A Virtual Bombshell


For some time the thought was that the mTBI, TBI and concussions suffered on a playing field were different from what was being experienced on the battle field.  The mechanisms may be different (collisions versus blast injuries) in nature but the resulting devastation may be similar.  Again we can look to the northeast to Boston University’s brain bank and researchers for this new finding;

Scientists who have studied a degenerative brain disease in athletes have found the same condition in combat veterans exposed to roadside bombs in Iraq and Afghanistan, concluding that such explosions injure the brain in ways strikingly similar to tackles and punches. […]

“Our paper points out in a profound and definitive way that there is an organic, structural problem in the brain associated with blast exposure,” said Dr. Lee E. Goldstein of Boston University’s School of Medicine and a lead author of the paper, which was published online Wednesday by the peer-reviewed journal Science Translational Medicine.

The paper provides the strongest evidence yet that some and perhaps many combat veterans with invisible brain injuries caused by explosions are at risk of developing long-term neurological disease — a finding that, if confirmed, would have profound implications for military policy, veterans programs and future research.

As I have stated before I feel the military has been on the cutting edge of brain injury research this finding – although noted by Dr. Hovda of UCLA as not being a large enough sample – may propel the military to rethink and take new approaches to our veterans suffering from brain related issues.

As James Dao of the New York Times wrote the profound effect may be this;

The paper also seems likely to fuel a debate that has raged for decades over whether veterans who struggle emotionally and psychologically after returning from war suffer from psychiatric problems or brain injuries.

Dr. Goldstein and his co-lead author, Dr. Ann McKee, co-director of the Center for the Study of Traumatic Encephalopathy at Boston University, assert that their paper shows that many of those veterans probably have organic brain injuries and should be given appropriate treatment and disability compensation.

The virtual battle that researchers are facing with the concussion issue on the sporting field now will have another field and many more researchers with more funds to help in creating a better understanding of concussions and TBI.

Advertisements

15 thoughts on “A Virtual Bombshell

  1. joe bloggs May 18, 2012 / 10:56

    Both Omalu and McKee’s work has been announced prematurely. Omalu showed evidence in a single soldier and McKee in four soldiers against a control group of four. The study lacks any power.

    Did any of them play football, suffer from automobile accident other brain trauma?
    Were they manifesting any clinical symptoms or was is this a case of correlation substituting for causation?

    Not every boxer gets CTE nor does every football player nor does everyone who suffers a brain injury. Why has SLI failed to publish incidence prevalence on CTE in football? Might it reduce its opportunity to secure grants.

    I am deeply concerned that the science does not support the conclusions being promoted by the press.

    The blast injuries are severe, they were undocumented, and the military instead put its vast resources into denial and treatments like dog petting and reike. This scientific spin, I would suspect as little more than grad for credit and funding, is grossly irresponsible to both BIRI and SLI. Our service members need to have their wounds properly researched and treated and not used to promote the financial goals or certain organizations.

      • joe bloggs May 18, 2012 / 11:37

        Nice pickup. Anne McKee sees evidence of TAU in the frontal cortex and is unable to determine whether it is do to prior or blast exposure. She found TAU not CTE. She therefore develops a murine model and exposes the rodent to a blast and throws them in a Morris Water Maze and declares that the similarities are striking.

        This is not a forum to go into the enormous flaws in this work. Mouse skulls and brains would not model blast pressure and injury in the same way as a human. Sheep and pigs are better. What is not in doubt is the soldiers had brain damage and symptoms.

      • Dustin Fink May 18, 2012 / 17:32

        Wish I could pay you joe to help with blog…

  2. A Concerned Mom May 20, 2012 / 06:42

    Inflammation seems to be related to so many diseases … hope effective treatments can be developed for athletes and military …

    http://www.fox5vegas.com/story/18560544/concussion-workshop-takes-place-in-las-vegas

    “Doctors have told Brown the damage he’s done to his brain is the equivalent of more than 370 car accidents.

    Brown however, is the first patient participating in a concussion treatment program based here in Las Vegas through the P.A.S.T. Retired Athlete Medical Group.

    “One of the things we found is there’s a lot of inflammation,” said Dr. Jon Roxarzade of Eternity Medicine Institute, the program’s primary treatment provider.

    “There’s a lot of inflammation that actually leads to proteins that are produced that actually cause deterioration of the brain cells,” he added.

    The players in the program are being treated with medication, counseling and hormone replacement for free.”

  3. A Concerned Mom May 20, 2012 / 15:33

    http://www.pbs.org/wgbh/pages/frontline/foreign-affairs-defense/woundedplatoon/do-combat-vets-suffer-the-same-devastating-brain-disease-afflicting-football-players/

    “This week’s new research has its detractors, who, in the Times article cite concerns ranging from the study’s small data set to its reliance on mice instead of humans to isolate blast-only injuries. In addition, there are also other studies in the works on similar topics. Dr. Omalu, for instance, told the Times that he has a paper in the works that looks at CTE in eight veterans who had been diagnosed with PTSD before their deaths. The results could complicate how the military diagnoses PTSD, a process that’s already under review by the Army.

