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Hope for Brain Injuries

posted by SK Brain Injury    |   December 7, 2011 09:00

 

Neuroscientist Adrian Owen explains how the system works

A method of communicating with brain damaged patients who appear to be in a vegetative state has been discovered by scientists in the UK and Belgium.

Writing in The Lancet medical journal they describe how they measured electrical activity in the brain to detect consciousness.

The technique, known as EEG, is painless and involves attaching electrodes to the head.

Doctors hope it can be used as a diagnostic tool in homes and hospitals.

The trial involved 16 patients at Addenbrooke's Hospital in Cambridge and the University Hospital of Liege in Belgium.

All had been diagnosed as being in a vegetative state - a condition where a person is awake, but has no sense of awareness of themselves or their surroundings.

The patients were asked to imagine wiggling their toes or squeezing their right hand. The brain activity of three of the 16 patients showed they were repeatedly able to follow commands.

Roy Hayim was not brain injured but describes what it was like being paralysed and unable to communicate

The report author, Professor Adrian Owen, from the Centre for Brain and Mind, University of Western Ontario, Canada said: "Many areas of the brain that activate when you perform a movement also activate when you imagine doing it.

"We know these three patients were conscious as they were able to respond repeatedly to the instructions we had given them. One of the patients was able to do it more than 100 times."

'Wrong' diagnosis

Professor Owen's team at the MRC Cognition and Brain Sciences Unit in Cambridge previously showed that it was possible to communicate with some vegetative patients using functional magnetic resonance imaging (fMRI).

But many brain injured patients cannot be assessed in these scanners because they have metal plates or pins, or they are unable to remain still.

The EEG device is comparatively cheap and portable. Professor Owen said: "This is exciting because it means we can get out into the community, take it to patients in nursing and care homes, and assess many more patients at the bedside to see if we can detect covert awareness."

Helen Gill-Thwaites, a consultant in the diagnosis of low awareness states at the Royal Hospital for Neuro-disability (RHN) in Putney said: "For a small proportion of patients EEG could be a very useful tool in the diagnostic process.

"It would however be a useful addition and not a replacement, to current methods of assessing severely brain-injured patients.

"Sadly, in my work outside of the RHN I meet many patients who have never had a proper assessment and have been wrongly diagnosed as being in a vegetative state."

Paul Matthews, Professor of Clinical Neurosciences, Department of Medicine, Imperial College, London said: "The approach suggests a simple, practical way in which some of these patients might be helped to communicate.

"This innovative work has taken fundamental brain science right to the bedside. Efforts to further evaluate this and related approach in the clinic should be prioritised."

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Probiotics Help in Treatment of Brain Injuries

posted by SK Brain Injury    |   December 6, 2011 18:00

Probiotics, added to nutrients supplied through a feeding tube to a patient with a traumatic brain injury, may improve outcomes, Chinese researchers suggest.

Professor Jing-Ci Zhu -- study leader from the Third Military Medical University School of Nursing and colleagues at the North Sichuan Medical College and Hospital in China -- said traumatic brain injury is associated with a profound suppression of a patient's ability to fight infection. Probiotics, found in yogurt and supplements, are live microorganisms thought to be beneficial to the host organism.

Patients often suffer hyper-inflammation due to the brain releasing glucocorticoids in response to the injury, the researchers said.

Suppression of the immune system can be measured by an alteration of helper T-cells (Th) from Th1 -- which stimulate action of macrophages to fight infection -- to Th2. Th2 cells recruit B-cells, which in turn are involved in antibody production.

The switch from Th1 to Th2 leaves patients vulnerable to infections including ventilator-associated pneumonia and sepsis, the researchers said.

In a small scale trial, 52 patients who had suffered traumatic brain injuries and who were being treated in the intensive care unit were either treated as usual or had their nutrition supplemented with probiotics.

The study, published in the journal Critical Care, found those who received the probiotics had increased interferon levels and a reduced number of infections, and spent less time in intensive care.

