Progesterone Now in Phase III Clinical Trials to Treat TBI

Emory University neuroscientist Don Stein, PhD has been studying the benefits and mechanisms of the hormone progesterone as a treatment for TBI for nearly 3 decades. He first became interested in progesterone when he observed that female rats recovered more quickly and completely from TBI than male rats, and that the probable explanation was that female rats produce a lot more progesterone in their brains than male rats.

Dr. Stein eventually figured out that progesterone helps by significantly reducing brain inflammation and brain swelling after a TBI. He found that injecting it into male rats within 24 hours of inducing a brain injury not only brought down mortality levels by close to two-thirds, but also brought their functional recovery level equal to that of females. He then sought and obtained FDA permission start experiments on human beings. Phase I and Phase II trials have been successful, and two nationwide phase III trials are now in progress.

This is important news for people concerned about brain injury. If the phase III trials are successful then Emergency Departments of trauma hospitals will stock progesterone and inject it into patients who have just arrived with a TBI. With regard to female patients their progesterone level varies significantly through life depending upon such factors as whether they are of childbearing years, menstruating, ovulating, etc.

TBI Affects The Elderly Differently

Elderly people don’t face the risk of TBI from wars or sports like young people. Their major risk factor for TBI is falls. One recent study in Finland by Niina Korhonen, B.M. stated that TBI from falls is a leading cause of death and disability in the elderly.

Older persons tend to recovery more slowly and less completely from TBI than middle-aged or young people. According to a special issue of the journal NeuroRehabilitation published on May 6, 2013 TBI in the elderly poses special diagnostic, management and treatment challenges. “As our understanding of TBI increases, it is becoming clear that its impact is not uniform across the lifespan and that the response of a young brain to a TBI is different from that of an old brain,” writes Guest Editor Wayne A. Gordon, PhD, ABPP, Vice Chair of the Department of Rehabilitation Medicine at Mount Sinai School of Medicine, New York, NY. If you are a family member of an older person who sustained a TBI it is important to be aware of this, and to make contact with a gerontologist or a rehab physician like Dr. Gordon who is familiar with TBI in the elderly.

Eye Tests Detect Traumatic Brain Injury

On 5/10/13 at the annual meeting of the Association for Research in Vision and Opthamalogy in Seattle, Dr. Peskind described the use of optical coherence tomography (OCT) to detect traumatic brain injury and monitor healing from TBI. OCT uses near-infared light to create images of subsurface biological tissue in slices. Used on the eye it is the equivalent of ultrasound. Dr. Peskind became interested in this when studying the eye health of war veterans exposed to blast injuries who reported symptoms such as memory loss, headache, muddled thinking and irritability. She noticed that all of them had trouble reading and showed erratic eye movements.

Dr. Peskind’s colleague Dr. Kardon says that since the eye arises embryonically from the same tissue as the brain studying the eye could tell us what is happening in the brain. He has used OCT to detect eye damage to soldiers. The same shock wave that causes subtle damage to the brain also causes subtle damage to the eye. Dr. Kardon also found that the eyes of a brain-injured person are ultra-sensitive to a light shined in their eyes. By hooking up small electrodes to the muscles around the eye, Kardon documented higher levels of involuntary blinking and squinting among veterans with traumatic brain injury. Yet another indicator is how fast the pupil contracts in response to a burst of light, he said. In studies of 140 people treated in a hospital emergency room after car accidents and other head trauma, Kardon and his colleagues found that slower pupil contraction was a sign of more serious brain injury. In cases where the existence of a TBI is disputed think about using these kinds of eye tests to gather additional evidence.

Addressing Sexual Dysfunction After TBI

For the millions of Americans living with TBI, there is often an unspoken problem: many suffer from sexual dysfunction, something that is easily overlooked as patients struggle with overwhelming physical and emotional issues that can last for years, new research has found.

Neuropsychologist Jhon A. Moreno at the University of Montreal says that the sexual difficulties usually become most apparent about six months after the injury and, if left unaddressed, worsen with time. The nature of the problems and how the victim handles them depend on factors such as age, gender, and the stressors on the victim (who could be an athlete, a soldier or a civilian breadwinner in a car or workplace accident). Dr. Moreno extensive study of TBI survivors published in J. NeuroRehabilitation found that 50% to 60% of people with TBI have sexual difficulties, such as reduced interest in sex, erectile dysfunction, pain during sex, difficulties in vaginal lubrication, difficulties achieving orgasm or staying aroused, and a sense of diminished sex appeal, Moreno said.

The research found that partners of those with TBI experienced personality and emotional changes, and a modification of family roles that can lead to a crisis, Moreno said. “For the spouse, the survivor becomes a different person, a person they do not recognise as the one they fell in love with in the past,” he said. “The spouse becomes a caregiver and this imbalance in the relationship directly affects sexual desire.” Marital separation rates can be as high as 78% among people with TBI, Moreno said. Moreno also said that medications for TBI survivors (such as blood pressure drugs, antidepressants, stimulants and anticonvulsants) can lower sex drive and cause other physical and mental problems. Some develop personality changes, such as reduced social skills and trouble knowing what is inappropriate to say or do with others, the study found. Yet experts said sexual issues associated with TBI don’t get much attention from physicians and rehabilitation professionals. Hence it is crucial to bring up these issues and get help before one’s self-image and sex-life falls apart.


