I think and think for months and years. Ninety-nine times, the conclusion is false. The hundredth time I am right. Albert Einstein June
Well once again we find ourselves in the midst of a hot summer in Tallahassee. The best thing about summer for me is my schedule opens up to perform a great deal more research on traumatic brain injury. My laboratory has recently submitted a preclinical grant to the National Institutes of Health using a multi-treatment protocol following frontal lobe brain injury. These treatments will all be delivered in the acute setting and include; progesterone, vitamin D, dietary zinc, 2-AG and thyrotropin releasing hormone. These treatment agents were chosen to because they have limited side effects and independently reduce specific injury-causing factors associated with traumatic brain injury in the early phases following injury. I’m excited about this work because I feel that a combinatorial drug protocol will allow for better behavioral outcomes. The reason I wanted to speak about this new research design is to enlighten our readers as to how I acquired much of the information of which this grant proposal was based on. In particularly what internet sites I use to acquire the literature I need to base my preclinical work on expected clinical outcomes.
I begin by scourging the past and current literature on clinical trials. This information allows me to not repeat the failures of others research and at the same time acknowledging their successes. Furthermore, I can establish which drug treatments are safe and at what concentrations they are being used to improve outcomes. It is this method of site review that allowed me to choose the treatment agents outlined in my current grant submission. The two primary internet sites I use are the Cochrane Library and Clinicaltrials.gov. These are reliable sites with professional reviews of past and ongoing clinical trials. I believe that these two sites will help you understand best what the present and future status that traumatic brain injury research holds. Surely there are other sites that can be used to acquire information but these two have always been useful to me. Please let me know if you have questions with regards to any clinical trials you review on these two sites and I will work to clarify them better for you.
Have a great month of June, Jake ‘When you reach the end of your rope, tie a knot in it and hang on.’ Thomas Jefferson April 2009
The Journal of Head Trauma Rehabilitation states that there are at least 5.3 million Americans living with a disability due to sustaining a traumatic brain injury (TBI). Each year at least 230,000 people are admitted to the hospital with a TBI. Unfortunately, 80,000 of these patients experience long term disability from their injury. The cost of care for this patient population is over 60 billion dollars a year with the majority of the funding issued for long term patient care (patients one year or more post-TBI).
It may seem obvious but the key to reducing long term care requirements is proper acute care management. First of all it is best that the patient be cared for in a trauma center if the head injury is moderate to severe. This care needs to begin within the first three hours of the injury if possible. Second it is crucial that the patient be admitted to an inpatient rehabilitation center that is properly equipped for this injury population. I can not stress high enough the importance of quality acute care to reduce the total needs of long term care. As a side note we as a community need to recognize that mild TBI is a serious health risk. Acute care for this population is just as crucial. Many mild TBI patients end up with long term disability defined by memory loss, attention deficit and headaches.
It is unfortunate that many TBIs are the result of accidents that are no fault of the patient. From community falls in the elderly to car accidents the situation that led to the injury could have been avoided had other parties been more responsible. Many legal teams are well equipped to investigate such accidents and subsequently secure the insurance funds needed to sustain quality long term care for the patient/victim. Please refer to this website for general information regarding medical law and the TBI patient: http://www.traumaticbraininjury.com
Please do not hesitate to blog me for more information on facilities and or funding resources for the long term needs of your family member who has experienced a TBI. I am also available to answer any questions this month with regards to clinical trials and new and exciting drug discoveries for TBI patients.
Thanks, Jake March 2009
Each year the Brain Injury Association (BIA) and its state affiliates promote brain injury awareness in the month of March. So here we are its March and this year’s focus is on concussions especially seen in adolescents who are playing Middle and High School sports. However, there are other populations in which we find a high prevalence of concussions such as driver’s in car accidents and those in the armed forces fighting in the Middle East.