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Brain Injury Depicted in new Movie "The Descendants"

posted by SK Brain Injury    |   December 6, 2011 15:00

The premise

Elizabeth King (Patricia Hastie) is in a water skiiing accident off Waikiki Beach. She suffers severe head trauma, falls into a deep coma and is maintained on life support for more than three weeks. Her husband, Hawaiian land baron Matthew King (George Clooney), must now assume full care of their two daughters while coping with the news that his wife had been having an affair and was preparing to leave him. Elizabeth's physician, Dr. Johnston (Milt Kogan), soon tells Matt that there is no hope of recovery. His wife has no measurable upper or lower brain function: She has no eye movements and no brainstem reflexes and her pupils don't respond to light. The doctor tells Matt that he has no legal choice but to follow her living will, which indicates that no extraordinary measures be performed if her condition is terminal. After bringing Elizabeth's family and friends together to say their goodbyes, Matt has the breathing tube removed, and over the next few days Elizabeth nears death.

Medical questions

How can a spouse continue to function and deal with family responsibilities when faced with loss and betrayal at the same time? Is it believable that a patient with severe head trauma resulting in no measurable brain function could continue to breathe on her own for days after the respirator is removed? Could such a patient ever recover? Is a spouse compelled to follow a living will in such a situation?

The reality

"People do what they have to do to survive," says Dr. Timothy Quill, palliative care expert and professor of medicine and psychiatry at the University of Rochester School of Medicine. It is believable that Matt would keep going for his children and for himself, as the movie shows, Quill adds.

Decision-making is difficult under emotional duress in this setting, says Dr. Bruce H. Dobkin, professor of neurology and director of the neurologic rehabilitation and research program at UCLA, but at least one family member usually rises to the occasion to be able to focus on weighing choices. The initial shock of the situation may keep people from fully grieving, and the parade of obligations and responsibilities may actually divert them from their deep emotions until weeks after a person has died.

It is believable that a patient like Elizabeth could continue to breathe on her own, says Dr. Thomas Carmichael, professor of neurology and vice chairman for research in the department of neurology at UCLA. Although loss of consciousness and brainstem reflexes indicate severe and diffuse damage to higher and lower brain centers, some spontaneous breathing can still occur for hours or even days after the ventilator is disconnected. The reason that patients like Elizabeth may keep breathing without ventilator support is due to the fact that the breathing centers are still partly functioning, Carmichael says.

A CT or MRI scan showing the extent of bleeding and brain damage would help predict the chances of any recovery, Dobkin says. But If there is loss of consciousness and no brainstem reflexes after an acute brain injury, meaningful functional recovery is not possible.

When essential brain centers are this badly damaged, Carmichael says, the condition is far worse than even a vegetative state in which upper brain centers are severely damaged but lower centers, including brainstem reflexes, are preserved enough for survival.

A spouse is generally required to follow the content and spirit of the living will, Quill says, especially when the living will is clear on what to do.

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"Heading" in Soccer Linked to Brain Injury

posted by SK Brain Injury    |   December 6, 2011 09:00

It may come as no surprise to many but scientists have found that repeatedly hitting a fast moving hard ball with your head – known as ‘heading’ in soccer – can damage the brain.

Using brain imaging techniques Israeli researchers found that 38 men who played soccer and said that they frequently ‘headed’ the ball had brain injuries similar to those seen in people with concussion, otherwise known as ‘mild traumatic brain injury’.

Soccer is one of the most popular games in the world and is often the preferred sport for primary school aged children as it is meant to be a ‘non-contact sport’ and therefore less likely to cause injury.

But the study authors, presenting their findings at the annual meeting of the Radiological Society of North America (RSNA) in Chicago, said that in adult recreational games the ball can travel at speeds of more than 50 kms an hour. In professional matches is can reach speeds of more than 125 km/hour.

The researchers said that it was repetitive headings were the problem, and that it was players who played a lot were at highest risk.

They established a threshold of 1000-1500 headings a year as the point where injury was most likely to occur.

"While heading a ball 1,000 or 1,500 times a year may seem high to those who don't participate in the sport, it only amounts to a few times a day for a regular player," observed radiologist and lead author Michael Lipton.

"Heading a soccer ball is not an impact of a magnitude that will lacerate nerve fibres in the brain," said Dr. Lipton. "But repetitive heading may set off a cascade of responses that can lead to degeneration of brain cells."

