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NABIS 27th Annual Medical-Legal Conference

This past week, the North America Brain Injury Society (NABIS) held its 27th annual medical-legal conference on traumatic brain injury.  As one of the co-chairs of the program, we brought together one of the nation’s top medical and legal experts. 

On Saturday, I gave a presentation on direct examination of experts in the traumatic brain injury case.  This lecture discussed the possible experts who can and should be retained in properly representing an individual with an acquired traumatic brain injury.  The presentation further discussed new ways to affectively present expert testimony utilizing the newest technologies and visuals available.  

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Bruce Stern Invited to Speak at Trucking Collision Seminar

The American Association for Justice Education’s Trucking Collision Seminar at the end of April provides the latest courtroom litigation strategies for representing victims of trucking collisions. A faculty of experienced trial lawyers and consultants will offer tools and tactics when representing victims and their families.

Mr. Stern has been invited to give a presentation on traumatic brain injury following trucking collisions.

Mr. Stern is a past chair of AAJ's motor vehicle collision, highway and premises liability section.

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International Brain Injury Association's 10th World Congress on Brain Injury

The International Brain Injury Association's 10th World Congress on Brain Injury started today. Yesterday attendees were treated to pre-conference workshops on Neuropsychiatry, Sports and Concussions and pediatrics.

The conference opened with the presentation of awards, including the Jennett Plum Award for Clinical Achievement in the Field of Brain Injury Medicine, the Young Investigator Award, the Lifetime Achievement Award, and the Early Career Award for Important Contributions to the Field of Brain Injury Science.

This years winners are:

  • Donald G. Stein - Jennett Plum Award
  • Olivia Gosseries - Young Investigator Award
  • Kristen Dams-O'Conner - Early Career Award
  • Marilyn Price Spivack - Lifetime Achievement Award
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International Brain Injury Association Elects New Officers

The election of the International Brain Injury Association (IBIA) Executive Committee was held by the incoming IBIA Board of Governors.  The results are as follows:

  • Chairman: David Arciniegas, MD
  • Vice Chair: Nathan Zasler, MD
  • Secretary: Lisandro Olmos, MD, PhD
  • Treasurer: Bruce Stern, Esq.
  • BOG Liaison: Jennie Ponsford, PhD

I am honored to have been re-elected to serve as treasurer for IBIA.

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Does Concussion Education Help Make Student Athletes Safer?

The good news is that most if not all states have passed a version of Washington State’s Zackery Lystedt law which is helping to educate high school athletic coaches, trainers, parents, and athletes about concussions and return to play.  The bad news, is that still, despite the passage of this legislation and a great deal of public information, new research finds that only 69% of student athletes that were surveyed in the study still played with concussion symptoms.  According to a recent news release, two studies published this month in the American Journal of Sports Medicine, that athletes were still returning to play much too soon.  Please continue reading to see a full copy of the press release about this study.

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Stern Elected to International Brain Injury Association Board of Governors

I was honored to be reelected to another term as a member of the International Brain Injury Association (IBIA) Board of Governors.  IBIA is dedicated to the development and support of multi-disciplinary medical and clinical professionals, advocates, policy makers, consumers, and others who work to improve outcomes and opportunities for persons with brain injury. 

This March, IBIA will be sponsoring the Tenth World Congress on Brain Injury, which is being held in San Francisco, California from March 19-22, 2014. 

For all attorneys who represent persons with traumatic brain injury, the North America Brain Injury Society (NAIBIS) will be holding its 27th annual conference on legal issues and brain injury at the same time and place.  For attorneys who register for the NAIBIS conference, admission to the world congress is free.  Links to both may be found below. 

IBIA-     http://www.internationalbrain.org/registration-information/

NABIS-   http://www.nabis.org/events/53/

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DTI Used to Examine the Brain's White Matter Microstructure in Ice Hockey Players

As part of the hockey concussion education project, researchers used MRI diffusion tensor imaging to examine the brain’s white matter microstructure in ice hockey players with a history of clinically symptomatic concussion compared with players without a history of concussion.

The researchers utilized six players with a history of concussion and eighteen players without a history of concussion who underwent 3-T DTI.  The researchers concluded “the results of the current study indicate that a history of concussion may result in alteration of the brain’s white matter microstructure in ice hockey players.  Increased FA based on decreased radial diffusivity may reflect neuro inflammatory or neuro plastic processes or the brain responding to brain trauma. 

Hockey Concussion Education Project, Part 3. ”White matter microstructure in ice hockey players with a history of concussion: a diffusion tensor imaging study”. Marc Muehlmann, M.D.,1,3 Peter Savadjiev, Ph.D.,1 Sylvain Bouix, Ph.D., Marek Kubicki, M.D., Ph.D., Eli Fredm an, B.A., Brian Dahlben, M.Sc., Karl G. Helmer, Ph.D., Andrew M. Johnson, Ph.D., Jeffrey D. Holmes, Ph.D., Lorie A. Forwell, M.P.T.,  Elaine N. Skop elja, M.A.L.S., Martha E. Shento n, Ph.D.,Paul S. Echlin, M.D.,12 and Inga K. Koerte, M.D., J Neurosurg / February 4, 2014

The continued use of diffusion tensor imaging to examine the brains of individuals who have sustained a mild traumatic brain injury (concussion) provided further fuel to defeat defense efforts to bar DTI’s use in MTBI cases.

