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January 31, 2008,
11:50 am
Brain Injury or Posttraumatic Stress Disorder?
A recent study by Dr. Hoge and colleagues, explored the symptoms of soldiers having suffered from mild concussions. This study looked at soldiers who lost consciousness following a head injury and assessed their symptoms. Surprisingly the study found that many of the long term symptoms the soldiers suffered from were more indicative of the psychiatric reaction to combat – not physical brain damage. More than 40 percent of the soldiers with injuries associated with loss of consciousness met the criteria for post traumatic stress disorder. The study suggests that while mild traumatic brain injury predicts a range of health problems, its effects are not significant after post-traumatic stress disorder and depression were considered. What does this mean in plain English? Basically that Dr Hoge and colleagues found that PTSD and Depression can account for the majority of the post mild TBI problems – the exception being headaches, setting the stage for a primary diagnosis of PTSD or Depression.
Click here to read the entire article from Medpage Today
Click here to read the entire the study in the New England Journal of Medicine
Click here to read the entire a review of the study from the New England Journal of Medicine
What does this mean to our returning soldiers?
Dr. James Kelly, a neurology professor at the University of Colorado and co-author of guidelines the military uses to identify traumatic brain injury, expressed concerns that doctors will attribute lingering health problems to psychological issues – dismissing true brain injury features as psychological only. Kahlor states that the military does not want to diagnose people with brain injury, and as such may diagnose individuals as suffering from PTSD (Post traumatic stress disorder), since PTSD and TBI present with similar symptoms.
One may wonder why our military would prefer a PTSD diagnosis. According to Sgt Kahlor, who has been diagnosed with PTSD and experienced concussions while surviving four explosions during his deployment to Iraq resulting in injuries such as a detached retina, seizure activity, and headaches, the military prefers to diagnose soldiers with PTSD because TBI disability compensation is much higher.
Click here to read the entire article from CNN featuring Sgt Kahlor
What can be done?
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 (Brain, October 2007). Diffusion tensor imaging uses magnetic resonance imaging technology to examine the integrity of white matter that is especially vulnerable to traumatic brain injury. Marilyn Kraus, MD says that “Even in patients with mild TBI - those identified as having minimal or no loss of consciousness – there were structural deficits”.
A study of 37 individuals with traumatic brain injury ranging from mild to severe, and 18 healthy volunteers, found that structural changes in the white matter correlate to observable cognitive deficits related to thinking, memory, cognition and motor skills. Dr Kraus explains that the white matter serves as a connector between different areas of the brain, allowing for the various areas to communicate, and that when white matter is damaged, areas of the brain may appear healthy but are actually “unplugged” and can’t function.
Click here to read the entire article on structural changes in the brain
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8:02 am
PTSD or TBI?
A recent study published in the New England Journal of Medicine, relayed that Post Traumatic Stress Disorder (PTSD) may account for most of the ongoing health problems and physical symptoms experienced by U.S. soldiers with mild traumatic brain injury returning from Iraq. The researchers studied 2525 U.S. Army infantry soldiers who had been deployed for one year in Iraq 3 to 4 months after their return home. Of these soldiers, 10.3% reported injuries resulting in an altered mental state, 4.9% reported injuries resulting in loss of consciousness, and 17.2% other injuries. 43.9% of those that reported a loss of consciousness due to injury were reported to have PTSD, as compared to 27.3% among those that reported an altered mental state. The researchers concluded that, “After adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache… Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home.” The following is an except of an article from CNN.com that discussed the findings:
Sgt. Ryan Kahlor has the same nightmare every time, a vision of walls painted in blood and fat, and men on top of houses, throwing pieces of Marines’ bodies off rooftops. It’s a vision he can’t shake, because he lived through it while deployed to Iraq last year.
“I have nightmares. I dwell on it. I think about it all the time,” said Kahlor, 24. “Staying asleep is hard. I associate a bed with the dreams I have. My parents think I’m crazy, but I sleep better when I’m on the floor.”
Kahlor has post-traumatic stress disorder, which can develop after surviving a traumatic event in which a person is physically threatened or injured.
He also experienced concussions while surviving four explosions during his 14 months in Iraq. He said these events left him with a detached retina, vertigo, memory problems and dizziness.
