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Med Students will Receive Training for Treatment of PTSD in Veterans

posted by SK Brain Injury    |   January 19, 2012 10:12

 Academic institutions are partnering with a military support initiative led by the Obama administration to improve care for post-traumatic stress disorder, depression and traumatic brain injury.

First lady Michelle Obama announced that 130 medical education programs have agreed to participate in a program ensuring that physicians are trained to recognize and treat combat PTSD and TBI. Obama spoke about the initiative Jan. 11 at Virginia Commonwealth University School of Medicine in Richmond, one of the participating schools.

"By directing some of our brightest minds, our most cutting-edge research and our finest teaching institutions toward our military families, they're ensuring that those who have served our country receive the first-rate care that they have earned," she said.

The effort is part of the administration's Joining Forces initiative, which coordinates support from different sectors of the economy for service members. Joining Forces Executive Director Brad Cooper said the majority of military personnel return from war without injury, but one in five soldiers are impacted by PTSD. A 2008 report by the Rand Corp. estimated that about 300,000 service members had developed PTSD or major depression stemming from deployments to Afghanistan or Iraq.

Many medical colleges offer training for treating PTSD, but most do not, Cooper said. Schools agreeing to join the Joining Forces program have pledged to ensure that future physicians are taught the clinical challenges of caring for veterans and other service members, many of whom are in their 20s and 30s and will need treatment over their lifetimes.

"The commitment is going to help train the nation's future physicians on military cultural issues, including PTSD and TBI as a focus," Cooper said. "They will also develop new research and clinical trials so that we can better understand and treat these conditions -- and share information and best practices through a robust collaborative forum that previously did not exist."

Participating schools will have access to websites that allow them to share educational resources, said John E. Prescott, MD, chief academic officer with the Assn. of American Medical Colleges. The initiative also will survey medical schools to understand the current scope of PTSD and TBI research and advances in clinical careThe American Medical Association applauded the Joining Forces initiative for its work, said AMA President-elect Jeremy A. Lazarus, MD. "By highlighting these issues to physicians, encouraging continuing medical education activities and working with Joining Forces initiative partners, the AMA is committed to ensuring that service members and their families receive the quality care they deserve."

Article from amednews.com

 

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Schools Need to Become Brain Injury Conscious

posted by SK Brain Injury    |   January 16, 2012 15:00

OUT OF concerns about brain damage, the National Football League and college teams are finally taking concussions seriously. But while this cautious new attitude is admirable, it can also create a false sense of security for parents of children itching to play football, hockey, or soccer. For if concussions are the cause of brain damage, the thinking goes, then youngsters have nothing to fear as long as they avoid concussions. That’s not true. There is reason to fear brain injuries from head traumas that don’t result in concussions.

That’s the logical conclusion from the latest evidence, admittedly incomplete, from the Boston University researchers who’ve done landmark work into sports-related brain injuries. But the research, outlined in last Sunday’s Globe by Derrick Z. Jackson, should be thoughtfully reviewed by any parent, coach, or administrator of a school-sports program.

The most chilling case is that of Owen Thomas, the popular captain of the University of Pennsylvania football team, who committed suicide at age 21. His brain, studied by the BU team, showed extensive evidence of chronic traumatic encephalopathy - the degenerative condition linked to behavioral changes, dementia, and premature death in former football and hockey players. The surprise wasn’t just that Thomas was so young; it was that he had never been diagnosed with a concussion. That suggests the disease came about because of repeated sub-concussive head impacts from playing football during his adolescence and young-adult years.

Thomas’s case, combined with other research, leads Robert Cantu, the co-director of the BU center, to recommend that children younger than 14 stay away from sports that involve repeated collisions, with potential hits to the head. That’s merely one person’s advice, not yet anything close to a scientific consensus. But it’s not too early to urge parents to think the risks through carefully. No one should simply assume that if a sport is sanctioned by a school, it’s risk-free for young kids to participate.

