Brain Injury Lawyer - New York

Shaken Bay Syndrome: Findings of International Symposium

Shaken Baby Syndrome (SBS), also known as childhood neurotrauma or inflicted traumatic brain injury, is the leading cause of death from childhood maltreatment.

An international symposium sponsored by the National Center on Shaken Baby Syndrome examined how to establish the incidence of inflicted traumatic brain injury in young children and explored issues of definitions, passive versus active surveillance, study designs, proxy measures, statistical issues and prevention. Key findings are published in a Special Supplement to the April 2008 issue of the American Journal of Preventive Medicine.

The mortality rate of victims of this intentional brain injury is about 25%, while survivors do very poorly. In a recent Canadian study, investigators found that after 10 years only 7% of the survivors were reported as "normal," 12% were in a coma or vegetative state, 60% had a moderate or greater degree of disability and 85% would require ongoing multidisciplinary care for the rest of their lives.

Presentations addressed two main themes: (1) the adequacy of current and/or projected systems for measuring the incidence of shaken baby syndrome; and (2) a review of available strategies for evaluating the effectiveness of primary programs for its prevention in large jurisdictions.

Writing in the supplement, Guest Editors Ronald G. Barr, University of British Columbia, Vancouver, and Child & Family Research Institute, and Desmond K. Runyan, The University of North Caroline, Chapel Hill, state, "...it is apparent that there is a 'bad news/good news' storyline emerging here. While the challenges to measuring inflicted injury are real and considerable, it is equally clear that considerable progress has been made and that reliable and valid measurement appears feasible and obtainable. Substantive work continues to be done toward providing reasonable measures that will be informative both about the nature and scope of inflicted neurotrauma in infants and about the possibility that prevention programs will be able to be demonstrated to be effective (or not) on the basis of empiric measurements. It is none too soon."

These articles appear in a Special Supplement to the American Journal of Preventive Medicine, Volume 34, Issue 4 (April 2008), Supplement 1, published by Elsevier.

Brain Damage Leads to Brain Tissue Loss

In a study of mild to severe traumatic brain damage, reported in the March 4 issue of Neurology, brain tissue loss was found in all degrees of brain injury. (NEUROLOGY 2008;70:771-778)

The analysis, using high-resolution MRI, found a loss of brain volume encompassing both frontal and posterior brain regions.

Notably, even patients with a mild injury had changes that could be reliably distinguished from the noninjured controls. The most reliable effects were in the frontal, temporal, and cingulated regions, although there were effects to varying degrees in nearly every brain region.

The patterns of diffuse tissue loss even in the absence of focal injury helped explain the well-known substantial handicap that patients have in the wake with a traumatic brain injury, particularly with concentration, working memory, organizing, planning, and mood changes, the researchers said.

The patients, spanning the full range of severity, received high-resolution structural MRI a minimum of one year after the injury. The loss of brain volume was substantiated even in the absense of other radiological evidence of brain injury.

You can order the full study from the Neurology journal by clicking here.

Can A Monitor Prevent Brain Damage During Surgery?

An interesting article appeared in USA Today concerning a monitor that can determine oxygen saturation in the brain during surgery. 

Although this monitor has been in existence for over ten years, it still faces resistance from some doctors who still question it usefulness.

In the past I have represented individuals who have sustained anoxic brain damage during surgery as a result of poor anesthesia techniques and poor monitoring of a patient's blood pressure.  Any device that will warn physicians when the brain is not receiving sufficient quantities of oxygen is a welcome addition to efforts to improve patient safety.

The device discussed in the article will detect subtle changes in the amount of oxygen reaching the brain and cause increases in blood pressure and blood flow to the brain so that sufficient oxygen reaches it.  The brain is extremely sensitive to oxygen deprivation.  After only a few minutes without sufficient supplies of oxygen, brain damage will start to occur.

You can read the full story by clicking here.

Concussions complicated by post traumatic stress disorder and depression

A new study published this week in the New England Journal of Medicine links the persistent problems following a concussion to the development of post traumatic stress disorder and depression.

According to a summary of the study reported in today's New York Times, the new report finds that soldiers who had concussions were more likely than those with other injuries to report a variety of symptoms in their first months back home, including headaches, poor sleep and balance problems. But they were also at higher risk for the stress disorder, known as PTSD, and that accounted for most of the difference in complaints. Symptoms of the disorder include irritability, sleep problems and flashbacks.

You can read the full Times story by clicking here.

Depression Following Concussion

Researchers at the Montreal Neurological Institute of McGill University have identified the neurological basis of depression in male athletes with persisting post-concussion symptoms. The study, published in this week's issue of Archives of General Psychiatry, has important clinical implications for the treatment of individuals who have suffered a cerebral concussion.

Although neuropsychological testing in these individuals was reported to be normal, many of these athletes reported significant symptoms of depression.  The researchers utilized funtional MRI studies which showed reduced brain activity in areas of the brain that are seen in patients suffering from major depression.