TBI Increases Suicide Risk

Does TBI increase one’s risk of suicide? It would appear so. Earlier this year the Pentagon reported an extremely grim statistic: In the first months of the year, a soldier was more likely to die from suicide than from war injuries. From early January to early May 2012, the suicide rate averaged nearly one per day among active-duty troops — an 18 percent increase from last year. In August President Obama signed an executive order that strengthened suicide prevention efforts for service members and veterans.

One project funded by the Department of Defense is led by Lisa Brenner, PhD, who is working with colleagues to adapt a civilian suicide prevention intervention for military personnel and veterans with traumatic brain injury (TBI). Brenner directs the VA’s Mental Illness Research, Education and Clinical Center (MIRECC) in Denver. She led a study examining suicide risk in 49,626 VA patients with a history of TBI. The team’s findings show that, overall, veterans with TBI have an increased risk of dying by suicide compared with veterans without brain injuries. This is consistent with findings among members of the general population. The analysis was published in the July/August 2011 issue of the Journal of Head Trauma Rehabilitation.

Injured Brain Extra Vulnerable to New Brain Injuries

It is sometimes the case that a person who sustained a mild traumatic brain injury receives a second one before healing from the first. When this happens is the ultimate outcome worse than if the first MTBI had healed? Yes says recent research on rats by UCLA neuroscientists Mayumi Prins, Daya Alexander, Christopher Giza and David Hovda. The reason is that MTBI (like other other forms of TBI) impairs glucose metabolism by brain cells leaving them in a weakened condition. A second brain injury while glucose metabolism is impaired leaves brain cells less able to withstand the new injury and is more damaging – leading to a worse outcome.

This information is important for somone who suffered two MTBIs days or weeks apart and who sues two different defendants for contributing to the final outcome of her two brain injuries. Even if the traumatic force from the second accident was seemingly minor it could have a major impact on the plaintiff’s ultimate outcome because of a prior brain injury close in time.

Portable Scanner Detects Bleeding in or on the Brain After Head Injury

The FDA has approved a portable wand that uses Near-Infrared (NIR) technology to detect bleeding in or on the brain. The Infrascanner Model 2000 device runs on two “AA” batteries and looks like a TV remote. It is meant to be used in the field to assess the probability that a person needs an emergency CT scan of the brain or neurosurgery. The device works by being applied to the victim’s head and held there. It emits near-infared waves that spot differences in the density of brain tissue in 8 quadrants of the brain. If there is bleeding on or in a particular quadrant its density will differ because of the presence of free hemaglobin in the form of bleeding or a clot. It doesn’t take the place of CT scans, but can be used to monitor head trauma patients or assess people at the scene of an accident.

Doctor examining a brain CT scan

A New Concussion Test That Uses Objective Factors

In March 2013 two neurologists at Mayo Clinic presented their research into finding an objective, biological marker for concussion that does not rely on subjective reporting of symptoms. Dr. David Dodick and Dr. Bert Vargas presented their findings at the American Academy of Neurology annual meeting in San Diego.

These doctors found significant abnormalities in heart rate and blood pressure in 21 patients who had just sustained a concussion. The timeliness and low cost of testing for such autonomic nervous system changes makes this kind of testing very useful. Brain scans are typically done so long as a patient has had a concussion that his or her brain has already healed by the time the scan is done, and these scans are very expensive.

The autonomic nervous system is a control system for automatic body functions like heart rate, blood pressure, digestion, breathing rate, and perspiration. Previously it was thought that disturbances in autonomic function were associated with moderate to severe TBI not mild TBI (which is equivalent to a concussion).

Tau Protein Clumps Found in Brains of People with TBI

In 2012 famed NFL linebacker Junior Seau killed himself and left a note asking that his brain be examined by neuroscientists to learn if abnormalities from concussions had caused his severe, unremitting depression with fits of rage. The conclusion of the researchers was that Seau’s brain had extensive lesions from multiple concussions and met the diagnosis of CTE (chronic traumatic encephalopathy). Until Seau’s death CTE could only be diagnosed on autopsy in deceased individuals.

Now Dr. Gary Small, a geriatric psychiatrist at UCLA, is one of a group of brain scientists working to diagnose CTE in living individuals. Small and his colleagues have found a chemical that can be injected into a living person which will light up clumps of tau protein in the brains of people with CTE while undergoing a PET scan. They call the chemical marker FDDNP. While scanning the brains of 5 retired NFL players age 45 or older with a history of multiple concussions they found tau protein clumps in the brain areas for memory, emotion, and behavior.

TBI Creates Significant Risk of Homelessness

Researchers from St. Michael’s Hospital in Toronto conducted a meta-analysis on all available scientific data regarding the prevalence of TBI in homeless individuals. Previous research demonstrated that homeless people in Canada suffer from several serious health concerns, are more likely to visit the emergency room, and also require longer hospital stays and are at raised risk of death when compared to those with homes.

The prevalence of TBI in this population, however, had not yet been determined. The study published in March 2013 showed that between 8 and 53% of homeless people have suffered a traumatic brain injury. Most of these individuals are men. A majority of these injuries were sustained prior to becoming homeless–an aspect that suggests that TBI may be a significant risk factor for homelessness. Any person having care or custody of an individual with severe TBI who is disabled needs to consider the fair present value of that person’s residual lifetime earnings. If that amount can be secured through a lawsuit and placed in trust for the disabled TBI survivor, with a responsible person administering the trust, the risk of homelessness will be eliminated.