The most common sources of brain trauma in team sports are football, soccer, and hockey. Football trauma can be reduced by having less strenuous practices, with limits on hard hitting; the sudden force of two players colliding at a high speed can jostle the brain. School football leagues, like the pros, should strictly penalize helmet-to-helmet tackling and the “launching’’ of tacklers into other players. But even with these precautions, parents should be wary: Football is a violent sport, and young players and their parents should be fully aware of the risks.

In soccer, injuries can occur when players repeatedly head the ball. The game can be played effectively without heading, and that’s an obvious way to all but remove the threat of brain trauma. Soccer leagues may reasonably await more evidence before making a major change to their sport, but limiting use of the head in practice seems like a sensible precaution, even before all the evidence is in.

Hockey is the most vexing case, because some of the worst head traumas occur in fights that have nothing to do with the playing of the game. At the youth level, bans on fighting and rules on hard checking into the boards should be strictly enforced. Meanwhile, coaches would best serve their players’ long-term hockey aspirations by emphasizing skill over aggression.

There is much more to be learned about possible links between chronic traumatic encephalopathy and youth sports. Thankfully, BU is moving ahead with its ground-breaking research. But parents, kids, and especially those in charge of youth sports programs shouldn’t wait for all the data to be in before taking precautions.

Article found in the Boston Globe

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Stem Cell Implants May Help Treat Brain Injuries

posted by SK Brain Injury    |   January 16, 2012 12:31

Implanted stem cells have substantially improved cerebral function in animals with brain trauma, but how they did it has remained a mystery. Now an important part of this puzzle has been pieced together by researchers.

In experiments with both lab rats and an apparatus that enabled them to simulate the impact of trauma on human neurons (brain and nerve cells), researchers at the University of Texas Medical Branch at Galveston identified key mechanisms by which implanted human neural stem cells (developing into neurons) help recovery from traumatic axonal injury.

A significant component of traumatic brain injury, traumatic axonal injury involves damage to axons and dendrites, the filaments that extend out from the bodies of the neurons, the Journal of Neurotrauma reports.

The damage continues after the initial trauma, since the axons and dendrites respond to injury by withdrawing back to the bodies of the neurons, according to a Texas statement.

"Axons and dendrites are the basis of neuron-to-neuron communication, and when they are lost, neuron function is lost," said Ping Wu, professor at UTMBG, who led the study.

"In this study, we found that our stem cell transplantation both prevents further axonal injury and promotes axonal regrowth, through a number of previously unknown molecular mechanisms."

Article found on Daily News and Analysis

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U.S. First Lady, Michelle Obama, Announces Brain Injury Initiative

posted by SK Brain Injury    |   January 12, 2012 10:26

First lady Michelle Obama announced Wednesday a commitment by medical schools to increase training of doctors and research of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The agreement is in conjunction with "Joining Forces," Obama's and Dr. Jill Biden's organization that encourages society's support of military personnel and their families.

More than 100 medical schools from the American Association of Medical Colleges have committed to initiative as well as 25 schools from the American Association of Osteopathic Medicine. The announcement was made at Virginia Commonwealth University in Richmond, VA, where the medical school has been a national leader in TBI research, partnering with Hunter Holmes McGuire VA Medical Center Veterans Affairs Hospital.

"I'm inspired to see our nation's medical schools step up to address this pressing need for our veterans and military families," Obama said. "By directing some of our brightest minds, our most cutting-edge research, and our finest teaching institutions toward our military families, they're ensuring that those who have served our country receive the first-rate care that they have earned." 

"Studies show that as many as 1 in 6 veterans from Iraq and Afghanistan have reported symptoms of PTSD," Obama said. "Since the year 2000, more than 44,000 have suffered at least a moderate grade of TBI."

The Rand Corp. said in a report in 2008 that about 300,000 military service members who have returned from Iraq and Afghanistan report symptoms of post traumatic stress disorder or major depression. The report also states that only about half have sought treatment. The Department of Defense reports that 229,106 military personnel have been diagnosed with TBI since 2000.

"We all must remember in this country, the end of war marks a very long period of transition," Obama said.

Veterans and returning military personnel are asked to make sharp transitions home from combat zones, she said, and although most returning do not suffer from PTSD or TBI, the transition home is when issues and incidents bubble to the surface.