More Powerful MRI Approved To View Brain Pathology

The power of MRI machines keeps increasing at amazing speed.  While most hospitals are still using Tesla 1.5 strength MRI machines, many have now switched over to the Tesla 3.O which enables physicians to see brain pathology including diffuse axonal injury previously missed.  However, much brain injury still is not capable of being seen on the Tesla 3.0 MRI leading to frustrating absence of objective proof of traumatic brain injury.  This is especially frustrating in court cases. While absensce of proof of brain injury does not mean that no brain injury occurred as it is now accepted by the medical community that brain injury can occur even in the absense of positive MRI or CT confirmation, none the less, the failure to be able to document the TBI using objective measures still causes problems in legal cases involving brain damage.

Now, however an MRI that is much stronger than any before has successfully completed safety trials at the University of Chicago.  This new MRI machine is rated at 9.4 Tesla and is capable of revealing the brain in a detail never before seen and which will allow the observer to view biological processes in the human brain.

The safety study was published in the November Journal of Magnetic Resonance Imaging in an issue focused on MRI safety.

Researchers and physicians hope that the 9.4T will usher in a new era of brain imaging in which they will be able to observe metabolic processes and customize health care.

You can read more by clicking here.

Hospital's Slow Response to Cardiac Arrest Leads to Hypoxic Brain Injury

Hypoxia (diminished oxygen) and anoxia (absence of oxygen) are leading causes of brain damage.  These events are often precipitated by cardiac arrest which causes the heart to stop pumping needed blood supply to the brain.  It is the blood that supplies needed oxygen to the brain.  The brain utilizes the majority of the bodies oxygen supply.

An article on the front page of today's New York Times, Hospitals Seen as Slow to Halt Cardiac Arrest reports the findings of a study published today in the New England Journal of Medicine where it was found that in nearly a third of cases of sudden cardiac arrest in the hospital, the staff takes too long to respond, thereby increasing the risk of brain damage and death.

In nearly 30 percent of the cases studied, it took longer than the national standard of two minutes to shock the heart and bring it back to normal function. This increased time leads to increased oxygen deprivation and increased brain damage.

The study and an accompanying editorial clearly find that these injuries are preventable and good hospital care would prevent this needless brain damage from occurring. 

Delays were more likely in patients whose hearts stopped at night or on the weekend, who were admitted for non cardiac illnesses, in hospitals with fewer than 250 beds and in units without heart monitors.

The lead author of the study, Dr. Paul S. Chan of St. Luke's Mid America Heart Institute in Kansas City,  MO is quoted as saying, "We know what works, what save lives. We have the technology available, and certainly the knowledge and skilled personnel in the hospital to shock patients back to normal rhythm. But it will take political will for hospitals to put those resources to better use."

Dr. Leslie A. Saxon, chief of cardiology at the University of Southern California in an accompanying New England of Medicine editorial is quoted as saying, "This is the kind of date we need to say, Let's make sure these preventable things never happen on our watch"

One thing the study recommends is that all hospitals have sufficient automatic defibrillators (which cost less than $500 a piece)  in place to shock the heart back to life along with better monitoring of all patients to alert staff to cardiac arrests.

Hopefully these recommendations will be implemented in hospitals throughout the country without delay to reduce these needless brain injuries.

New Study Confirms Even Minor Impacts Can Cause Concussions and Traumatic Brain Injury

An important new study to be published in the December issue of the journal, Neurosurgery confirms that impacts considered to be minor can cause a concussion and a traumatic brain injury.

The study is based upon date obtained from sensors placed in football helmets.  Researchers at the University of North Carolina studied the amount of force that the player received on impact.

Using special accelerometers embedded in helmets, researchers were able to measure in real time the amount of g-force players' heads experienced at impact, where on the head the players were hit and the directional force of the hits -- linear (straight) or rotational (twisted). The system is called HITS, or Head Impact Telemetry System.

"People see massive hits and think, 'that's the one!' and ignore more trivial blows," said Kevin Guskiewicz, Ph.D., senior author on the papers and chair of the department of exercise and sport science in UNC's College of Arts & Sciences. "Now we know that these trivial hits may be just as serious as the harder ones."

Hopefully this information will cause those who believe that minor impacts cause no permanent injury to reevaluate their opinions.  There is no such thing as a minor head injury.  All head injury must be treated seriously.

Exposure To Lead Can Affect Ability of Brain to Respond to Later Brain Injuries

Exposure to lead can hinder the brain's ability to recover from injury, a recent study in laboratory animals shows.

Researchers at Jefferson Medical College wanted to know if it was possible that lead might alter the potential for plasticity, the ability of the brain to compensate for an injury.  Their finding is reported in the latest issue of the journal, NeuroToxicology.

They studied young rats that were fed a diet supplemented with lead and compared them to others on a diet without lead. They found that even brief exposures to lead affected the ability of the brain to respond to later brain insults.

It is well known that lead exposure had detrimental effects on learning and memory.  This new study implicates lead as a cause of the failure of the brain to properly heal following insults later in life including traumatic brain injury.

Top ten emerging areas of neuroscience research

The Neurotechnology Industry Organization (NIO) has announced the top ten emerging areas of neuroscience that will impact the future of treatments for brain and nervous system.

According to NIO, the trade association that represents the 500 companies worldwide developing treatments for the brain and nervous system, the US economic burden of brain-related disorders has reached more than $1 trillion, highlighting the acute need for continued neuroscience research and therapeutic development.