A new military study published Wednesday in the New England Journal of Medicine says soldiers who suffered concussions in Iraq were not only at higher risk of developing post-traumatic stress disorder and depression, but also that the depression and PTSD, not the head injuries, may be the cause of ongoing physical symptoms.
Click here to read the rest of the CNN article
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January 28, 2008,
8:20 am
Proportion of Autism can be detected by gene tests
According to a recent study published in the February issue of the American Journal of Human Genetics, variations of genetic material, such as translocation, inversions, gains, and losses, are common among patients with Autism. According to Stephen Scherer, Ph.D., of the Hospital for Sick Children, and one of the authors of the study, overlapping or recurrent chromosomal changes were observed in 13 different genetic regions in the 427 patients with autism in the study.
One thing that is important for physicians to come to terms with, with regards to the identification of autism, is that genetic testing can and should be used when autism is suspected as a part of a good clinical work-up. The following is an excerpt of an article from Medpage Today that reviews the study:
The “most compelling result” was a copy number variation on chromosome 16 that was seen in 1% of the autism patients but not in healthy controls, the researchers said.
The same copy number variation was reported in December in Human Medical Genetics and again Jan. 9 in the New England Journal of Medicine. (See: Chromosome 16 Mutations Linked to Autism)
But Dr. Scherer and colleagues also found a range of other abnormalities that can be detected with microarray analysis or karotyping and which might be used to help make a diagnosis of autism. “Structural variants were found in sufficiently high frequency influencing ASD to suggest that cytogenetic and microarray analyses be considered in routine clinical workup,” they wrote.
Click here to read the entire article from Medpage Today
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January 21, 2008,
8:27 am
Soldiers: Brain Injured and Unaware?
According to a CNN article on January 17th, up to 20 percent of our troops returning from Iraq and Afghanistan may have suffered from brain injuries, however due to lack of awareness they have not received treatment. Why is this happening? The Army says it’s because they have a difficult time identifying and treating the affected troops because the soldiers themselves don’t recognize the symptoms – so they go unreported.
In an effort to address these limitations the Army is now checking soldiers before and after deployment in an attempt to identify and treat individuals with a traumatic brain injury as soon as possible. The Army is also trying to teach soldiers traumatic brain injury symptoms such as headaches, dizziness, sleep disorders, nausea or memory problems, so that the individual soldier can seek treatment more quickly.
Click here to read the entire article from CNN
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8:27 am
abnormal brainstem function may be responsible for irritable bowel syndrome
According to a recent study published in the January 9th issue of the Journal of Neuroscience, abnormal brainstem function may be responsible for irritable bowel syndrome. The purpose of the study was to seek out abnormal neurological responses for anticipated pain. According to Steven Berman, M.D., of UCLA, when patients with irritable bowel syndrome anticipated abdominal pain that was not dangerous via stimuli they showed increased activity in areas of the brain that dictate sensation of pain and emotional arousal. One of the most important symptoms of irritable bowel syndrome is anxiety about the condition, which can increase sensation of physical symptoms. The following is an excerpt of an article from Medpage Today that reviews the study:
The investigators studied 14 women with irritable bowel syndrome and 12 healthy women. Participants underwent a balloon-driven rectal distention procedure that causes no tissue damage but creates sensations of pressure. The procedure included a light-based visual cue to signal the start. Distentions of 25 and 45 mm Hg were induced, as was a sham distention of 5 mm Hg.
Questionnaires administered just prior to the procedure confirmed that the irritable bowel syndrome patients were more anxious, angry, and stressful beforehand than the healthy individuals. The patients had mean scores of 6.0 for stress, 6.0 for anxiety, and 5.8 for anger at baseline. Corresponding values for controls were 3.2 (P<0.0001), 2.5 (P<0.0001) and 2.4 (P=0.0002).
During the procedure, activity in participants’ insula, amygdala, and brainstem was monitored with functional MRI.
Click here to read the entire article from Medpage Today
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8:27 am
Abnormal brainstem function responsible for irritable bowel syndrome?