"If you are struggling, please don't be afraid to speak up. If you know someone else is struggling, encourage them to seek help. Asking for help is a sign of strength," Obama said. "It can help fight the stigma of PTSD and other mental health issues, not just for military but for all Americans."

Many military members do not seek treatment for mental and psychological illness because they worry it will harm their careers, the report from the Rand Corp. said. PTSD and depression among military personnel returning from service could cost the nation as much as $6.2 billion in the two years following deployment.

The first lady closed her remarks by encouraging the medical students, doctors, researchers in this new venture and reminding the military they will have support.

"And to all of the troops and veterans we have here, that no matter where you are, no matter what you're going through, please know that America will be there for you and your families," she said.

Article found at WNEM.com

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Gabrielle Giffords TBI Came at a Breakthrough in Brain Medicine

posted by SK Brain Injury    |   January 8, 2012 09:40

When U.S. Rep. Gabrielle Giffords was shot in the head one year ago today, many thought there was little chance she would survive, let alone open her eyes, walk or talk.

But the Arizona congresswoman, who will attend a vigil on Sunday in Tucson to remember the rampage that left six dead and wounded her and 12 others, had determination, abundant resources and, most importantly, a new era in brain medicine on her side.

"We're at an evolution today with traumatic brain injury, much like where doctors were with cancer and heart disease some 40, 50 years ago," said Dr. Geoff Manley, chief of neurotrauma at the University of California San Francisco School of Medicine. "We're just now learning that people like Giffords can not only be treated but can have meaningful recoveries."

Giffords benefited from aggressive approaches to surgery and therapy born out of wars in Iraq and Afghanistan. Military doctors found that soldiers formerly dismissed as the "expectant dead" could recover with the right treatment. That approach, unheard of less than two decades ago, played a key role in Giffords' treatment and recovery.

The world also benefited from Giffords' ordeal. The spotlight on her story brought a greater awareness to a number of areas - the importance of Level 1 trauma centers, the potential of brain trauma therapy, the grueling recovery process, the need for long-term treatment to be more available to most people and the call for more research to take the field out of its infancy.

Hundreds involved

Giffords, 41, can now walk - albeit with a significant limp. She also can talk in broken speech and understand everything said to her. She still has substantial weakness on the right side of her body, a product of being shot through the left side of her brain, but she continues to improve.

Whether she has a political future hinges on her progress.

Giffords' medical journey started in Tucson and continued in Houston and North Carolina. She moved faster than expected through a series of milestones made possible by teams of surgeons, nurses, rehabilitation therapists and other specialists and support staffs.

"You're talking hundreds of people," said Dr. Brent Masel, medical director at the Transitional Learning Center in Galveston and the national spokesman for the Brain Injury Association of America. "It's an enormous project. Repairing a life is an enormous project and it takes a while."

Months of therapy

The recovery process was long and intensive, beginning with emergency responders to the shooting and a Giffords aide who kept pressure on her head wound and held her upright to prevent choking, an act her staff credits with saving her life. She underwent multiple surgical procedures at University Medical Center in Tucson and at Memorial Hermann - The Texas Medical Center. Then she engaged in months of therapy, a process that likely would've been truncated for other patients because of their insurance companies, Masel said.

The materials used to treat and rehabilitate the congresswoman included drills and scalpels used in surgery; a computer-generated synthetic implant that replaced part of her skull; plastic piping, straps and pulleys that helped to increase strength in her weakened right side; and an adapted shopping cart that helped her relearn to walk.

It wasn't cheap. The tab for her therapy alone, which was paid for by her federal employee workers' compensation insurance, has totaled about $1.26 million since she began inpatient and then outpatient work, based on daily cost estimates from the Brain Injury Association of America.

Giffords has acknowledged that most people wouldn't be able to afford such treatment, and her staff has worked with Masel and others to draw more attention to the value of extended therapy for traumatic brain injuries, said her spokesman, Mark Kimble.

