs . Based on work published in March 2014 a team of experts at the University of Pennsylvania (including a neurosurgeon, bio-engineers, and mathematicians) say that tau coils around the microtubules of axons the way that cross-ties compress and hold a bundle of sticks  together. When a force is applied to the brain slowly these tau coils stretch cross-wise and allow the microtubules to adjust to the force by elongating up to double their normal length.

When a force is applied too abruptly (as in a fall or car crash) the tau coils do not have time to stretch which would transfer some of the energy away from the microtubules and give the microtubules a chance to elongate. This is why the microtubules break and form huge swellings called axon retraction balls which block nutrients from being transported into the brain cell. Below is an illustration of how tau protein coils hold axonal microtubules together in a normal brain.

Vacuum Pressure Promotes Healing After Severe TBI

Following severe traumatic brain injury brain swelling compresses brain tissue and limits blood flow to damaged tissue in the area of injury as well as healthy surrounding tissue, so more tissue dies. Is there a way to prevent this outcome? Possibly. According to study by Drs. Louis Argenta and Michael Morykwas published in the August 2014 issue of Neurosurgery the application of a vacuum (i.e. a negative pressure zone) over bruised brain tissue in pigs produced much better healing by increasing blood flow following an experimentally induced traumatic brain injury. Applying 100 mm Hg. Pressure for 3 days reduced blood leakage from the brain, increased blood flow in the brain, and produced a much smaller area of visible brain contusion in the treated pigs than pigs treated with a smaller vacuum or no vacuum over their site of brain injury.

Gene Variant Helps Explain Differences in IQ Outcome After TBI

It has long been known that people with superior or above average intelligence have lots of extra neurons (something called neuronal reserve) and they tend to recover from a TBI with better cognitive function than people of average intelligence. Recently Aron Barbey, Ph.D, a researcher at the College of Applied Health Sciences at the University of Illinois, did a study on how a group of people with average intelligence did on IQ tests following recovery from a TBI.

What Dr. Barbey found is that outcome is associated with genetic variants of a gene that produces neurotrophic growth factor in the brain. Neurotrophic growth factor is responsible for the growth of new neurons to replace neurons destroyed by TBI. Dr. Barbey’s research showed that people who have the Met/Met or Met/Val variants recover better than people with the Val/Val variant; and that TBI survivors with the Val/Val variant end up scoring an average of 8 points lower on IQ testing. In light of this new information brain injury rehab specialists may seek to create new interventions to help people with the Val/Val subtype of the gene in question.

If you have a TBI and you are involved in or contemplating being involved in cognitive therapy, you might wish to get tested to see which gene variant you have.

Miracle Drug in Final Stage Testing for Severe TBI

People with severe TBI from high velocity head impacts often have skull fracture with extreme brain swelling. If the brain swelling is not rapidly contained and reversed the patient is likely to die or end up in a permanent vegetative coma. Several decades ago Don Stein and other scientists noticed that female rats recovered better and more quickly from TBI than male rates when their progesterone hormone levels were at their highest. When they injected male rats with progesterone (a female hormone) they recovered from TBI equally well as the female rats.

In June of 2010 BHR Pharma, LLC, started testing its proprietary formula of progesterone (called BHR-100) on patients with severe TBI in a double blind study – one in which neither the patient’s family nor the treating doctor knew if the patient was receiving a placebo or the experimental drug. Ultimately 154 sites and 1,180 patients have participated in the trial which is now in stage 3. Some of the patient recoveries have been utterly remarkable, bordering on the miraculous when compared to historic outcomes for patients with severe brain swelling.

One well publicized example is that of Andrea Vellinga, a 30 year old mother, who suffered severe TBI with extreme brain swelling in August 2011 when struck on the head by a falling tower at a county fair. Although the exact mechanisms are still be elucidated, what is known so far is that progesterone has a “neuro-protective” effect on brain cells which have been traumatized.