TBI Increases the Risk of Parkinson’s Disease

Researchers at the UCLA Department of Neurobiology led by Dr. Marie-Francoise Chesselet demonstrated in 2012 that inducing a moderate TBI in rats caused the rats to lose 30% of their dopamine-producing neurons within a 26 week period following the TBI. This made the rats vulnerable to developing Parkinson’s Disease (PD).

The researchers found that exposing the brain injured rats to the neurotoxic pesticide paraquat led them to lose 30% of their dopamine producing neurons in just 13 weeks. They concluded that TBI alone is a risk factor for delayed onset of PD, and that it renders the brain more vulnerable to developing PD following separate brain insults.

Similarities of TBI and PTSD

While the moderate and severe forms of TBI are associated with blunt or penetrating head trauma and loss of consciousness, PTSD (an anxiety disorder) is associated with exposure to a terrifying, life-threatening danger that need not involve either head trauma or loss of consciousness. Yet the consequences of TBI and PTSD are remarkably similar. Both manifest as sleeplessness, anxiety, depression, and difficulties with memory and concentration. To further complicate matters some PTSD patients do suffer head trauma and some cannot remember if they did or not since the overwhelming fright they suffered has left them with only a patchwork of memory about the event, some of which is temporarily or permanently repressed.

So how do you differentiate TBI from PTSD and how do you treat a patient when you’re not sure? The advice from Dr. Lonser, an expert at the National Institutes of Neurological Disorders and Stroke, is not to waste time on diagnosis. The important thing is to treat the disabling behavioral symptoms. Whether the problems come from TBI or PTSD treatment should not depend on diagnostic labels. According to Micaela Cornis-Pop Ph.D., polytrauma/TBI coordinator with the U.S. Department of Veterans Affairs (VA) central office, “The mainstay of treatment [should be] symptom-specific intervention, such as managing headaches and improving sleep, and education.”

Caution issued against early withdrawal of Life Support for severe TBI

On 8/29/11 the Canadian Medical Association issued a caution against early withdrawal of life support for patients with severe TBI. They found that 70% of hospital deaths among patients with severe TBI came from withdrawal of life support within the first three days of admission to ICU. Yet withdrawing life support during that time frame based on low GCS (Glasgow Coma Scale) score could be a mistake because the low score could be due to the temporary effects of drugs or medicine and not the permanent effects of the brain injury.

Bedside EEG Test Shows Some TBI Patients Called Vegetative Are Aware

In the November 10, 2011 issue of The Lancet Dr. Damian Cruse and colleagues describe an inexpensive, bedside technique for ascertaining if a person who appears to be in a vegetative state from severe TBI has awareness or not. The research team asked 16 severe TBI patients diagnosed as vegetative and 12 healthy controls to imagine moving their right fingers and toes while attached to a bedside EEG machine. Three of the TBI patients (19%) showed changes in their EEG consistent with being aware and generating mental imagery in compliance with the task similar to what the healthy controls did. This is a breakthrough since until now the only equipment available to make this kind of determination was a functional MRI machine which is too expensive for most facilities to acquire.

Alzheimer’s Type Brain Degeneration Triggered By TBI

Douglas Smith, MD, Professor of Neurosurgery and Director of the Center for Brain Injury and Repair at Penn’s Perelman School of Medicine teamed up with neuropathologist William Stewart, MD, from the University of Glasgow, Scotland, to study the long term neuro-degenerative effects of a single TBI on the human brain. They used post-mortem examination of tissue slices of the brains of people who had sustained one non-fatal, moderate-to-severe TBI many years before death.

They concluded that just one moderate-to-severe TBI can initiate changes in brain tissue characteristic of Alzheimer’s disease involving the widespread appearance of tau tangles among axons and beta-amyloid plaques in brain cell bodies. These changes were visible in young and middle aged adults at an age long before the risk of Alzheimer’s disease is significant. Their study was published in the summer 2011 issue of Brain Pathology.

Radiological Proof that MTBI Reduces Working Memory

In the September 2012 issue of the journal Radiology Taiwanese researchers present a study on 20 patients with mild TBI and 18 healthy controls which shows deficits in working memory in the mild TBI patients. While being scanned by a functional MRI machine, the test subjects underwent a series of memory tests involving number sequences, and the ability to sustain attention and use selective attention.

As the memory tests got harder the mild TBI patients did worse than the healthy controls, and unlike the healthy controls their level of neural network activation in their frontal lobes did not increase with increased task difficulty. This constitutes evidence that mild TBI interferes with and limits working memory for a period of time following injury.

traumatic brain injury in sports

CDC Redefines Concussion

The most recent definition of a concussion by the federal Centers for Disease Control (CDC) is as follows: “A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.”

This is a very significant change in definition. In the past a concussion was viewed as simply a transient alteration in consciousness caused by head contact or whiplash which might or might not involve injury to the brain. The new definition makes it clear that a concussion is a form of brain injury. Thus any concussion from any source should be taken seriously and the victim should be examined by a doctor.

Flu Drug Helps Patients with Severe TBI

Amantadine is an old drug originally developed to treat respiratory infections caused by the flu. In September 2012 Dr. Joseph Giacino (a neuropsychologist who teaches at Harvard University and sees patients at Mass. General Hospital in Boston) published a study on the use of Amantadine in patients with severe brain injury who were unable to communicate as a consequence of their injury.

Patients who took the drug improved their ability to communicate much more rapidly than patients who took a placebo. The patients who took Amantadine were able to answer “yes” or “no” questions and consistently follow commands after four weeks, while the patients in the placebo group could not.

Near-Infared Light Treatment for TBI

On April 2, 2015 Veteran’s Affairs released information about research underway by Dr. Margaret Naeser at VA Boston Healthcare System on revitalizing damaged brain cells using a combination of red light and near infared light. Dr. Naeser is trying the technique on war veterans with TBI using a helmet with light-emitting diodes (LEDs). The theory behind the treatment is that the energy centers in brain cells, the mitchondria, are damaged by trauma, and the light emitted by the diodes stimulates activity by the mitochrondria.

The LEDs also promote improved blood flow in the brain cells exposed to the light as shown by neuro-imaging. Results to date are promising, but the treatment remains investigational at this point. Dr. Naeser says that while cognitive rehabilitation “exercises” the brain, LEDs can also help by promoting blood flow to damaged tissue and by stimulating sub-cellular mitochondria (energy production centers) that were put into a resting state by trauma

TBI Ages the Brain According to New Study

Dr. James Cole of the Imperial College London published an important paper on TBI and brain aging in the April 2015 issue of the Annals of Neurology. Prior to the study Dr. Cole and colleagues developed a computer program to track normal aging of the human brain using MRI images. After age 40 normal adults show a general decline in white matter thickness as well as thinning of grey matter in specific areas of the brain. For the study Dr. Cole did MRI brain scans on 99 people who had suffered varying levels of TB from one month to 46 years post injury. What he found was that normal controls have zero difference between their chronological age and predicted brain age, whereas in the TBI group the subject’s brains appeared an average of 5 years older than their chronological age. Dr. Cole said the difference between chronologic and actual brain age (based on MRI imaging of brain tissue) is much greater for people with more severe TBIs. He also said the study shows that the effects of TBI on brain health and tissue size go on for years after the initial injury.