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Advanced MRI Used to Study Effects of Concussion

The hockey concussion education project under the leadership of Dr. Paul Echlin and in collaboration with a team from Harvard Medical School/Bingham  and the women’s hospital/Massachusetts General Hospital/Athinoula A. Martinos Center for biomedical imaging/Western University of Canada had published new findings from an advanced MRI analysis of male and female collegiate ice hockey athletes.  According to their press release:

The international team used advanced MRI imaging and innovative analysis techniques to study the probable acute effects of concussion on the brain; and the resulting studies demonstrate multi-modal microscopic acute organic changes in the brains of athletes that have suffered clinically diagnosed concussions.              

Says Paul Echlin, MD, CCFP, Dip Sports Med, CAQSM, and lead author on the study, “What are our societal goals - will we foster the development of our young people’s cognitive, social and physical potential in a safe and protected environment - or will we continue to teach and reward a culture of violence and accepted brain injuries as “part of the game”?  HCEP has published peer-reviewed scientific findings twice, in 2010 and in 2012, highlighting the high incidence of concussion and the damage inflicted on our young hockey players.  Are we able to evolve and make significant or even radical changes in the sports themselves based on the scientific evidence of too many serious short and long-term brain injuries?”

Please continue reading for more information from the press release.

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Objective Documentation of Brain Damage in MTBI One Year Post Injury

In doing research for a brief on the admissibility of DTI and NeuroQuant, I came upon an article from June 2013, entitled Mild Traumatic Brain Injury:  Longitudinal Regional Brain Volume Changes from the Department of Radiology, NYU School of Medicine. Yongxia Zhou, PhD, Andrea Kierans, MD Damon Kenul, BS. , Yulin Ge, MD,., Joseph Rath, BS, Joseph Reaume, BS Robert I. Grossman MD, and Yvonne W. Lui, MD. Radiology Vol. 267, No.3 (June 2013).

The purpose of their study was to investigate longitudinal changes in global and regional brain volume in patients one year after mild traumatic brain injury and to correlate such changes with clinical and neuro cognitive metrics.  Keep in mind, defense courtroom doctors routinely testify that individuals with mild traumatic brain injury all recover within six months.

The researchers utilized 28 patients with mild traumatic brain injury (with 19 followed up at one year with post traumatic symptoms after injury)  and matched them with 22 control subjects (with 12 followed up at one year).  Automated segmentation of brain regions to compute regional gray matter and white matter volumes was performed by using 3-dimensional T-weighted 3.0T magnetic resonance imaging and the results were correlated with clinical metrics.

The NYU researchers found that one year after mild traumatic brain injury, there was measureable global brain atrophy larger than that found in the control subjects.  The authors concluded “these observations demonstrate structural changes to the brain one year after injury after a single concussive episode.  Regional brain atrophy is not exclusive to mild severe traumatic brain injury, but may be seen after mild injury.  In particular, the anterior part of the cingulum and cingulated gyros isthmus as well as the precuneal gray matter may be distinctively vulnerable one year after mild TBI.

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Mild Brain Injury Increases Risks for All Psychiatric Outcomes

A new study published in the American Journal of Psychiatry out of Denmark found an increase in risk for all psychiatric outcomes after brain injury.  The Danish researchers investigated the relationship between head injury and subsequent psychiatric disorders.  According to the abstract, the authors used linkable Danish nationwide population-based registers to investigate the incidents of schizophrenia spectrum disorders, unipolar  depression, bipolar disorder, and organic mental disorders in 113,906 not six individuals born between 1977-2000 who received in inpatient or emergency department diagnosis of head injury .  Data were analyzed by survival analysis and adjusted for gender, age, calendar year, presence of psychiatric family history, epilepsy, infections, auto immune diseases, and fractures not involving the skull or spine. 

The results and conclusions were:

Results  Head injury was associated with a higher risk of schizophrenia (incidence rate ratio [IRR]=1.65, 95% CI=1.55–1.75), depression (IRR=1.59 95% CI=1.53–1.65), bipolar disorder (IRR=1.28, 95% CI=1.10–1.48), and organic mental disorders (IRR=4.39, 95% CI=3.86–4.99). This effect was larger than that of fractures not involving the skull or spine for schizophrenia, depression, and organic mental disorders, which suggests that the results were not merely due to accident proneness. Head injury between ages 11 and 15 years was the strongest predictor for subsequent development of schizophrenia, depression, and bipolar disorder. The added risk of mental illness following head injury did not differ between individuals with and without a psychiatric family history.

Conclusions  This is the largest study to date investigating head injury and subsequent mental illness. The authors demonstrated an increase in risk for all psychiatric outcomes after head injury. The effect did not seem to be solely due to accident proneness, and the added risk was not more pronounced in persons with a psychiatric family history.

Orlovska S et al. Head injury as risk factor for psychiatric disorders: A nationwide register-based follow-up study of 113,906 persons with head injury. Am J Psychiatry 2013 Dec 10; [e-pub ahead of print]. (http://dx.doi.org/10.1176/appi.ajp.2013.13020190)