    Bonus: In order to study CTE, scientists need brains. As NPR’s Only A Game recently reported in light of former NFL linebacker Junior Seau’s recent suicide, there is intense competition among researchers to obtain the brains of the deceased. The show’s audio and written pieces offer a unique look at an emerging field of study.”

    • Don Brady, PhD, PsyD, NCSP, Licensed Psychologist May 20, 2012 / 23:32

      Based on your comment…suggest you read the noted neurologist, Antonio Damasio, MD, text entitled Descartes Error; Emotion, Reason, and the Human Brain (1994).

      Excerpts from his Introduction follow:

      …I began writing this book to propose that reason may not be as pure as most of us think it is or wish it were, that emotions and feelings may not be the intruders in the bastion of reason at all: they may be enmeshed in its networks…(p xii)
      .
      ..feelings are just as cognitive as other percepts. (p. xv)

      …At the onset I made my view clear on the limits of science: I am skeptical of science’s presumption of objectivity and definitetiveness. I have a difficult time seeing scientific results,especially in neurobiology, as anything but provisional approximations, to be enjoyed for a while and discarded as soon as better accounts become available. (p. xviii)

      …Our conversations then began in earnest, with the strange life of Phineas Gage. (p. xix)

      and on page 258 this perception is found:

      …so many “facts” are uncertain and that so much of what can be said about the brain is best stated as working hypotheses

      • A Concerned Mom May 21, 2012 / 07:35

        Thanks for the suggestion Dr. Brady … I found a book review in the LA Times.

        http://articles.latimes.com/1994-10-07/news/ls-47420_1_human-brain

        “Once a good husband and father, Elliot complained of headaches and then seemed to lose his concentration and sense of responsibility. He took a battery of psychological tests. They showed nothing. Elliot was coherent and smart with a flawless memory of his life story. He was referred to Antonio Damasio, who found a brain tumor pressing on Elliot’s frontal lobes.

        Surgery was essential and although Damasio was able to remove the tumor, Elliot’s behavior began to resemble Gage’s. Unlike Gage, however, Elliot was there for Damasio to study.

        From Elliot, we learn to question our cultural admonitions to “keep a cool head” and “separate emotions from reason.” Emotion is an intrinsic part of intelligence, Elliot’s case reveals; having lost access to the part of his brain that provides emotional cues, Elliot could not make decisions.”

  4. A Concerned Mom May 21, 2012 / 15:33

    Short interview with Dr. Bob Stern:

    http://www.wbur.org/npr/153152871/vets-return-with-brain-injuries-oft-seen-in-football

    “RAZ: So there’s no way to tell if somebody is affected by CTE through a brain scan. You can’t determine that just by doing an MRI.

    STERN: Well, we’re trying to right now. I was very fortunate in getting a grant from the National Institutes of Health recently to do just that. And to me, that’s really the big next step. We really have a good understanding of the neuropathology of this disease, what it looks like after people die. But now, we really need to move this field forward by being able to diagnose people while they’re alive so we can understand how common it is, so we can understand what the risk factors are, so we can understand how to treat it and prevent it.”

    • Joe Bloggs May 21, 2012 / 18:24

      Bob Stern needs to stop this spin. He should gauge his response based on the lack of progress in imaging for a range of brain disease including but not limited to alzheiner’s, frontotemporal demtia and vascular dementia. Twenty years of promises and virtually no results.

      BU is getting out of control.

      • A Concerned Mom May 21, 2012 / 20:10

        Did you see the BU/SLI teams footage in the Hard Knocks video? McKee, Stern, Nowinski and Cantu are interviewed beginning at the 9:30 min. mark. They say they have an ongoing study of 100 former football players with advanced imaging techniques – MRS. They’re looking into genetics and chemical changes. The 24 min. mark has some additional footage on imaging.

        http://www.abc.net.au/4corners/stories/2012/05/10/3499950.htm

  5. Joe Bloggs May 21, 2012 / 21:44

    Anne McKee says CTE is slow progressive disease. I guess that does not apply to vets.

    Stern states it will take two or three years. Let’s see in Iraq, CT, MRI, fMRI with varying coil strengths from 1.35T to 7T and they find nothing. Then in 2007 we decide diffusion tensor imaging will work but no convincing result.

    UPMC and UCLA tried selling an imaging solution for Alzheimer’s for a decade, but that basically still has issues.

    The issue is functional performance not damage illustrated on image. Every brain injury is unqiue and so is its recovery.

    Don’t hold your breadth, STern is not a neuroradiologist. This is very tough work.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s