BlueCross BlueShield just released its Health of America Report showing that concussion diagnoses have increased 43% from 2010-2015. The rise was particularly marked in children and teens with a 71% rise in diagnosed incidences. Not surprisingly the rate in male patients during the fall season was double that of females. “Connecticut, Pennsylvania and Massachusetts had the highest rates of concussion diagnoses for patients 10-19. The study also reported an increase of 84% in post-concussion syndrome diagnoses with an interesting split–“more females then males ages 20-64 experienced post-concussion syndrome (61.3% vs. 38.7%).”
Some percentage of the increase could be attributed to a growing recognition of the long term impact of concussion, particularly the increased rate of suicide linked to the condition. However, it is disturbing that the concussion diagnoses increased in nearly every state from 2010-2015. The significant change raises questions on causation and indicates the need for more research.
In 2001, Teasdale and Engberg published an article in the Journal of Neurology, Neurosurgery and Psychiatry, entitled Suicide after Traumatic Brain Injury: A Population Study. The researchers reviewed data from Danish hospital admissions covering the years 1979-93 and found that patients who had sustained a TBI had an increased risk of suicide. The authors in that study concluded, “The increased risk of suicide among patients who had an MTBI may result from concomitant risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among the more serious cases implicates additionally physical, physiological, and social consequences of the injuries as directly contributing to…suicide.”
In a recent research article, Lauren B. Fisher, et al. evaluated data from a brain injury-focused database, the BI Model Systems National Database, to further evaluate whether or not suicide rates are higher in TBI patients. Using patient health questionnaires detailing self-reported suicide attempts over a period of twenty years, the authors concluded that those who suffer a TBI are indeed at “greater risk for depression and suicidal behavior.” The outcome of the study indicates the need for “routine screening and mental health treatment in this population.”
An exciting new technology received FDA clearance according to a press release put out by BrainScope on September 26, 2016. According to the press release, BrainScope announced that the FDA has cleared the company to market the Ahead 300, “its most advanced medical device for use in assessing traumatic brain injury.” The product was developed in partnership with the US Department of Defense.
According to the release, 95% of people who go to the emergency room have mild symptoms. These are not always diagnosed as a concussion or Traumatic Brain Injury (TBI.) As we discussed in other posts even mild concussions can cause long term effects in injured patients, particularly children. The Ahead 300 advances diagnosis of TBI using proprietary smart phone and electroencephalography (EEG) technology. It allows for fast indication of TBI so that treatment can be administered immediately in the ER or at the doctor’s office. The tool also provides “clinicians with a digitized, streamline report delivering a comprehensive an objective panel of results to facilitate their differential diagnosis.”
On Monday, September 26, 2016, I had the pleasure of giving a presentation entitled “Dispelling the Myths of a Mild Traumatic Brain Injury: All Traumatic Brain Injury is Serious.”
My presentation addressed 10 myths surrounding Mild Traumatic Brain Injury, such as concussions are not serious, everyone recovers from mild TBI, mild TBI is not permanently disabling, one does not need to lose consciousness, and conventional neuroimaging is sensitive to mild TBI. The three day event in Nashville brought together some of the country’s leading trial attorneys and medical experts who presented on a myriad of medical and legal issues surrounding the preparation of a TBI case.
The symposium was sponsored by the Brain Injury Association of Tennessee and the Tennessee Trial Lawyers Association.
The theory of neuroplasticity holds that the brain will change and adapt to different conditions including to childhood injuries. This theory is often challenged and sometimes referred to as a “myth.” However, a new study by Seena Fazel and colleagues from the Department of Psychiatry at University of Oxford in the United Kingdom delivered data that supports the claims of neuroplasticity theorists. Fazel’s conclusions reveal that the later a mild TBI is sustained, the worse the health and social outcome is for the patient. The study also found a causal effect between childhood Traumatic Brain Injuries (TBIs) and the risk of brain impairment and social dysfunction at later stages in life.