Top 10 trends of 2007:

• Advancing discovery tools underpin innovation: beyond biochips and brain imaging, recent advances in neuroinformatics, image-based neural circuit analysis, and neural computation are accelerating the pace of neuroscientific discovery beyond what was imagined a decade ago.
• Neuroimmunology leading to new treatment targets: the discovery that immune molecules play a crucial role in shaping neuronal connections opens up new treatment targets for Alzheimer's, autism, ALS, Parkinson's, schizophrenia, and nerve injury.
• National Neurotechnology Initiative: momentum for the new $200M/year federal R&D initiative aimed at accelerating translational neurotech innovation and improving the effectiveness of FDA review process for neuroscience drugs, devices and diagnostics grows.
• Neurodevice interfaces improve prosthetics and treatments: advanced brain-machine interfaces (BMI) enable the severely handicapped to independently compose e-mails and operate a TV in their homes. Other neurodevices provide functional stimulation for the treatment of pain, Parkinson's, obesity, and psychiatric disorders.
• Addiction advances: new research clarifies the role of drugs on sleep, cocaine's potency, and the brain changes that occur due to abuse leading to new treatment strategies for this epidemic impacting over 1.1 billion worldwide.
• Normal aging brain gets more attention: more research and development is being focused on thinking impairments that only partially limit independence and quality of life for senior citizens, adults and school aged children.
• Neurosoftware will penetrate nursing homes and schools, as brain fitness software becomes new first-line treatment strategy.
• Regenerating the spinal cord: new experimental therapies in development could open the doors for research to improve treatments for people with spinal cord injuries, brain injuries, stroke, and other severe movement disorders
• Prevention evidence grows: you are what you eat; smoking is as bad as we thought; and new studies reveal the effects of environmental substances on Alzheimer's disease, Parkinson's disease and others.
• Emotional disorders research advances: new research continues to link neurogenesis to treatment of depression. A better understanding of PTSD should lead to new treatment regimes.
• Neuroscience infiltrates society: from neuroeconomics to neuroesthetics to neuroethics and neurolaw, the influence of neuroscience on society continues to grow.

New Lead Poisoning Recommendations Released by CDC

The Center for Disease Control's Advisory Committee on Childhood Lead Poisoning Prevention has issued new recommendations in a report issued last week.

Lead contamination and exposure to lead is associated with significant cognitive impairments, motor impairments and behavioral difficulties in children.  In 1991 the CDC defined  the blood lead level (BLL) that should prompt public health action as 10 units.  Since that time, strong evidence has been discovered to show that lead levels below 10 units should be of concern to public health officials as well as parents and medical personnel. 

The full CDC Lead report  can be found on line at the CDC web site. The report is dated November 2, 2007 and is number 56(RR08); 1-14; 16

Stem Cells May Help Restore Memory In Brain Damaged Individuals

New UC Irvine research is among the first to demonstrate that neural stem cells may help to restore memory after brain damage. 

In a study published in the Oct. 31 issue of the Journal of Neuroscience it is reported that , mice with brain injuries experienced enhanced memory -- similar to the level found in healthy mice -- up to three months after receiving a stem cell treatment. Scientists believe the stem cells secreted proteins called neurotrophins that protected vulnerable cells from death and rescued memory. This creates hope that a drug to boost production of these proteins could be developed to restore the ability to remember in patients with neuronal loss.

"Our research provides clear evidence that stem cells can reverse memory loss," said Frank LaFerla, professor of neurobiology and behavior at UCI. "This gives us hope that stem cells someday could help restore brain function in humans suffering from a wide range of diseases and injuries that impair memory formation."

To test memory, the researchers gave place and object recognition tests to healthy mice and mice with brain injuries. Memories of place depend upon the hippocampus, and memories of objects depend more upon the cortex. In the place test, healthy mice remembered their surroundings about 70 percent of the time, but mice with brain injuries remembered it just 40 percent of the time. In the object test, healthy mice remembered objects about 80 percent of the time, while injured mice remembered as poorly as about 65 percent of the time.

The scientists then set out to learn whether neural stem cells from a mouse could improve memory in mice with brain injuries. To test this, they injected each mouse with about 200,000 neural stem cells that were engineered to appear green under ultraviolet light. The color allows the scientists to track the stem cells inside the mouse brain after transplantation.

Three months after implanting the stem cells, the mice were tested on place recognition. The researchers found that mice with brain injuries that also received stem cells remembered their surroundings about 70 percent of the time -- the same level as healthy mice. In contrast, control mice that didn't receive stem cells still had memory impairments.

Next, the scientists took a closer look at how the green-colored stem cells behaved in the mouse brain. They found that only about 4 percent of them turned into neurons, indicating the stem cells were not improving memory simply by replacing the dead brain cells. In the healthy mice, the stem cells migrated throughout the brain, but in the mice with neuronal loss, the cells congregated in the hippocampus, the area of the injury. Interestingly, mice that had been treated with stem cells had more neurons four months after the transplantation than mice that had not been treated.

This new research offers renewed promise for those suffering from profound brain injuries.