The researchers identified five areas, in the frontal lobe (behind the forehead) and in the temporo-occipital region (the bottom-rear areas) of the brain that were affected by frequent heading. Those areas are responsible for attention, memory, executive functioning and higher-order visual functions.

In a related study, Dr. Lipton and colleagues gave the same 38 amateur soccer players tests designed to assess their neuropsychological function. Players with the highest annual heading frequency performed worse on tests of verbal memory and psychomotor speed (activities that require mind-body coordination, like throwing a ball) relative to their peers.

"These two studies present compelling evidence that brain injury and cognitive impairment can result from heading a soccer ball with high frequency," Dr. Lipton said. "These are findings that should be taken into consideration in planning future research to develop approaches to protect soccer players."

Dr Litpon said the impact of heading in children was also on his agenda for study.

While heading is an essential part of the game, Dr Lipton hopes his team’s findings will be used to create safe guidelines for play in the future.

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Brain Injury - A Ticking Time Bomb

posted by SK Brain Injury    |   November 26, 2011 13:40

It was sad to read about the death of a fellow Zimbabwean, Mbongeni Ndlovu, 28, who died in Oldham, UK. He died from severe head injuries following an alleged assault.

He was taken by ambulance to the Royal Oldham Hospital but police say he refused to co-operate, with suggestions that he may have discharged himself.

The most important question from this tragic story is whether or not there were missed opportunities to save him? His death caused imponderable grief to his family and friends. It also touched the hearts of many people who did not know him before.

Head injury is a ticking time bomb. The main danger of a head injury is bleeding and brain swelling. The earlier the patient is treated, the better the prognosis. Therefore, it is important to recognise the sinister symptoms that could suggest a severe head injury which needs investigations such as head scanning (head CT scan). These include a period of loss of consciousness, drowsiness, worsening headaches, confusion, strange behaviour, speech problems, vomiting particularly in the morning, dizziness,  loss of balance, weakness of an arm or leg, blurring of vision, seeing double, blood oozing from the ear, clear fluid leaking from an ear or nose, deafness and breathing problems.

In view of the fact that the symptoms of a severe head injury may not develop straight away, the victim of a head injury should have someone with them for at least the first 48 hours after the event. Often, assault charges are changed to murder when the assault did not appear to have caused grievous harm at the time of report, then resulted in death from a head injury days to weeks later. Hospitals do not usually discharge someone without some advice and some patients are kept in hospital if there is no one at home to monitor them.

It is advisable not to take alcohol and drugs that cause drowsiness, for example sleeping tablets and strong pain killers. These could confuse the picture.

There are many cases where a victim had contact with either the police or hospital prior to succumbing to a head injury. This appears to be the case with Mbongeni Ndlovu.

In some cases, the sinister symptoms of a severe head injury may not be present at the time of contact, but the mode of injury should arouse suspicion. Lack of co-operation by a victim is frustrating to law enforcement officers, however this could be the only significant symptom suggestive of a severe head injury. When the victim has alcohol on board, their lack of co-operation, violence, confusion, unsteadiness and slurred speech may be attributed to alcohol, only for the victim to be found dead at home or in a prison cell.

In UK, there are reports of a small number of cases (6% of all the deaths in police custody) where the actions of the police were directly attributable to the detainee’s death. Unfortunately, the statistics for head injuries in police custody in Zimbabwe could not be obtained. This is a controversial subject and the police are often accused of brutality, impetuous behaviour, racism and cover-ups.

In some of the cases, the presence of either drugs or alcohol may have played a part by increasing the person’s readiness to resist arrest and reducing their susceptibility to pain. After the hullabaloo and trauma of an arrest, the police should have a duty of care to their detainee and refer him for an assessment by a doctor if a head injury is suspected.

A knock on the head is common and usually there is nothing to worry about. The most common causes of severe head injuries are road traffic accidents, falls and assault. Although head injuries are common, death from head injury is low. Very few patients with head injuries (1-2%) require admission to hospital. Only a minority of patients, about 0.2% of all patients attending accident and emergency departments, with a head injury will die as a result.

The majority of all people who sustain a head injury are male and assaults account for a significant number of those who sustain a head injury (30-50%) and alcohol is involved in a significant number of cases.

If you sustain a head injury and you develop some of the symptoms I have described above, you need to be seen by a doctor urgently.  Your health is your priority, so take care of yourself.