A good patient

It is largely a result of her exhaustive regimen of physical, occupational, speech and music therapies, along with her and her family's positive outlook, that has allowed her to progress more quickly than expected in her recovery, said Dr. Gerard Francisco, chief medical officer at TIRR Memorial Hermann, where Giffords has been participating in therapy since Jan. 26.

While Giffords could previously only communicate in short one- or two-word bursts, she is becoming better able to talk in full sentences, said Francisco. He said she has "good days and bad days."

'She's very fortunate'

Giffords is also able to initiate questions and converse, said Dr. Nancy Helm-Estabrooks, a speech specialist who, along with another therapist, worked with the congresswoman at no cost during a two-week intensive program in Asheville, N.C. There, Giffords engaged in a range of activities designed to challenge her to express ideas by speaking, drawing, gesturing and interacting with an iPad and laptop.

The exercises have supplemented her more than 11 months of therapy through TIRR Memorial Hermann to add to her progress, Helm-Estabrooks said.

"This underscores what we've been telling people - that brain injury recovery takes place over long periods of time and have to be supported by the appropriate rehab approach," Francisco said. "She's very fortunate that she has the resources."

Other techniques she gained from were a direct result of increased exposure to brain injuries during the age of improvised explosive devices in Iraq and Afghanistan. Dr. Peter Rhee, Giffords' lead trauma surgeon in Tucson who served as a military surgeon in those countries, led the procedure to remove part of Giffords' skull in the immediate aftermath of the shooting. The procedure, pioneered in the military, relieved pressure on Giffords' swelling brain that could have been fatal. It was among a series of more aggressive approaches to surgery and treatment that have been used with wounded troops and were implemented with the congresswoman. 

Manley acknowledged that treatment of traumatic brain injury still has a long way to go. Giffords has shown that recovery is possible, he noted, but now the field needs to build on the momentum - find better ways to diagnose patients and predict outcomes, produce more data on what works best and when, and pioneer even more cutting-edge treatments.

Tissue regeneration

Memorial Hermann doctors are conducting such cutting-edge research, specifically using stem cells. The research, a Department of Defense - funded trial about to enroll people who have suffered brain injuries, involves the injection of stem cells from the patients' bone marrow. Doctors hope those stem cells can regrow healthy tissue.

"Seeing patients like Gabby is really inspiring us to come up with new treatments - treatments that will return patients to normal, not just recover to a certain extent," said Dr. Dong Kim, Giffords' neurosurgeon at Memorial Hermann. "In the next 10 to 20 years, thanks to therapy that regenerates brain tissue, I think you'll see that."

Article found at chron.com

 

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Hormonal Dysfunction and Brain Injury

posted by SK Brain Injury    |   January 6, 2012 09:38

Over 7 years ago, Dr. Mark L. Gordon began his crusade promoting the relationship between head trauma and the progressive loss of life-promoting hormones. Dr. Gordon began lecturing to physicians at national and international medical conferences, presenting thousands of compelling studies about the causes and effects of traumatic brain injury on quality-of-life issues.       

Dr. Gordon, working with professional boxers, mixed martial artists, retired football players, motocross racers, and now veterans suffering with "Post-Traumatic Stress Disorder," has found the majority are suffering with one or more hormonal insufficiency or deficiencies noting that each had experienced at least a minimal traumatic brain injury (mTBI).

In 2006, after giving a lecture on mTBI, Dr. Gordon was approached by ESPN: Outside the Lines to provide the framework for a program looking at Sports and TBI. On January 21, 2007, Dr. Dan Kelly, a neurosurgeon and expert on TBI, and Dr. Mark Gordon provided the science and clinical aspects of hormonal dysfunction arising out of TBI.

A number of well-known sports celebrities, each with documented TBI and under Dr. Gordon's care, shared their experiences before and after hormone replenishment. 

Whether the trauma was mild, moderate, or severe it still altered the brain's ability to regulate the patient's hormones leading to increased risk of heart attack, stroke, emotional instability, drug and alcohol abuse, depression, anxiety, mood swings, memory loss, fatigue, confusion, amnesia, poor cognition, learning disabilities, decreased communication skills, poor healing, frequent infections, poor fracture healing, poor skin quality, increased body fat, decreased muscle strength and size, infertility, and loss of sex drive.

