Neuroscientist Reveals How Mild TBI Kills Brain Cells

Dr. Sergei Kirov is a neuroscientist and Director of the Human Brain Lab at the Medical College of Georgia. He has been working with living slices of human brain tissue for years to gain a better understanding of why brain cells die from stroke or trauma. Using a two photon laser scanning microscope he can see exactly how brain cells respond to these events. In the March 2013 issue of the journal Brain Dr. Kirov published an article explaining how mild TBI kills brain cells.

Mild trauma causes blood flow constriction to astrocytes which swell up and smother neurons (the brain cells we need to think, remember, speak, and so forth). Astrocytes are support cells that help route blood and nutrients to brain cells. Neurons can die directly from the failure of astrocytes or from being stressed by bloated astrocytes. When neurons are stressed they run out of the energy they need to pump out sodium ions, pump in potassium ions and keep a proper metabolic balance necessary for their continued existence. This phenomenon is called depolarization.

Cognitive Deficits Remain One Year Post MTBI

In the January 2013 issue of Frontiers of Human Neuroscience researchers from the United Kingdom published their findings that one year after suffering mild traumatic brain injury a group of 36 adult survivors showed cognitive impairment in their short term memory and information processing speed in comparison with a group of 36 aged-matched control subjects who did not have head injuries. In the past there has been some confusion about whether chronic cognitive problems in people with MTBI are primary or the result of post-concussion syndrome symptoms such as headache, insomnia, and depression. The purpose of this research was to test for primary cognitive deficits independently of other issues.

The conclusion was that in this group of 36 survivors (which may or may not be representative of the entire population of MTBI survivors) chronic cognitive problems were a primary outcome of MTBI.

Doctor examining a brain CT scan

Long Term Damage From Mild TBI Confirmed By Neuro-Imaging

Defense lawyers in mild TBI cases typically argue that any damage to the brain from mild TBI is quickly reversed and that MTBI symptoms should be gone within a few months if the victim is not faking or exaggerating. But is this defense claim true? Neuro-radiologist Pratik Mukherjee, M.D., PhD., of the prestigious UCSF Medical Center just published a study in the 4/19/13 issue of the Journal of Neurosurgery showing “abnormally decreased functional connectivity” years after the occurrence of mild TBI.

To make this finding he used a relatively new imaging technique known as magnetoencephalography (MEG) which maps brain activity by recording magnetic fields produced by natural electrical currents in the brain.

Hyperbaric Oxygen Treatment May Restore Lost Brain Function for TBI Patients

Patients suffering significant brain damage from stroke or TBI typically reach a plateau of recovery, beyond which no amount of therapy appears to help. Now there may be a therapy to jump start recovery in such patients years after they reached their plateau. Dr. Shai Efrati of Tel Aviv University’s Sackler Faculty of Medicine and colleagues at the Sagol School of Neuroscience have just demonstrated that placing stroke patients in hyperbaric oxygen chambers reinvigorates dormant neurons years after their recovery stopped.

Hyperbaric oxygen treatment (HBOT) increases brain oxygen ten times normal. Dr. Efrati’s analysis of brain imaging showed significantly increased neuronal activity after a two-month period of HBOT treatment in stroke patients compared to control periods of non-treatment. Remarkably the patients with increase in metabolic brain activity showed improvements such as a reversal of paralysis, increased sensation, and renewed use of language. Dr. Efrati has not tried HBOT on chronic TBI patients, but in principal HBOT should work for them. Hopefully his research group or another research group will follow up on TBI patients to see if HBOT has the same dramatic effect in jump starting stalled recovery.

Does Your State Have An EPIC Project To Prevent Bad Outcomes From TBI?

Epidemiologists estimate that 1,000 people die every week from traumatic brain injuries in the United States. But if you suffer a severe brain injury in Arizona, the National Institutes of Health say you will likely receive the best emergency services treatment available in the country. The National Institutes of Health chose Arizona as the only state to evaluate the national standards for prehospital emergency care of Traumatic Brain Injury (TBI). Because it has adopted the Excellence in Prehospital Injury Care (EPIC) project, AZ has trained nearly 100 fire departments and ground/air ambulance companies in the national standards, covering more than 80 percent of the population.

Those agencies send treatment information to the Arizona Department of Health Services and The University of Arizona College of Medicine for tracking and evaluation. “The EPIC partnership across the state is allowing the implementation and evaluation of state-of-the-art treatment at the scene of an accident and is tracking how EMS care impacts the final outcome of patients,” said Dr. Daniel Spaite, Professor of Emergency Medicine at The University of Arizona College of Medicine. “We know that treatment decisions immediately after a severe brain injury are critical. If you don’t live in AZ, then contact your state government’s Department of Health Services to request that it join the same EPIC partnership.