Interestingly, a concussion does not have to include a bump to the head. For example whiplash injuries that occur when a driver is exposed to a rear-end collision can cause a concussion even though the driver’s head may not have hit the steering wheel. In fact all concussions have an acceleration-deceleration component with regards to the movement of the brain inside its skull casing. Certainly the concussion is made worse if there is a bump to the head included in the injury dynamics because then we are also dealing with considerable focal swelling of brain tissue that must also be resolved on top of injury repair that is needed due to the acceleration-deceleration of the brain. During acceleration-deceleration the brain is like that ‘slinky’ you watched roll down the stairs at home when you were growing up. The front part of the ‘slinky’ moves forward pretty easily but there is a lag time for the back part of the ‘slinky’ to catch up. The lag time represents a stretching of the brain and when the brain stretches there is damage to the covering of the nerves in your brain. This covering is referred to as myelin. It is the myelin that allows for electrical signals to travel quickly throughout the brain. Without intact myelin the electricity slows down. The damage due to a concussion occurs at the level of the myelin and in fact slows down the brain. This damage is primarily in areas of the brain that allow you to make quick decisions and remember to pay the home mortgage bill.
Concussions are most often classified as mild traumatic brain injuries and in fact on standard MRI show no signs of injury and therefore the progression of the disease either positive or negative is hard for physicians to track. Diffuse tensor imaging is one way to evaluate the injury status but that option is not available locally in the Tallahassee area. Therefore, it is especially important that you have a neuropsychological evaluation to determine what level of injury you may have sustained and then follow-up evaluations to determine how your treatment of the disease process is progressing.
Most concussions will improve over a period of days but for those that are long lasting there can be serious consequences to work and or school productivity. Treatments at this point are used primarily to fight inflammation. Patients with concussions by definition have whiplash-type of injuries and medical attention to the cervical spine needs to be given. In fact many of the headaches following a concussion can be reduced by cervical spine realignment.
Ongoing research at the Florida State University College of Medicine includes a research trial evaluating the genetics of concussions and predispositions of high school athletes to post-concussion syndrome. We also have a model for concussions used in the rat where we are evaluating the treatment effects of neurosteroids on improving memory after brain injury.
Don’t forget to where your helmets! February 2009
Have you ever misplaced your car keys? Walked all around your house wandering where they might be? But then all of a sudden thought to yourself what am I looking for? That’s how every minute of everyday felt for me after my brain injury. I literally would forget what I had forgotten!
Amnesia is just one of the many frustrating things that occur following a severe head injury. I considered myself very lucky given that physically I was fine but my ability to function in such a cognitive world was certainly reduced. After one year I had fully regained my memory capacity and my career goal was finally clear to me. I trained and worked as a physical therapist to help others with neurological disease for the next four years. Then I decided that I could perhaps do more for my patients by getting involved with research. So through the guidance of Dr. Cathy W. Levenson at Florida State University I received a Ph. D in Neuroscience and now focus my research on finding a cure for traumatic brain injury!
I was fortunate enough to gain three years of experience at Emory University with an ongoing clinical trial using progesterone acutely for brain injury. We have seen tremendous results so far with a decrease in mortality of greater than 50% and a 30% reduction in disability measures in both men and women. Furthermore, we are in the early stages of combining progesterone with other therapies that include thyrotropin releasing hormone and vitamin D that appear to further promote recovery. It is truly an exciting time in the field of brain injury research which is aided by our affiliation with the High Magnetic Laboratory. It’s amazing how clearly we are able to define our results due to this partnership!
As a member of the brain injury advocacy group I see myself as the scientific and clinical distributor of information to our community. I hope that bloggers will submit their inquiries to me in order to better understand the molecular and behavioral mechanisms of brain injury and look to me for hope and information on past, current and future clinical trials as they relate to brain injury.
I consider my brain injury a blessing today. It was a defining moment in my life that I used to become a better person both personally and professionally. The diffuse nature of this disorder certainly makes it difficult to cure but I believe that an understanding of the time course of the disease and a willingness to treat with multiple drugs and rehabilitation modalities at these set time points that we can maximize outcomes to the point that this disorder is no longer ambiguous. I’m a true believer in the extraordinary reparability of the nervous system. We as a research population need only to find the best ways to tap into the system and it will do the rest for us! My colleagues and I are mechanics in training. Once we are fully licensed we will be able to make the patient’s car purr!