Diffusion Tensor Imaging Can Detect Brain Damage Even in Mild TBI

Researchers report that diffusion tensor imaging can identify structural changes in the white matter of the brain that correlates to cognitive deficits even in patients with mild traumatic brain injury.

The study is published in the October issue of the journal Brain.

"We studied patients with all severities of traumatic brain injury -- mild to severe -- and found that abnormalities in white matter existed on the spectrum," said Dr. Marilyn Kraus, associate professor of psychiatry and neurology at the University of Illinois at Chicago College of Medicine and lead author of the study. "Even in patients with mild TBI -- those identified as having minimal or no loss of consciousness -- there were structural deficits."

Diffusion tensor imaging uses magnetic resonance imaging technology to examine the integrity of white matter that is especially vulnerable to traumatic brain injury. This imaging modality allows researchers to quantify and qualify structural changes in white matter, particularly in chronic TBI patients.

Thirty-seven TBI patients (20 mild and 17 moderate to severe) and 18 healthy volunteers underwent diffusion tensor imaging and neuropsychological testing to evaluate memory, attention, and executive function. All subjects were at least six months post-injury, and the majority were high-functioning people who were employed or in school at the time of evaluation.

The researchers found that structural changes in the white matter correlate to observable cognitive deficits related to thinking, memory and attention. Patients with more severe injuries had greater white matter abnormalities, representing a permanent change in the brain.

"We know that discreet brain areas are important for specific types of functioning, such as thinking, memory, cognition and motor skills," said Kraus. "But what's also very important is that the white matter serves as the connection between these significant areas of the brain."

In some ways, the brain is similar to a computer, said Deborah Little, director of MRI research in the department of neurology and rehabilitation medicine at UIC and co-author of the study. "You have the CPU and the memory, but they are worthless unless they are connected to each other. The white matter of the brain has the same function as the cables of the computer."

When white matter is damaged, areas of the brain may appear healthy but they are actually "unplugged" and cannot function.

Patients who have a contusion, or bruising of the brain, can also suffer from subtle and diffuse damage to the white matter. The researchers believe that not only the focal lesion but the damage to the white matter is very important.

In the study, the researchers were also able to determine axonal damage (tearing of the axons that allow one neuron to communicate with another) in white matter versus abnormalities in the myelin (the protective sheath that, if damaged, can disrupt signals between the brain and other parts of the body.) If an axon is severed, the damage generally cannot be repaired.

Bacterial Meningitis Vaccine Approved for Children As Young As Two Years of Age

The US Food and Drug Administration has approved the vaccination of children for bacterial meningitis.

The FDA expanded the age range for the vaccine Menactra, made by Sanofi-Aventis, to as young as two years old. Previously, the age range was 11 to 55. 

About 2,600 people fall ill annually from bacterial meningitis, an inflammation of the lining surrounding the brain and spinal cord, with 10 percent dying from it, the FDA said. The US Centers for Disease Control and Prevention recommends vaccination for travellers to countries where the infection is a problem, those with damaged spleens, college students living in dorms and military recruits, among others. The infection can cause seizures, brain damage, memory loss and death in otherwise healthy people in less than 48 hours, with a 15% fatality rate if treated with antibiotics.

Marked by fever, headache, and stiff neck, the relatively rare disease is more serious than viral meningitis.

Stroke Warnings Often Ignored

Despite much effort to educate the public to the warning signs of stroke, a new study released by the American College of Emergency Physicians concludes that the elderly either fail to recognize the signs of an impending stroke or fail to follow up with immediate emergency care. 

The study found that patients were afraid to go to the emergency room because they feared dying alone.  Other's didn't want to inconvenience family or friends by asking to go to the hospital.  Many didn't believe that they were actually having a stroke despite being knowledgeable about stroke symptoms. 

The researchers studied 344 stroke patients in emergency rooms.  All were over 65 years of age and 41 percent were over 80.  On average, patients delays seeking treatment three hours from the onset of symptoms.  Some patients waited over a week.  Only half the patients believed that they were having a stroke or a TIA, a transient ischemic attack that is ofter a precursor to a stroke.

It's important that we get the word out that it is important that individuals who are experiencing the signs and symptoms of a stroke, seek immediate medical attention.  The first three hours after a stroke are critical.  Often clot-busting medication can be administered that will prevent a full blown stroke from taking place.

Stroke symptoms include slurred words, inability to formulate words, numbness and weakness on one side of the body, severe headache, trouble seeing in one or both eyes, confusion and trouble understanding speech, facial droop and difficulty in walking including loss of balance and coordination.

TIA's which are temporary blockages of the arteries that feed the brain are often precursors to a stroke.  The symptoms of the same as a stroke but disappear after 10 or 15 minutes.  Immediate emergency care following a TIA is essential to prevent a stroke from occuring.

 

New Injury Control Research Center for Traumatic Brain Injury Established at New York's Mount Sinai School of Medicine

Congratulations to New York City's Mount Sinai School of Medicine for being designated by the Centers for Disease Control and Prevention (CDC)  as its newest Injury Control Research Center (ICRC). The new center will conduct research on persons with traumatic brain injuries in order to better understand the consequences of their injury and to help enhance the quality of their lives.