Also in 2007, Dr. Gordon's book The Clinical Application of Interventional Endocrinology was published, offering medical documentation to support the causes, clinical findings, laboratory testing, specific hormone replacement strategies, and the outcomes for Traumatic Brain Injury associated with hormonal dysfunction.

Recently, Dr. Gordon was featured on the cover of Life Extension Magazine (Jan. 2012) with an interview article on "Using Hormones to Heal Traumatic Brain Injury." In this piece, Dr. Gordon shares his views on how the medical community is presently addressing patients with TBI and presents one of many cases where a young man was being treated with three anti-depressants that did not control his depression. When he was found to be significantly deficient in one of the major hormones, replacement allowed him to be weaned off his traditional medication by his psychiatrist (within 6 months). Two years after the fact, he is living a quality of life that was previously unobtainable.   

This paradigm shift from treating hormonally deficient individuals experiencing both cognitive and behavioral problems with medications that mask the symptoms to a treatment protocol that focuses on replenishing the missing hormone(s) is starting to catch on. The relationship between behavior and hormones is indelibly connected, answering why many of the traditional medications fail.

As indicated in the Life Extension article, Dr. Mark L. Gordon has a grant from Access Medical Laboratories of Jupiter, Florida to provide free hormonal testing to veterans of the Gulf War and Law Enforcement. Again, the consultation and laboratory fees are at no cost to you or anyone for that matter.

Article found at sacbee.com


Read more here: http://www.sacbee.com/2012/01/03/4159326/traumatic-brain-injury-hormonal.html#storylink=cpy

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The Effects After a Brain Injury

posted by SK Brain Injury    |   January 2, 2012 12:00

The events that occur with major brain injuries and head trauma may be very similar to a rare but devastating ocean-related disaster. The initial trauma is the first insult to the brain, but what happens in the hours and days afterward may be even worse.

Neurological events called "brain tsunamis" occur several days after severe head trauma and may be responsible for inducing brain damage, according to a new study. Preventing these tsunamis or "killer waves" could help patients with severe head trauma avoid further brain damage and possibly retain most of their brain function.

The "brain tsunamis" are actually large population of brain cells that undergo massive depolarizations. Much like the weather-related tsunamis, these large waves of depolarizations spread slowly but persistently throughout the brain, causing widespread brain dysfunction.

These wave-like depolarizations have been studied in brain trauma patients for decades. But the new research showed for the first time that brain tsunamis are responsible for causing further brain damage in afflicted patients. The brain tsunamis drew the attention of the U.S. military as head injuries became a very common injury among veterans of the Iraq and Afghanistan wars.

The study is a collaboration between Kings College Hospital in London and the University of Cincinnati School of Medicine in Ohio. The researchers followed 103 people across seven different centers worldwide who underwent neurosurgery following major head trauma. Fifty-eight of those patients experienced the "brain tsunami" event, leading to a spread of cell depolarizations within the cortex.

The researchers measured the extent of the depolarizations by placing a linear strip of electrodes on the surface of the brain as the patient underwent neurosurgery. The patients were then followed for the duration of their post-operative care, to see whether the outcome of the neurosurgery was favorable.

The investigators hope that their results may alter the long-term treatment of brain trauma patients in a way that could possibly lead to better outcomes. Previous studies have identified other ways to improve outcomes in humans with brain injury.

In this case, the researchers hope that the spreading cortical depolarizations could somehow be stopped before they start in trauma patients undergoing surgery. So far, however, the investigators have not speculated how that could be achieved.

"Our ability to monitor and understand what happens in the brain after a severe injury hasn't advanced significantly in decades. The brain is like a black box, but the process of spreading depolarizations now gives us a window into that box," said principal investigator, Jed Hartings, of the University of Cincinnati College of Medicine.

The study was published in the journal Lancet Neurology.

