Doctor examining a brain CT scan

Diffusion Tensor Imaging Shows Tiny White Matter Tears in Brains of TBI Patients

DTI (diffusion tensor imaging) is a relatively new form of MRI that can be used to scan the white matter tracts of the brains of patients with TBI for hidden damage that does not show up on conventional MRI. DTI works by revealing the diffusion of water molecules across white matter with small tears not visible on MRI. Researchers from the University of Cambridge and Cambridge Hospital in England just published a paper in which they were able to correlate positive DTI findings with objective disability on the Glasgow Outcome Score.

The worse the small white matter tears the worse the disability for the TBI patient. The paper is titled Mapping Traumatic Axonal Injury Using Diffusion Tensor Imaging: Correlations with Functional Outcome. It appears in the online open-access journal PLoS One May 2011, Volume 6, Issue 5. The lead author is Virginia Newcombe.

Vitamin D Deficiency Linked to Chronic Fatigue in TBI Patients

In April 2010 Dr. Jessica Schnieders from Rijnstate Hospital in Arnham, The Netherlands, published a study looking at Vitamin D levels and hormone levels in 180 TBI patients (50% of whom had fatigue and 50% of whom did not). She found that 51% of TBI patients were severely fatigued 10 years after their brain injury. She found Vitamin D deficiency in 65% of these patients. Although growth hormone and sex hormone levels were deficient in the fatigued group this was not found to be related to fatigue. Dr. Schnieders speculates that altered lifestyle is the problem and that the fatigued TBI patients persons with TBI are less active and spend less time outside in the sun. She plans to do follow up research to ascertain if giving these persons extra Vitamin D corrects their fatigue condition.

Will there ever be a Simple Blood Test for TBI?

Although blood tests exist for many pathological conditions (e.g. heart attacks and mononucleosis), the FDA has never approved a blood test to diagnose neurological conditions such as Parkinson’s disease, Alzheimer’s disease or TBI. Although these neurologic conditions are associated with specific protein breakdown products (called biomarkers), they don’t get into the body’s bloodstream in appreciable quantities. That’s because the brain has its own circulatory system called the blood brain barrier (BBB) which is designed to keep harmful blood-born substances from getting to the brain. The BBB not only screens out many neuro-toxins and drugs from reaching the brain, but it also restricts what substances will be transferred from cerebral blood circulation to the body’s blood stream.

As of the Spring 2011 Banyan Biomarkers, Inc. was working with the FDA to get approval for a new test to diagnose TBI on a spectrum of severity based on the amount of protein biomarkers for TBI. The day may finally come when there is a simple blood test for TBI that can be administered in hospital emergency rooms.

Researcher urge re-classification of TBI as a Chronic Disease

In the August 2010 issue of the Journal of Neurotrauma two physicians highly familiar with TBI urged the insurance industry and health care system to reclassify TBI as a chronic disease instead of a one-time event. The two physicians issued this recommendation after conducting an exhaustive medical literature review on 25 years worth of research on the effects of TBI. They are neurologist Brent Masel, M.D. (a clinical associate professor at University of Texas Medical Branch at Galveston) and Douglas DeWitt, M.D. (Director of the Moody Center for Traumatic Brain & Spinal Cord Injury and President/Director of the Transitional Learning Center in Galveston for rehabilitation of TBI survivors).

Dr. Masel and Dr. DeWitt argue that TBI should be treated as a chronic disease because it sets off an ongoing process which impacts multiple organ systems over a long period of time and which may cause or accelerate other diseases and disorders that can reduce life expectancy.

Examples of conditions which TBI can cause include: neurologic disorders like epilepsy; neurodegenerative disorders like Alzheimer’s and Parkinson’s; neuroendocrine disorders such as pituitary or growth hormone deficiency; psychiatric and psychological disorders such as depression, anxiety, and substance abuse; and non-neurologic disorders such as sexual dysfunction and metabolic dysfunction affecting the body’s ability to absorb, utilize, and convert amino acids.

According to these physicians, viewing TBI as a single episode (which heals the way a broken bone does) deprives persons with TBI of the long term treatment and support they deserve as well as the level of research funding required to find ways to minimize or avoid the many potential complications of TBI.

Protein and Calories lessen effects of Severe TBI in the Acute Stage

The U.S. Department of Defense has just announced a finding by the Institute of Medicine regarding nutritional therapy for severe TBI. The IOM study showed that during the first two weeks of treatment for severe TBI, a high calorie, high protein diet can reduce brain inflammation and improve outcomes. The nutritional components which appeared to be the most helpful were the B vitamin choline, the amino acid-like compound creatine, n-3 fatty acids commonly known as EPA and DHA, and zinc. Choline helps replenish acetylcholine. Creatine stimulates activity of brain mitochondria. EPA/DHA (omega 3s) are anti-inflammatory substances that rebuild brain cell membranes. Zinc helps remove toxic substances, buffers brain cells from oxidative damage, and switches on expression of neuro-protective genes in brain cells.

