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Friday, April 29, 2011

Long-Term Depression Linked to TBI

About 30 percent of traumatic brain injury (TBI) patients will develop clinical depression, a level three times higher than the general population, according to a new study from Vanderbilt University.  By examining more than 100 previously published studies done over several decades on patients that had experienced TBIs resulting from motor vehicle accidents, falls, assaults, and sports injuries, the Vanderbilt researchers were surprised to discover that the incidence of depression seems to hold steady for people with TBIs even years later.

 “Any patient who has a traumatic brain injury is at a real risk for developing depression, short and long term,” said Dr. Oscar Guillamondegui, study co-author and professor in Vanderbilt’s Division of Trauma and Surgical Critical Care. “It doesn’t matter where on the timeline that you check the patient population – six months, 12 months, two years, five years – the prevalence is always around 30 percent across the board.  In the general population about 9 percent to 10 percent of people have depression.”

 The study didn’t show a distinction between mild and severe brain injuries, meaning a patient who sustains a concussion might be just as likely to develop depression as one with a fractured skull and severe bleeding on the brain.

 “Nine months out, they may have developed depression as a result of the injury, but because the injury seemed mild they may not have had a visit with a physician who could pick up on the problem,” said study co-author, Melissa McPheeters, a health-care epidemiologist and co-director of Vanderbilt’s Evidence-based Practice Center.

 “Patients and their families need to know about this,” McPheeters said. “They need to know what to look for because they are the ones who will see the changes first.”

 The researchers also suggested that practitioners should ask about whether a patient has a history of TBI, when they are initially seen for symptoms such as irritability, restlessness, anxiety, and sleeplessness, so that both conditions can be treated together.

Wednesday, April 13, 2011

Research Underway to Develop Drug to Help TBI Victims

A chemistry professor at the University of Notre Dame is working on research intended to create a drug that could be given to a patient immediately after a traumatic brain injury to slow or reduce injury to the brain.  In December, Professor Mayland Chang received a $100,000 grant from NFL Charities (a charitable foundation of National Football League owners) to design and develop a drug for the treatment of TBIs.  When a brain suffers an injury, it causes biochemical changes that lead to tissue damage and the death of some brain cells.  Professor Chang and a colleague at the University of Missouri have been working on developing and defining inhibitors to block those chemical changes, potentially saving brain cells that otherwise would die.  They have found that some compounds will rescue as much as 60% of the brain that was destined to die.  Chang is currently testing a compound she developed on mice.  But human testing is still several years away. 

Friday, April 1, 2011

Opening Day for Colorado Rockies Brings New TBI Protocols

Major League Baseball and the Major League Baseball Players Association have adopted a new series of protocols under the new joint policy regarding concussions.

The biggest change is the creation of a seven-day disabled list (DL) which can be used instead of rushing a player back too soon after a possible concussion or placing him on the 15-day disabled list.  The seven-day disabled list will aim to allow time for the concussion to clear, prevent players from returning prematurely, and help clubs keep a full complement of players during the player’s absence.  If a player on the seven-day DL is out for more than 14 days, he will automatically and retroactively be transferred to the 15-day DL, effective with the first day of the initial placement, and with the prior 14 days applying to the initial 15-day maximum term.  This is implemented on a trial basis for the 2011 season.

Some of the other new key protocols include:

•Mandatory baseline neuropsychological testing requirements for players and umpires during Spring Training, or when a player joins a club during the season, formalizing a process that most individual Clubs follow;

•Protocols for evaluating players and umpires for a possible concussion, including during incidents typically associated with a high risk, such as being hit in the head a by a pitched, batted or thrown ball or by a bat; being in a collision with a player, umpire or fixed object; or any time when the head or neck of a player or an umpire is forcibly rotated; and

•Protocols for clearing a concussed player or umpire to return to activity; prior to the time that a concussed player is permitted to play in any game (including Major League, Minor League or extended Spring Training games), the Club must submit a “Return to Play” form to MLB’s Medical Director; submission of the form is required irrespective of whether the player was placed on the Disabled List.

A committee of experts created the policy, which will oversee the manner in which concussions are diagnosed initially and will be used to determine when players and umpires can return to the field following a concussion.  The Commissioner's Office will conduct an orientation for club medical staffs regarding the new protocols, and each club will be required to have a mild traumatic brain injury specialist in its home city.