According to a recent study published in the January 9th issue of the Journal of Neuroscience, abnormal brainstem function may be responsible for irritable bowel syndrome. The purpose of the study was to seek out abnormal neurological responses for anticipated pain. According to Steven Berman, M.D., of UCLA, when patients with irritable bowel syndrome anticipated abdominal pain that was not dangerous via stimuli they showed increased activity in areas of the brain that dictate sensation of pain and emotional arousal. One of the most important symptoms of irritable bowel syndrome is anxiety about the condition, which can increase sensation of physical symptoms. The following is an excerpt of an article from Medpage Today that reviews the study:
The investigators studied 14 women with irritable bowel syndrome and 12 healthy women. Participants underwent a balloon-driven rectal distention procedure that causes no tissue damage but creates sensations of pressure. The procedure included a light-based visual cue to signal the start. Distentions of 25 and 45 mm Hg were induced, as was a sham distention of 5 mm Hg.
Questionnaires administered just prior to the procedure confirmed that the irritable bowel syndrome patients were more anxious, angry, and stressful beforehand than the healthy individuals. The patients had mean scores of 6.0 for stress, 6.0 for anxiety, and 5.8 for anger at baseline. Corresponding values for controls were 3.2.
During the procedure, activity in participants’ insula, amygdala, and brainstem was monitored with functional MRI.
Click here to read the entire article from Medpage Today
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January 17, 2008,
2:49 pm
Posttraumatic Stress Symptoms Triple with Combat Exposure
Crystal Phen reports in Med Page today (January 16, 2008) that ”posttraumatic stress disorder (PTSD) was three times more common among troops involved in combat in Iraq or Afghanistan than among those not so exposed.”
Not so surprisingly, Tyler C. Smith, Ph.D. of the Naval Health Research center found in a prospective population-based cohort study, that combat exposure for individuals serving in the Army or Air Force increased the likelihood of PTSD. It was also found that the odds for PTSD more than doubled for those exposed to combat in the Navy or Coast Guard and Marines.
In one recent study, the rate of PTSD was 11.8% among regular forces and 12.7%
among reserves at screening immediately after deployment, whereas it jumped to
16.7% and 24.5%, respectively, six months later. (See: Mental Health Problems of Iraq Veterans May Be Delayed)
To get prospective rates, the researchers analyzed health outcomes from 50,184 participants surveyed in the 22-year longitudinal Millennium Cohort Study.
The cohort included active military duty and reserve or National Guard personnel surveyed at baseline from July 2001 to June 2003 before the wars in Iraq and Afghanistan and again an average of 2.8 years later.
The rates of new onset self-reported symptoms were:
7.6% among those deployed with self-reported combat exposures.
1.4% among those deployed without self-reported combat exposures.
2.3% among those not deployed.
In a nutshell, the studies are showing that specific combat exposures are the problem, and that deployment (itself) does not significantly affect the onset of PTSD.
The article also listed characteristics of individuals who are at higher risk of PTSD: being female, divorced, younger, less educated, black, reserve or National Guard member, health care specialist, a self reported smoker or a problem drinker. Furthermore, persistent PTSD symptoms were found to be more common among those who were older, higher educated, divorced, smokers, drinkers, health care specialists, reservist, or national guard members.
Although the overall prevalence was not high, especially compared with the up to 30% rate among veterans of the war in Vietnam, it still represents a substantial number of cases because of the number of military members exposed to combat over time in Iraq and Afghanistan, the researchers said.
Particularly in these wars, they added, “the unpredictability and intensity of urban combat, constant risk of roadside bombs, multiple and prolonged tours, and complex problems of differentiating enemies from allies can leave many troops with high stress levels and possible lasting health consequences.”
While the risk conferred by combat exposure may not be preventable, they concluded, special attention might need to be paid to the more vulnerable subsets of the military populations.
Click here to read the entire article from Medpage Today
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January 15, 2008,
12:39 pm
Tricks to improve your memory
Having problems remembering what you went into the other room for? In CNN’s Health segment Lisa Mulcahy reports on exercises which can help you stay on task. Here are a few that I found to be potentially helpful, and a couple that were just unusual enough that I may have to try.
Problems keeping track of you to-do’s: Play a mind game. Use creative visualization to connect the dots between activities on your agenda. Scott Hagwood presents the following example “Say you have to remember to buy milk and also take your son to the dentist. You can link those tasks together by imagining your son drinking a glass of milk, and seeing the milk wash over his teeth, depositing calcium.”
Need to ace that presentation? Stop and smell the roses. A recent study in Germany proposes that literally sniffing a rose (or rose scent) improves recall. This was conducted by having student s sniff a rose scent as they matched pairs of cards; they were then re-exposed to the scent as they slept. When they woke up the “rose-sniffers” had better recall memory, than those who didn’t get to sniff anything.