This article found at www.theatlantic.com

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Head Protection in Winter Sports

posted by SK Brain Injury    |   January 2, 2012 09:43

As my family prepares to hit the slopes this ski season, one of the foremost safety issues on my mind is proper head protection.

My kids were chuckling recently as I rooted through garage boxes fishing out ski helmets and helping them try them on for a fit check. I’ll admit, I’m something of a safety geek, but when it comes to prevention of head injuries, there are some things we should all practice.

According to the U.S. Centers for Disease Control and Prevention, traumatic brain injury accounts for a significant percentage of sports-and-recreation- related injury.

The majority of such injuries happen to children younger than 18. Moreover in the last decade, traumatic brain injury-related emergency room visits have increased 57 percent.

While many factors may account for this apparent increase in head injuries, it is clear that children are at substantial risk from a common and preventable health condition.

Winter sports often involve speed and ice – two factors associated with trauma. Head injuries may result from skiing, sledding, tubing, skating, snowboarding or hockey.

The most important safety measure to reduce the risk of traumatic brain injury is use of a protective helmet. Helmets worn should be approved for the activity and properly fitted.

The helmet should be well-maintained, consistently worn during the sport or recreational activity and properly worn. It is wise to ensure a good fit each season to account for a child’s growth. Chin straps should always remain fastened during the activity and should promote a snug fit.

Even helmet use does not provide absolute protection from head injury. Further preventive measures need to be taken including enforcement of a no-head-hit policy in competitive activities and the practice of safe recreational and sports-related techniques and behaviors to minimize the risk of injury.

During activities such as skiing or snowboarding, it is important to stay in control and keep an eye out for others to avoid collision. Keeping a safe distance from others on the slopes, as well as from obstacles such as trees, especially in narrow conditions, will enhance safety.

Traumatic brain injury is more commonly known as concussion. Because many recreational winter activities involve the risk of concussion, the CDC recommends that parents and coaches become familiar with a simple four-step action plan to follow if a head injury occurs.

After a bump or blow to the head, the child should stop the sport or activity. Next, after the head injury, the child should undergo evaluation by a trained health-care professional.

The third step for coaches is to inform the parent or child care-giver that a head injury has occurred so that the child may be properly monitored. Lastly, the child should not resume the sport or activity until he is symptom-free and cleared by the health professional.

Taking simple preventive measures for head trauma and appropriate precautions when it occurs will minimize the risk of adverse consequences from this common form of injury.

Article from The Durango Herald

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Helping Soldiers with Brain Injuries

posted by SK Brain Injury    |   December 30, 2011 19:00

Three NATO troops were killed by a roadside bomb in Afghanistan Wednesday. That kind of attack has caused nearly 40 percent of fatalities in Afghanistan and Iraq. It often causes the what's considered the "signature wound" of these wars: brain injuries. CBS News correspondent Clarissa Ward in Afghanistan says the military is taking a new approach.

Getting treated by Capt. Amy Gray can entail playing with dogs, watching movies, even getting massages.

An occupational therapist, Gray heads the concussion care center at Forward Operating Base Fenty where a simple technique is making the world of difference in treating soldiers with mild traumatic brain injury, known as brain sprain.

"I tell them, 'Your mission when you are with me is to sleep, relax and get better,'" she said.

Specialist Nick McKee was inside his base when an insurgent rocket exploded less than 20 feet away from him. He escaped without a scratch but quickly knew something was not right.

"I felt nauseous all that day and pretty much had headaches ever since," he said. "Trouble sleeping mainly. Trying to go on like it didn't happen -- that was probably the hardest part."

Despite incredible developments with blast-resistant vehicles, traumatic brain injury is still the most common injury on the battlefield. In the last 10 years, more than 320,000 servicemen and women have been diagnosed.

Up until recently, mild concussions often went untreated. If soldiers weren't visibly wounded, they kept on fighting, sometimes resulting in serious long-term health issues.

Now the military is rethinking its approach.

"What we found is that if we get them in the first 24 hours, get them down, get them a good night's sleep, their symptoms go away," said Gray.

More than 200 soldiers have passed through here since Gray arrived in May. Almost all have returned to duty within a week.