Brain tsunamis are seizure-like waves of electrical activity in the brain caused by Traumatic Brain Injuries (TBIs) and strokes. Much like a tidal wave in the ocean, brain tsunamis build power, wash through the brain, and subside, leaving behind a path of destruction. The waves exhibit electrical signal voltage up to ten times that of normal causing changes to chemistry balance, blood flow, and transfer of oxygen through the brain. During the ebb of the wave, they also cause the brain to short-circuit as evidenced by a period of “dead air” in audio recordings. Doctors have been able to track the process of brain tsunamis for several years but only recently have been able to identify the extent of damage.
A new study published in the Journal of Head Trauma Rehabilitation calls into question whether acute cognitive and physical rest improves concussion recovery times. Thomas A. Buckley, EdD, ATC of the Department Kinesiology and Applied Physiology at the University of Delaware conducted a study to determine if rest after concussion would result in a shorter recovery time in a population of college-aged student-athletes.
This hypothesis was based on the 4th International Consensus Statement on Concussion in Sport which recommends rest after injury as “a corner stone for acute concussion treatment” and outcomes. The authors noted that “rest” was achieved by discontinuing “school attendance, academic work, electronics usage and [any] exercise.” Prescribing rest was also believed to reduce the risk of repeated concussion and the “rare, but potentially fatal, second-impact syndrome.”
Symptoms of concussions often disappear within 7-10 days of an injury–prompting medical release back to sports play. However, preliminary results of a new imaging study presented at a recent American Academy of Neurology conference showed that brain changes caused by “temporary” concussions may last six months or more after the injury. The study, which is ongoing, used diffusion tensor imaging (DTI) to exam connective brain tissue or “white matter” in eighteen students with concussions. White matter brain changes are also associated with stroke and Alzheimer’s.
A study by doctors at Montefiore Medical Center and Albert Einstein College of Medicine provides additional support that use of Diffusion Tensor Imaging (DTI) may be clinically helpful to patients with mild Traumatic Brain Injuries (TBI) because it shows possible evidence of brain repair in post-injury patients. Scans conducted one year post-injury show that patients who exhibited abnormally high fractional anisotropy shortly after injury were “significantly associated” with better overall health outcomes.
The DTI scans were performed on a control group and on 39 injured subjects within 16 days of injury and one year later on 26 returning patients. According to the study, the patients were also tested for changes in cognition and symptomology. The results showed that DTI may be a “marker of compensatory neural mechanisms and an indicator of favorable outcome.” This is supportive data to an earlier study showing positive results from DTI use in pediatric patients, and an important study that used DTI to check the movement of water molecules in the brain of NFL players. In the NFL study the scans showed that those with marked deviations in fluid movement also demonstrated “abnormalities in attention and concentration, executive function, learning/memory and spatial/perceptual function.”
The ability to identify areas of damage and potential for repair are expected to inspire development of new effective treatments for patients with TBIs. Cognitive and physical effects of even mild TBIs may require extensive and long-term treatment from various healthcare providers including doctors, physical therapists, occupational therapists, and psychologists. If you or someone you know has suffered a TBI you should consult an experienced attorney to find out if you can seek reparation to get assistance with medical bills—consultations are usually free and services are often offered on a contingency basis.
Brent Masel, M.D., the medical director of the Brain Injury Association-America published a paper which called traumatic brain injury a chronic disease. In that paper, Dr. Masel outlined a list of medical conditions associated with traumatic brain injury and encouraged that a TBI be looked at, “not as an event, not as the final outcome, but rather as the beginning of a disease process.”
More recently, Charles Wilkinson, Ph.D. and Elizabeth A. Colasurdo, researchers with the Veterans Affairs Puget Sound Health Care System in Seattle issued a press release stating: “Although studies and civilians indicate a 25%-50% prevalence of hormonal deficiencies resulted from brain injury, surprisingly there is limited data on the prevalence and symptoms in military veterans.”