Surgeons Heal Damaged Brain Tissue by Restoring Blood Flow

In the April 2011 online issue of the journal Stroke neurosurgeons at the Krembil Neuroscience Centre, Toronto Western Hospital, reported the first ever successful brain bypass surgeries. The neurosurgeons operated on 29 patients (ave. age 41) who had lost grey matter along with cognitive function as a result of reduced flow from cerebrovascular disease. At 11 months post-op the patients underwent MRI which showed a 5.1% increase in the grey matter that had shrunk. Dr. Tymianksi and his team were elated since their goal was to stop progressive loss of brain tissue by increasing blood flow, not to reverse the tissue loss. Brain bypass could conceivably help patients with head trauma or whiplash that lose grey matter due to disruption of cerebrovascular blood circulation.

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In-Home Cognitive Retraining

Following a TBI many persons suffer from cognitive problems, and even when diagnosed as mild these problems can impair daily functioning at work and home since they effect attention, concentration, cognitive processing speed, multi-tasking, short term memory, problem-solving, and decision-making.

Unfortunately a significant percentage of TBI survivors with cognitive problems do not have the resources to pay for cognitive retraining. This occurs for a great variety of reasons. For people in car accidents the other driver may have been uninsured or underinsured and the victim may not have been able to pay for adequate medical payments coverage. The victim may not have had health insurance because he was unemployed, laid off or worked in a job which did not provide benefits at the time of the incident.

If this is your situation what can you do? There is a company called Posit Science at which sells inexpensive software for brain retraining on your home computer. If you go to their website and search for TBI you can read about what they offer. It may be worth your while.

Falls Supplanting MVA’s as Leading Cause of Fatal TBI’s

The July 2011 issue of the American Journal of Preventive Medicine reviews statistics on fatal TBIs from 2003-2008. During those years the percentage of fatal TBIs from motor vehicle accidents (MVAs) continued to decline while those from falls continued to rise. As of 2008 fatal TBIs from MVAs accounted for 31% of all fatal TBIs, while falls came in second at 29% and acts of criminal and non-criminal violence came in at 20%. Men suffered fatality rates 15 times higher than women, and workers 65 and over had the highest TBI fatality rates of all workers (2.5 per 100,000 per year). Experts say that falls have increased significantly as a cause of fatal TBI because more of our aging population is over age 65, while vigorous enforcement of seatbelt laws and improved safety features of automobiles (including side airbags and computerized sensing of imminent collisions) have lowered fatalities from head injuries in MVAs.

The occupation with the highest number of fatal TBIs was construction. The highest rate of fatal TBIs was associated with the transportation, agriculture, forestry, and fishing industries, recording nearly half of all work-related TBI fatalities.

Faith in Higher Power Helps TBI Survivors in Rehab

Brigid Waldron-Perrine, Ph.D., a recent graduate from Wayne State University, and her mentor, Lisa J. Rapport, Ph.D., professor of psychology at Wayne State University’s College of Liberal Arts and Sciences, reported in June 2011 that personal faith in a higher power improves the emotional and physical outcome of rehabilitation for TBI patients. Their conclusion was based on a study involving neuropsychological testing of 88 individuals diagnosed with TBI, most of whom were male, African American Christians. The improved outcome was associated with the feeling of a personal connection with a higher power, not with belonging to a religious group or participating in public worship activities. Most likely the feeling of connection helped by reducing stress, negativity, and loneliness, and by increasing positive emotions including trust and optimism.

TMS Therapy May Wake Up Comatose TBI Patients

In July 2011 Dr. Theresa Pape announced that by using a series of TMS treatments she had significantly increased alertness in Josh Villa, a father of 3 children left in a deep coma after an auto accident 6 years before. TMS or transcranial magnetic stimulation uses a coil to send harmless magnetic pulses into the brain, and it has been used effectively to reduce depression. Thanks to TMS Mr. Villa is now able to raise his head, look at other people and utter a few simple words (“Mom,” “Help me,” and “Pain”). Dr. Pape theorizes that TMS activated dormant neurons in his brain, causing them to send their axons into the brainstem and rebuild the damaged RAS (reticular activating system) required for conscious alertness. She will try the therapy on three other patients in the coming years.