Sub-Concussive Brain Trauma Causes Auto-Immune Brain Response

Until now it was thought the brain could only be damaged by trauma sufficient to cause a concussion – an event marked by loss of consciousness or by detectable alteration of consciousness (such as dazing, confusion or memory loss). A new study of 67 college football players shows that sub-concussive trauma (trauma below the level required to cause a concussion) can damage the brain by leaking a protein called S100B into the bloodsteam that causes antibodies to form.These antibodies attack the protein and set off an auto-immune response in the brain of the same type that researchers have seen cause dementia. Prior to this study S100B had only been seen in head-injured athletes who had sustained concussions.

The study concluded that the more sub-concussive head trauma an athelete endures the greater the amount of protein S100B circulating in the brain’s bloodstream, and the greater the auto-immune response. The study was conducted by Damir Janigro, Ph.D., the director of cerebrovascular research in Cleveland Clinic’s Lerner Research Institute, and his collaborators Nicola Marchi, Ph.D., of Cleveland Clinic and Jeffrey Bazarian, M.D., M.P.H., of the Clinical and Translational Science Institute at the University of Rochester Medical Center. A sideline bloodtest costing $40 can be done to detect S100B after a football player suffers a hard hit even if he isn’t knocked out or put into an obviously confused state. Any player with elevated S100B should be evaluated by a neurologist and kept from play as the doctor directs. The study can be found at in the March 6, 2013 online issue of PloS One.

New Research Confirms Value of Rehabilitation for TBI

Pate Rehabilitation has several facilities in Texas to help people with TBI recover lost functions. On March 4, 2013, physicians from Pate published a landmark article in the journal Physical Medicine and Rehabilitation which definitively shows that well-designed, well-executed rehabilitation services (such as physical therapy, occupational therapy, cognitive therapy, and speech therapy) produce better outcomes for people with TBI than natural healing of the brain. The authors of the study are Hayden M.E., Plenger P., Bison K., Kowalske K., Masel B., and Qualls D. This puts to rest on old objection to brain injury rehabilitation services that the gains made by patients in rehab is really attributable to spontaneous healing of the brain rather than the services themselves.

CTE (Chronic Traumatic Encephalopathy) Killed Junior Seau

Medical investigators from the National Institutes of Health have concluded that when NFL linebacker Junior Seau committed suicide in May 2012 he was suffering from CTE (chronic traumatic encephalopathy). CTE is a degenerative brain disease accompanied by personality change, mood swings, and violence. CTE results from cumulative blows to the head and has affected boxers and football players in their 30s and 40s. The distinct pathological changes evident in Seau’s brain match up with all the concussions he suffered during twenty years of football and with testimony from family members that Seau became moody, depressed, irritable, angry, and socially isolated close in time to his suicide.

New Treatment for TBI Related Migraine

One of the most common consequences of TBI is chronic headache. Sometimes a TBI sufferer develops severe migraines that are partially or fully disabling. Curing such migraines has proved elusive despite the use of pain medications, anti-depressant medication, bio-feedback, neuro-feedback, and other approaches. Recently a chiropractic neurologist in Cranston, Rhode Island by the name of Victor Pedro, D.C. has developed an anecdotal reputation for significantly reducing the frequency and severity of post-traumatic migraine headaches. He allegedly does it by reorganizing the traumatically damaged brain through intensive eye exercises that restore normal pupillary responses. He calls his technique “cortical integrative therapy.” Dr. Pedro claims to have helped 150 patients over the past three years. Could there be something to this? Possibly. Since the optic nerve links eye and brain, and since migraines often have a visual component, the idea of vision therapy to affect the brain is not as off-beat as one might assume. If any readers of this blog have treated with Dr. Pedro I would certainly like to hear of their experience.

Brain Imaging Study Pinpoints Source of Depression in Concussed NFL Players

Neurologist Kyle Womack, MD released a study at the 2013 American Academy of Neurology annual meeting showing that DTI (diffusion tensor imaging) analysis of white matter damage in a particular region of the brain could predict depression after traumatic brain injury with 100 percent sensitivity and 95 percent specificity. The study was conducted on 26 retired NFL players, of whom 5 were found to be depressed on the Beck Depression Inventory. Dr. Womack works at the Pine Creek Medical Center and his research was done at the University of Texas Southwestern Medical Center.