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Study Suggests, Pine Tree Extract Helpful in Treating Brain Injury Survivors

posted by SK Brain Injury    |   November 22, 2011 15:26

A new study has suggested that using pine tree extract can help facilitate healing in traumatic brain injury (TBI) patients.
Researchers at Auckland University of Technology (AUT) are examining the use of supplements developed from New Zealand pine tree bark. The belief is this extract can possibly aid in improving the cognitive difficulties that often emerge after an individual sustains a TBI.Professor Valery Feigin, Director of AUT’s National Institute for Stroke and Applied Neuroscience, is leading the team of researchers looking at the effects of Enzogenol, which is a Pinus Radiata bark extract, on a group of individuals who sustained a mild traumatic brain injury (mTBI). Enzogenol is the brand name given to the supplements.According to a press release issued today, Fagin said,
“Every day, 90 New Zealanders sustain a brain injury, ranging from mild to severe. Acquired brain injury - including stroke and traumatic brain injury - is the leading cause of disability and death in this country costing our health system an estimated $100 million per year.“Many supplements claim health benefits, however this research is one of very few evidence-based treatments. Until now, there has been a lack of effective medication for mild TBI. Other than brain exercises, there are limited treatments available to improve damage as a result of TBI.”
According to the U.S. Centers for Disease Control and Prevention (CDC), cognitive issues can emerge in the form of concentration problems, attention difficulties, memory problems and/or orientation problems.Cognitive difficulties are not uncommon after suffering a TBI, whether it be a mild, moderate or severe injury. TBI patients often go through cognitive therapy, sometimes for years, after sustaining a brain injury.For the pilot study, researchers tracked 60 individuals who were experiencing cognitive difficulties, for either a six or 12 week period of time. The goal was to investigate the effectiveness of Enzogenol to see if it made any difference in cognitive deficiencies three to 12 months post-injury.Preliminary results suggest an improvement in daily cognitive functioning.Senior Research Fellow Dr Alice Theadom said in the press release,
“The pilot trial has revealed some promising findings for use of the Enzogenol supplement to improve everyday cognitive failures. We’ll now be looking at conducting a full scale clinical trial to determine the effectiveness.”
In New Zealand "brain injuries caused by stroke, motor vehicle crashes, sports injuries, assaults and falls are the leading cause of disability and death." Brain injuries costs about $NZ100 million ($76.07 million) a year, according to the Herald Sun. In the U.S. an estimated 1.7 million people sustain a TBI annually, of which 52,000 die, 275,000 are hospitalized and 80 percent are treated and released from hospital emergency rooms. These figures do not include those who have not sought treatment, or are unaware they have suffered a TBI, as is often the case with concussions and mild head injuries.The results of this pilot study were given at New Zealand's first national conference on stroke and applied neuroscience. The primary researchers hope to conduct a full scale study to determine the effectiveness of using pine tree bark in connection with TBI treatments.


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Understanding Brain Injury in Soldiers

posted by SK Brain Injury    |   November 20, 2011 16:17

When the dust settled, two soldiers were strewn along the Kandahar City street, a diplomat was dead and Pte. William Salikin was trapped inside what remained of the crumpled military jeep.

It was 1:25 p.m. on Jan. 15, 2006. The driver of a bomb-laden Toyota van that zipped out from a tangle of taxis took the life of diplomat Glynn Berry, the legs of Master Cpl. Paul Franklin and left Cpl. Jeffrey Bailey face down in a sewage ditch. His severe head injuries would leave him in a medically induced coma for two months.

Salikin, who was 22, had several broken bones, burns and spinal cord injuries. But it was the damage from having his head thrown against the rear window of the Mercedes G-Wagon that heralded his entry into the ranks of those injured soldiers who have most confounded the Canadian Forces, those with mild traumatic brain injury.

Invisible to the human eye, it is hauntingly real to those who have been targeted by improvised explosive devices, pounded by rocket-propelled grenades and shunted violently around the Afghan battlefield.

The rise of the roadside bomb as the signature weapon of the decade-long war, coupled with the advances in protective equipment, means more soldiers have survived the staggering blasts.

Their brains are another story. They’ve suffered indignities that doctors are only beginning to understand.