CDC’s Injury Control Research Centers (ICRC) are located at 13 universities throughout the United States. At each ICRC, scientists from a wide spectrum of disciplines focus upon discovering how to prevent and control injuries more effectively. They also work to identify critical knowledge gaps in injury risk and protection and also conduct research to address these gaps.

This network of ICRCs also provide technical assistance to injury prevention and control programs within their geographic region. At the Mount Sinai ICRC the focus will be only TBI, including concussion, while other centers focus on other disabilities.

Mount Sinai’s new Center will evaluate promising treatments that address many of the consequences of brain injury, such as impaired cognitive functioning, mood disturbances, and emotional difficulties. The Center will help better identify people with brain injury, and their needs and problems. Lastly, it will look at improving community integration and functioning, and will help educate those most affected by TBI.

Girls At Higher Risk for Sport Concussion Injuries

I am back from the North American Brain Injury Association (NABIS) conference on traumatic brain injury where I gave a talk to the lawyer's section on how to deliver an effective opening statement in a brain injury law suit and look forward to resuming my brain injury blog posts. 

Today's New York Times carries an important article entitled, Girls Are Often Neglected Victims of Concussions. The article reports on a study conducted at Ohio State University to be published in the Journal of Athletic Training which that concluded that girls take longer for their sports concussion symptoms to resolve and are more susceptible to concussions than boys are in the same sports.

The study found that girls playing high school soccer sustained concussions 68 percent more often than boys did and that female concussion rates in high school basketball were almost three times higher among girls than boys.  The study also found that girls consistently took longer for their post concussion symptoms to resolve.

While doctors are uncertain as to why the rates of concussions and the severity of symptoms are higher in girls than in boys, the primary theory is that girls may be more honest in reporting their symptoms and injuries than boys are.  Others also point to the fact that the neck muscles in girls are not as strong as boys so that the head is more prone to move upon impact. 

You can read the entire story by clicking here.   

Brain Autopsy of WWE Wrestler Benoit Shows Extensive Brain Damage

In a Manhattan press conference today, physicians associated with the Sports Legacy Institute announced their findings today concerning the examination of the brain of pro wrestler Chris Benoit who killed his wife, son and then himself.

Not surprisingly, the examination of his brain showed extensive areas of brain damage.  All four lobes of his brain showed extensive cell death which is consistent with the multiple concussions he sustained while engaged in professional wrestling.

Benoit's brain was examined by the research team which included noted neurosurgeons Julian Bailes and Robert Cantu who along with retired pro wrestler, Chris Nowinski, author of Head Games, established the Sports Legacy Institute to look at the mounting evidence of permanent brain damage caused by concussions sustained by athletes.  Head Games is an excellent source of information on the dangers and long term effects of concussions

The brain experts had not problem concluding that the brain damage they found were due to the multiple concussions that Benoit sustained. But, the physicians could not say with absolute certainty that this brain damage was the cause of Benoit's erratic behavior on the night of the murders. They did say however, that the this type of brain damage can cause depression and irrational behavior in an individual.  Similar brain abnormalities were also found on autopsy of the brains of other athletes who committed suicide including pro football player, Andre Walters.

A full report of the press conference can be found at ABC News. 

The type of fluid given to victims of severe brain damage influences survival

Persons with severe traumatic brain injury are frequently administered fluids to maintain their blood pressures.  An adequate blood pressure translates into a sufficient amount of blood reaching the brain in order to provide needed oxygenation of brain tissue.  If blood pressures are not maintained at proper levels then an individual's brain will not receive sufficient oxygenated blood.  Oxygen is the "food" for the brain and it's absence will cause brain cells to rapidly die.

A new study published in the New England Journal of Medicine, August 30th issue suggests that persons who are given saline solution rather than albumin, a protein solution manufactured from the blood, have double the the survival rate at 24 months after injury.

"We determined that the 2-year mortality rate was significantly high in those patients who received albumin-based fluids compared to those who received saline, particularly those patients with severe brain injuries who presented with traumatic coma," said the study's lead author, Dr. John Myburgh, director of the division of critical care and trauma at the George Institute for International Health, in Sydney, Australia.

"Given the significant difference in mortality that we observed, we recommend that albumin-based fluids be avoided for the acute fluid resuscitation of patients with traumatic brain injury," added Myburgh, who's also a professor of critical care at the University of New South Wales.

After two years, the researchers behind the new study found that people with traumatic brain injuries who received albumin had a 63 percent higher risk of dying than those given saline. For those with severe brain injuries, the albumin group had an 88 percent increased risk of death compared to the saline group.

Still needed are answers to the critical question of why saline administration produced a better outcome than the albumin.

Read more about this study by clicking here.

Vote for TBI Question for Democratic Presidential Debate

If you have been following this blog, you know about Darcy Keith from Fishers, Indiana and the important question she posed to ABC news in connection with the recent republican presidential debate in Iowa.  Now we have a chance to again vote and hopefully the question will be asked in the democratic debate scheduled for August 19th. 

Here's the question:  How are you going to address the needs for services, treatment, rehabilitation and public education for those who have suffered from a traumatic brain injury.

