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.

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.

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.

Human Stem Cells Fix Broken Neurons In Mice Brain

Su-Chun Zhang, a professor of neuroscience and neurology, at the University of Wisconsin-Madison published a study in April 2013 demonstrating that human stem cells can successfully implant themselves in the brains of mice and heal neurological deficits. Zhang cultivated the human stem cells in his lab. He then caused damage to a part of the mice brains involved with learning and memory which disabled them from recalling how to find a hidden platform in a water maze.

Subsequently Zhang transplanted the stem cells to the damaged areas of the mice brains, allowed time for integration of the stem cells, and retested the mice. He found the mice could now learn to find the hidden platform. After sacrificing the healed mice he observed that the stem cells had grown into healthy, functional, adult mouse neurons that interfaced with mouse neurons responsible for memory and learning. This pioneering work is not immediately applicable to fixing brain damage in human beings, but can serve as a model for potential future therapies.

Spontaneous Brain Repair After TBI

A significant block to spontaneous brain repair following closed head trauma is intra-cerebral bleeding. Free blood in the brain is toxic to new brain cells that could be developed from stem cells. Research published in the online journal Nature on April 24, 2013 shows that glial cells called oligodendrocytes migrate to the damaged area, stop the bleeding, and create scars in the brain. Stem cells can then produce new neurons in a non-toxic environment.

The only problem is that scar tissue creates a restrictive barrier in some parts of the brain. researchers develop treatments that foster brain repair. The lead author of this fascinating study is Chay T. Kuo, M.D., PhD, George W. Brumley Assistant Professor of Cell Biology, Pediatrics and Neurobiology at Duke University. Anyone interested in using stem cell therapy to promote brain repair after TBI will need to take this finding into account.

TBI Benefits From The $100 Million Obama Allocates For New Brain Mapping Project

On April 2, 2013 President Obama announced his initiative to spend $100 million to develop new, more sophisticated brain mapping technologies that would help neuroscientists pinpoint how brain wiring is disturbed in conditions including TBI, Alzheimer’s, autism, and schizophrenia. Current imaging technology is able to show in detail what happens in isolated parts of the brain, but cannot show how brain wiring is affected across the brain.

This higher level of information is necessary to truly understand and treat TBI and the other conditions. Institutions that will play a role in using the money to develop the new optical and electronic imaging technology include Cornell’s Kavli Institute and the Howard Hughes Medical Institute.

Acupuncture Reduces Some TBI Symptoms

Consequent to a TBI many soldiers have to deal with headaches, insomnia, and decreased ability to tolerate stress. At the George E. Whalen Veterans Health Administration (VHA) in Salt Lake City, Utah, acupuncture is being used to provide some relief soldiers with these symptoms. With the use of even a few basic points, patients are reporting a decrease in the intensity of their headaches, better sleep, and increased ability to cope on a daily basis.

Civilians who sustain a TBI from a motor vehicle accident, a fall or a blow to the head, who are living with similar symptoms, may want to give acupuncture a try. It’s cheaper than and has less side effects than prescription medicines over the long run.