"I'm sleeping and eating and pretty much just anxious to get out to my guys," said McKee.

Gray: "I go from becoming Capt.Gray to mom and they will literally call me 'mom.'"

Part officer, part mother: Capt. Gray is wholly committed to treating her soldiers.

Article and related video found at cbsnews.com

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Link Between Brain Injury and Violence

posted by SK Brain Injury    |   December 30, 2011 13:30

Individuals who've had a severe traumatic brain injury are at subsequent risk for violent behavior, but the same association was not seen for patients with epilepsy, Swedish researchers found.

Compared with the general population, adults with traumatic brain injury had an adjusted odds ratio for a later conviction for a violent offense of 3.3 (95% CI 3.1 to 3.5), which was a 5.8% absolute increase in risk, according to Seena Fazel, MD, of Oxford University in Oxford, England, and the Karolinska Institute in Stockholm, and colleagues.

Patients with epilepsy, in contrast, had an odds ratio for violence of 1.5 (95% CI 1.4 to 1.7) after adjusting for age, sex, and sociodemographic factors, but this increase was no longer present after adjusting for familial confounding (OR 1.1, 95% CI 0.9 to 1.2), the researchers reported online in PLoS Medicine.

While evidence has linked serious mental illness with violent behavior, it has been less clear whether neurologic disorders do so, despite the common, long-held belief that epilepsy increases risk for violence.

To explore these potential associations, the researchers analyzed longitudinal data from several Swedish population-based registries, identifying 22,947 patients with epilepsy and 22,914 individuals who had experienced a severe traumatic brain injury over a 35-year period.

Each case was matched with ten matched population controls.

Among those with traumatic brain injury, 71.1% were male and mean age at the time of the injury was 24.8 years. For those with epilepsy, 52.1% were male and mean age at diagnosis was 19.8 years.

A total of 8.8% of patients who had had a serious traumatic brain injury later were convicted of a violent crime, as were 4.2% of those with epilepsy.

The odds ratios for violence were attenuated in both groups with adjustment for substance abuse, to 1.2 (95% CI 1.1 to 1.3) in those with epilepsy and to 2.3 (95% CI 2.2 to 2.5) in those with traumatic brain injury.

Further analyses determined that patients whose onset of epilepsy occurred before age 16 were significantly less likely to exhibit later violent behavior (χ2 = 52.1, P<0.001), as were those whose seizures resulted in unconsciousness (χ2 = 12.9, P=0.005).

"The finding that certain subtypes of epilepsy (including simple partial seizures and temporal lobe epilepsy) are associated with higher rates of violent crime may assist in clarifying mechanisms and potential treatments, and suggests that these patients could be assessed for violence risk if these findings on subtypes are validated," the researchers wrote.

For the traumatic brain injury group, diagnosis before age 16 again was associated with a lower risk of violence (χ2 = 35.7, P<0.001), as was having a concussion only rather than more severe brain injury (χ2 = 21.9, P<0.001).

However, individuals whose brain injuries were focal had higher risk compared with those having hemorrhagic injuries or cerebral edema (χ2 = 6.4, P=0.04).

The researchers controlled for potential familial confounding by comparing the risk for cases and unaffected siblings. For the traumatic brain injury group, the odds ratio remained doubled after this adjustment (OR 2, 95% CI 1.8 to 2.3).

"As these siblings shared half the genes and most of the early environment, this allowed us to partly account for personality traits that are associated with both violence and head injury or epilepsy," Fazel and colleagues explained. These traits could include risk taking and impulsivity, they noted.

Further research will be needed to more fully explain the protective effects of younger age and the influence of repetitive, less severe brain injuries on later violent crime.

There also may need to be a revision to current recommendations regarding patient assessment after head injury to include evaluation for violence risk, according to the researchers.

Limitations of the study included its use of patient registries, which may have resulted in either underestimation or overestimation of risk.

Risks in patients with epilepsy also may have been influenced by treatment with anticonvulsants, which can have mood-stabilizing properties.

Article found at www.medpagetoday.com

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