Although the question wasn't asked directly to the candidates during the debate, it was asked in a post debate interview.  Darcy was pleased with the response although it did not address the important issue of public education and awareness of this silent epidemic that affects millions of Americans.

Here is Darcy's response:

The public education of Traumatic Brain Injury is very important.  There is a negative stigma associated with traumatic brain injuries. Most folks don't understand what type of injury this is, not to mention the affect it has on survivors, family caregivers and society.

You can now vote by clicking this link to have this question asked on national television of the democratic candidates.  Simply open the link and then click the box under the video that says rate it.  Click the fifth star to give it the highest possible rating.

Let's go Darcy!

fMRI Used To Detect Concussions and Return to Play Decisions In Athletes

fMRI (Functional MRI studies) have been reported to be used by the University of Pittsburgh to assist in making important return to play decisions following sports concussions.

A five year study funded by the National Institutes of Health is published in the August issue of Neurosurgery.  This study conducted by the Sports Medicine Concussion Program at the University of Pittsburgh School of Medicine  found that the brain activity in children and adolescents on functional MRI (fMRI) was clearly related to their performance on neuropsychological tests of attention and memory and to their report of symptoms such as headaches.

The study authors Drs Lovell and Collins conclude that the results of their study confirm crucial objective information that is commonly obtained by neuropsychological testing to help team doctors and athletic trainers make critical decisions about concussion management and safe return to playor understanding the recovery process after sports-related concussions.

The study helps define concussion and recovery for safe return-to-play and confirms information obtained by neuropsychological testing.

A concussion can occur when an athlete receives a traumatic force to the head or upper body that causes the brain to shake inside of the skull. Injury is defined as a concussion when it causes a change in mental status such as loss of consciousness, amnesia, disorientation, confusion or mental fogginess. The severity, effects and recovery of concussion are difficult to determine because no two concussions are alike, and symptoms are not always straightforward.

In recent years, research has shown that until a concussed brain is completely healed, the brain may be vulnerable to further injury, which has led to published studies that have raised public awareness and significantly changed the way sports concussions are managed. Importantly, much of this research has included data that proves the usefulness of objective neuropsychological test data as part of the comprehensive clinical evaluation to determine clinical recovery following concussion.

While neuropsychological testing has become an increasingly useful tool, no other published studies have examined the relationship between changes in computerized neuropsychological testing completed in a medical clinic and brain function as measured by fMRI.

fMRI is one of the few brain scanning tools that can show brain activity, not just the anatomy. Traditional brain scanning techniques such as MRI and CT are helpful in viewing changes to the brain anatomy in more severe cases, but cannot identify subtle brain-related changes that are believed to occur on a metabolic rather than an anatomic level.

fMRI can determine, through measurement of cerebral blood flow and metabolic changes, which parts of the brain are activated in response to different cognitive activities.

For more information on published research concerning sports concussion management, visit the UPMC Sports Medicine Concussion Program Web site .

3-D Brain Imaging

Three dimensional (3-d) brain imaging is the latest advance in medical technology to assist neurosurgeons in brain surgery.

The computerized procedure uses interactive 3-D technology to map the human brain and help guide neurological surgeons during epilepsy surgery and procedures to remove malignant brain tumors.

This imaging technology can help surgeons better determine the location of tumors for removal. The 3-D mapping also helps guide surgeons during epilepsy procedures to see exactly where electrodes have been placed in the brain and portions of the brain that may have to be removed to help stop seizures.

The procedure has been implemented at Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania  which is one of first medical centers in the U.S. to develop and begin using technology.  The software used to power this system is called MediCAD.

DTI (diffusion tensor imaging) and fMRI (functional magnetic resonance imaging) images of the brain are integrated and downloaded, using the MediCAD software, onto PCs in the operating room (OR). This allows the surgeons to view almost real-time digital map of a patient’s brain and better perceive brain activity information. MediCAD also allows the surgeons to virtual “slice” the brain into sections, zoom in for close-ups of sections of the brain and even rotate the image in various directions.

Now is this cool, or is this cool?

This new technology will certainly improve the accuracy of neurosurgeons and hopefully will be expanded to other brain surgeries as well.

New Hope for Patient's in Minimally Conscious State

According to new's report's, tomorrow's edition of the journal Nature has an article on how deep brain stimulation caused a patient who was in a minimally conscious state for six years to begin talking and eating on his own!

The term "minimally conscious state" is used to describe patients who have recovered past the stages of coma and vegetative state and have some degree of conscious awareness of their surrounds on a non consistent basis.

Brain scans taken of this gentleman showed that he had severe brain damage but that there were many brain circuits that were still functioning properly.  The researchers implanted electrodes in his brain to stimulate an area known as the thalamus region.  Two days after surgery, the doctors turned the electrodes on as an initial test of deep brain stimulation.  When they did that, the man was able to keep his eyes open longer than before the surgery, and he was able to turn his head when someone spoke.

Over the next six months, the doctors gradually gave the man deep brain stimulation. He gained the ability to chew and swallow food and to talk more, even occasionally saying sentences up to six words long.

More research is necessary before it can be determined exactly what group of patient's can be helped by deep brain stimulation treatment.