Have problems remembering names? Exercise your eyes. British researchers have found that a simple eye exercise can help you retain words you are about to hear. Simply move your eyes back and forth horizontally for 30 seconds before entering a social gathering with new people.
Difficulty Absorbing critical info? Breathe deeply. Sonia Lupies, Ph.D., director of the Center for Studies on Human Stress at the Douglas Institute in Montreal, Canada says that “attention is the main door to memory”, as such, keep your mind focused during meetings by meditating beforehand. “Never meditated before? Sit or lie on the floor in a quiet room in a comfortable position, rest both hands on your stomach, and breathe deeply, focusing on the silence. Try to meditate for at least 10 minutes daily.”
Multi-tasking not your strong point? Learn a new language. You don’t have to become fluent, just drill vocabulary with an instructional CD, this will create new pathways in the brain, which can help you stay on top of everything you already have on your plate.
Want to power through a grocery run? Play mah-jongg. If you want to remember things more quickly, grab a few friends and start a mah-jongg night. It’s not just for elderly ladies. It’s a pretty complicated game of skill in which players visually match tiles as quickly as possible. Mastering the game may help you rapidly commit locations to memory. You can play solo, too.”
Lisa also presents exercises to assist with not being able to find your parked car, delivering the punch line, mastering a new work-out move, and reducing forgetfulness.
Click here to read the entire article from CNN
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January 9, 2008,
9:11 am
Occupational Therapy Increases Gains for Stroke Patients
A study involving over 1000 individuals recovering from stroke in the U.K. and Hong Kong demonstrated that functionally based Occupational Therapy increased the capacity of the individuals in the study group to perform activities of daily living and created a lower risk for deterioration. The study focused on community dwelling OT patients and did not include hospitalized individuals. The Occupational Therapy provided was functionally oriented to areas like personal care, light meal preparation, managing money and personal shopping. This study highlights the value of functionally based rehabilitation for neurological injuries.
Reference: Legg L. et al. Occupational Therapy of patients with problems in personal activities of daily living after stroke: Systematic review of randomised trials. BMJ 2007 November 3; 335;922
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8:29 am
Where thoughts occur in the brain
A recent study conducted by a team of Carnegie Mellon University neuroscientists and computer scientists has identified patterns of activity in the brain whilst looking at particular objects. Participants in the study, while submerged in an MRI scanner, were asked to look at various similarly categorized images, five tools and five dwellings. The categorical similarities in the images were purposeful to see if “specific,” rather than broad-spectrum, objects could be identified. The study was the first of its kind in that previous studies were only able to distinguish between broad categories of objects, such as “tools,” through observing active parts of the brain.
Participants were shown specific images during MRI scanning and asked to think about the functions of those images; during this process the Carnegie Mellon team of scientists were able to identify the exact image that they were looking at. They were able to develop a computer program based upon an algorithm reflecting the patterns of brain activation when looking at particular images that aided them in this process. The scientists were able to predict which image a participant was looking at based on information gathered from “previous participant’s” brain activity, something they were uncertain was possible. The following is an excerpt of an article from Medical News Today that reviews the study:
A team of Carnegie Mellon University computer scientists and cognitive neuroscientists, combining methods of machine learning and brain imaging, have found a way to identify people’s thoughts and perceptions of familiar objects by identifying the patterns of brain activity associated with the objects. This new method, developed over two years under the leadership of neuroscientist Professor Marcel Just and Computer Science Professor Tom M. Mitchell, enables them to identify the mental state associated with a four-second viewing of a line drawing of one of 10 different objects, including five tools and five dwellings.
A dozen study participants enveloped in an MRI scanner were shown drawings of the objects one at a time and asked to think about its properties. As they did that, Just’s and Mitchell’s method was able to accurately determine which of the 10 drawings a participant was viewing based on their characteristic whole-brain neural activation patterns. To make the task more challenging for themselves, the researchers excluded information in the brain’s visual cortex, where raw visual information is available, and focused more on the “thinking” parts of the brain.
The scientists found that the activation pattern evoked by an object wasn’t located in just one place in the brain. For instance, thinking about a hammer activated many locations - i.e. how you swing a hammer activated the motor area, while what a hammer is used for, and the shape of a hammer activated other areas.
Click here to read the entire article
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