The full article can be found in Nature, Aug. 2, 2007; vol 448: pp 600-604.

Army Institutes Educational Campaign to Recognize Traumatic Brain Injury

The Army in recognition of that many, if not most brain injuries are invisible to the casual and even medical observer, is launching an education program to teach 1 million soldiers how to recognize symptoms of brain injuries and Post Traumatic Stress disorder.

The program is designed to educate the Army about the signs and symptoms of traumatic brain injury and concussions and to encourage troops to get treatment.

The program will include the active military, the Army Reserves and the Army National Guard, both here and abroad.

Everyone is to receive a one-hour briefing on brain injuries and stress, in which teachers will be equipped with videos, slides and a list of expected questions and answers. It will be done through a rarely used "chain teach" program, that is, the subject is taught to leaders, who then teach it to soldiers, continuing down through the Army's chain of command.

I wonder if this program can be modified and used at all emergency rooms in the United States to train doctors, physician assistants, nurses and others about the hidden and invisible signs of concussion and brain injury?

Acute Hospital Care Following Severe Brain Trauma

The miracles of modern medicine continue to save the lives of more and more individuals who have sustained severe brain injury.

How to best manage the care of a patient with severe brain injury involves the intervention of a multiple medical specialties.

An article in this month's British Journal of Anesthesia entitled Traumatic Brain Injury: intensive care management discussed the multidisciplinary team led by neurointensivists, neuroanaesthetists, and neurosurgeons.  The aim of care is the avoidance of secondary injury, maintenance of cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation.

The review discussed he intensive care management of severe TBI with emphasis on the specific measures directed at the control of intracranial pressure and CPP.

For more information on reading this entire article click here.

More Evidence of the Dangers of Multiple Concussions in Professional Football

More medical evidence establishing the link between repeated concussions and permanent brain damage has been reported in today's New York Times.

The Times reports that Dr.Omalu, the neuropathologist who first reported finding evidence of persistent brain damage on autopsy examination of the brains of retired football players has now confirmed a fourth case.

Dr. Omalu examined the brain of  former Pittsburgh Steelers offensive lineman Justin Strzelczyk, who died at age 36 following a car accident.  Before the accident, Strzelczyk was suffering from depression, mood swings and memory difficulties which related back to the multiple concussions and head trauma that he sustained in his years playing professional football. 

Strzelczyk is the fourth former National Football League player to have been found post-mortem to have had a condition similar to that generally found only in boxers with dementia or people in their 80s. The  condition is known as chronic traumatic encephalopathy and has been established in the brains of boxers subjected to repeated brain trauma. The diagnosis was made by Dr. Bennet Omalu, a neuropathologist at the University of Pittsburgh Medical Center. In the past five years, he has found similar damage in the brains of the former N.F.L. players Mike Webster, Terry Long and Andre Waters. The finding will add to the growing evidence that longtime football players, particularly linemen, might endure hidden brain trauma that is only now becoming recognized.

Omalu is quoted in the Times article as saying,  “This is irreversible brain damage,” “It’s most likely caused by concussions sustained on the football field.”  Omalu's findings have been backed up by other physicians who were asked to consult on this matter.

A great deal of credit for this continued investigation must go to Christopher Nowinski,  a former Harvard football player who retired from wrestling because of repeated concussions in both sports.  He is the author of a great book entitled, Head Games--Football's Concussion Crisis and has become an outspoken critic of how professional sports handles the issues related to repeat concussions and when to allow players to return to play.

Nowinski has teamed up with Dr. Omalu as well as with Dr. Julian Bailes, the chairman of the department of neurosurgery at West Virginia University and the Steelers’ team neurosurgeon during Strzelczyk’s career to form an organization, the Sports Legacy Institute, to begin conducting more formalized research.

“We want to get a idea of risks of concussions and how widespread chronic traumatic encephalopathy is in former football players,” Nowinski said. “We are confident there are more cases out there in more sports.” according to the Times. 

Next Tuesday, the NFL Mild Concussion Committee has scheduled a meeting in Chicago to discuss head trauma in the NFL.  The NFL continues to resist the mounting evidence of the link between head trauma, concussions, depression and other psychiatric conditions as well as early onset Alzheimer's Disease. I am hopeful that they begin to seriously address the issues raised by Dr. Omalu's findings.

You can read the full Times story by clicking here.

Head Injury and Stroke Increase Risk of Alzheimer's Disease

Recent studies have shown that the risk of Alzheimer's disease is increased following a head injury. 

Now researchers have determined the mechanism for this increased risk.  They have determined that following the death of brain cells after a stroke or head injury, levels of a protein known as amylois-beta increase causing the formation of plaque on the victim's brain.

It's hoped that future medical research will develop a way of preventing the release of this hormone.

The current study has great implications for boxers, football players and others who have sustained repeated head injury.  Each such injury increases the formation of plaque and adds to the risk of future development of Alzheimer's disease.

The study is published in the journal Neuron. Depletion of GGA3 Stabilizes BACE and Enhances Beta-Secretase Activity. Volume 54, Issue 5, 7 June 2007, Pages 721-737

New Guidelines for Managing Severe Traumatic Brain Injury

The 3rd edition of the Guidelines for the Management of Severe Traumatic Brain Injury developed by the Brain Trauma Foundation are published in a special supplement (Voume 24 Supplement 1) of Journal of Neurotrauma. 

The first guidelines for the management of traumatic brain injury (TBI), developed by the Brain Trauma Foundation, became available in 1995 and emphasized the potential for improved outcomes by reducing or preventing secondary brain injury caused by hypoxia, hypotension, and intracranial hypertension during the critical hours and days after injury. The updated Guidelines reflect the cumulative evidence of human TBI studies published in the neurotrauma literature through March 2006. New topics include Hyperosmolar Therapy, Prophylactic Hypothermia, Infection Prophylaxis, Deep Vein Thrombosis Prophylaxis, Brain Oxygen Monitoring and Thresholds, and Anesthetics, Analgesics, and Sedatives.

The revised guidelines can be viewed free at the Brain Trauma Foundation web site.

More research on Parkinson's Disease and Head Trauma

As many of you know, many years ago, I was the first attorney to successfully prove the link between brain trauma and Parkinson's disease in a legal case I handled. That lawsuit brought on behalf of a young woman who developed Parkinson's Disease shortly after the concussion she sustained in a car crash resulted in a substantial jury verdict in her favor.

Since then because of the paucity of medical research on the link between Parkinson's Disease and head trauma,I have always been interested in new research in this area.

Now, new research points to increased risk of developing Parkinson's disease following head trauma.  European researchers report that the odds for the illness increase as exposure to these brain insults rises.

The research shows that people who were knocked unconscious even once had a 35 percent increased risk of developing Parkinson's and more than two-and-a-half times more frequently in people who had been knocked out more often.

The findings are published in the May 30 online edition of Occupational and Environmental Medicine.  You can read more on this story by clicking here.

Can lowering the temperature of a child's brain prevent further brain damage?

A national clinical trial to examine the effects of induced hypothermia on children suffering traumatic brain injury has been announced. 

By cooling a child who has hit their head to about 90 degrees - almost nine degrees below normal body temperature - doctors believe they reduce subsequent brain swelling, preventing further injury. Children are cooled with special cooling blankets and intravenous injection of cooled saline.

You can read the full news article by clicking here.

To be effective, hypothermia must be induced within six hours of injury. Because of the time-sensitive nature, federally mandated parental consent will be waived for this trial if the parents cannot be reached on time.

Can Progesterone Treatment Improve Outcomes Following Brain Injury?

In adult patients with acute traumatic brain injury (TBI), progesterone treatment may improve outcomes -- especially in cases of moderate injury -- according to a report in the April issue of the Annals of Emergency Medicine.

However, the results of this study really send a mixed message about the protective effects of Progesterone.  Progesterone patients remained in coma longer than control patients, the report indicates, but fewer patients in the progesterone group (10/77, 13%) died within 30 days of injury compared with the control group (7/23 patients, 30.4%).

The reduction in mortality associated with progesterone was most prominent among patients with more severe brain injury (as measured by their Glasgow Coma Scale score), the investigators say.

On the other hand, at 30 days, survivors of severe traumatic brain injury who had received placebo were slightly less disabled than those who had received progesterone, the report indicates, but those with moderate traumatic brain injury who had received progesterone were significantly less disabled than those who had received placebo.

Drinking large amounts of alcohol can decrease the size of your brain

Drinking heavy amounts of alcohol over a long period of time may decrease brain volume, according to research that was presented at last weeks American Academy of Neurology's 59th Annual Meeting in Boston.

The study found the more alcohol people drink on a regular basis, the lower their brain volume.  The study evaluated MRI scans 1,839 people,  ages 34 to 88, who were classified as non-drinkers, former drinkers, low drinkers (one to seven drinks per week), moderate drinkers (eight to 14 drinks per week), or high drinkers (more than 14 drinks per week). MRI scans were performed and used to measure brain volume, which can be thought of as a measure of brain aging.

"Research has shown that there is a beneficial effect of alcohol in reducing incidence of cardiovascular disease in people who consume low to moderate amounts of alcohol. However, this study found that greater alcohol consumption was negatively correlated with brain volume," said study author Carol Ann Paul, MS, of Wellesley College in Wellesley, MA.

This cross-sectional study found people who had more than 14 drinks per week had an average 1.6 percent reduction in the ratio of brain volume to skull size compared to people who didn't drink. In other words, brain volume decreased .25 percent on average for every increase in drinking category (i.e. non-drinkers, former drinkers, low drinkers, moderate drinkers, or high drinkers).

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Cognitive Deficits Following Chemotherapy

An article in Sunday's New York Times, confirms the link between chemotherapy and cognitive deficits.

In the past, oncologists dismissed patient complaints of short term memory loss, an inability to concentrate, difficulty retrieving works, trouble with multitasking and a general feeling that they lost their mental edge.  (Sounds like many other doctors who dismiss complaints of the post concussion syndrome following head trauma)

Now according to the Times, "There is now widespread acknowledgment that patients with cognitive symptoms are not imagining things, and a growing number of oncologists are rushing to offer remedies, including stimulan