This much is known: mild traumatic brain injury, or concussions, can steal sleep, memory, physical abilities and the moods of the fighting fit. Its symptoms are frighteningly similar to post-traumatic stress disorder and doctors fret about whether one causes the other.

Salikin’s head injury wiped his memory of the blast, slurred his speech and left him with anger issues that have taken him almost six years to recover from.

“That blast is simultaneously the scariest thing that’s happened to somebody, and at the same time it’s a physical insult, like a baseball bat hitting you hard,” said Rakesh Jetly, the Canadian Forces’ chief psychiatrist.

It’s also stealing the careers of hundreds of those who signed up to serve their country.

In stark contrast to the United States military, the Canadian Forces has never said how many of its soldiers have been diagnosed with brain injuries.

Whether it doesn’t know or simply refuses to make the figures public is unclear.

The military’s line is that concussions affect 6.4 per cent of soldiers who’ve been to Afghanistan. It’s much lower than the 12 to 20 per cent of American soldiers estimated to have suffered brain injuries and — whether higher or lower — it’s likely inaccurate.

That’s because the figure originates with a survey of 1,817 soldiers from 2009, just 4.7 per cent of all Canadians who have fought in the country since 2001.

That study attributed the lower statistics to the Canadian military’s shorter, six-month rotations overseas, though more recent studies have suggested a free-for-all public health-care system like Canada and the United Kingdom may provide less incentive to seek immediate care, compared to America’s more onerous private system.

In short, according to the theory, U.S. military personnel know they have a limited-time offer for state-of-the art care paid for by their government.

There are only 278 Canadian soldiers since May 2004 who have ended up on the disability payroll at Veterans Affairs Canada, according to statistics provided to the Star.

But brain injury experts say the problem is likely under-reported, even in cases where soldiers have suffered multiple concussions — a likely scenario for the more than 10,000 front-line personnel who have served two or more tours in Afghanistan.

Based on the volume of cases that Dr. Shawn Mitchell sees in the clinics he runs at the Ottawa Rehabilitation Centre — the closest such facility to CFB Petawawa — he thinks soldiers may try to overcome or live with their symptoms rather than seek help.

“First of all, there’s a culture of denying it, just like in sport, because they want to go back,” he said.

That could spawn a serious public-health problem among veterans.

“If it’s not being picked up, these people deteriorate. They get worse. The other problem is that if it gets missed and gets labelled, they’ll become disabled.”

That hits a sensitive spot with the military. Officials started screening for concussions in 2009, capturing only those cases that emerged in the last two years of the war.

 

Since then, the Americans have dubbed traumatic brain injury the signature wound of the campaigns in Iraq and Afghanistan, they’ve set up specialized brain injury recovery clinics at Kandahar and on other bases overseas, and the NATO allies have launched an intensive three-year study into the problem that will wrap up in 2013. It’s being led by Dr. Bryan Garber, a Canadian.

“That’s huge, the level of respect that Canada has within NATO on these issues,” Jetly said.

Despite the activity, little is known about the causes, symptoms and treatments for traumatic brain injury.

“I think we’ve added structure to something that was maybe not as structured,” said Lt.-Col. Markus Bessemann, the military’s head of rehabilitation medicine. “I don’t know that there have been any major breakthroughs either in diagnoses or treatment.”

For now, the military is trying to treat the symptoms it sees in the hopes the science will catch up.

Sleep,says Jetly, is the “cardinal problem” for soldiers who have post-traumatic stress disorder and for depressed personnel, as well as those with mild traumatic brain injury. But medical researchers haven’t come up with the “magic bullet” telling doctors how to identify which symptoms go with which ailment.

“We can chase forever trying to find out why, or we can work on it,” Jetly says. “The key ends up being that when you look at these people who make these sacrifices for their country, the ethical thing for us to do is to look at them very carefully afterward and, if things have changed for the worse, aggressively look at them and do what you can to help.”

In the case of Salikin, now a corporal, that help has taken six years to return him to where he was on the morning of Jan. 15, 2006. After being threatened with a medical discharge from the military, he was last year awarded the Sacrifice Medal, an honour reserved for soldiers wounded in battle.

The agonizing hours of physiotherapy and frustration are almost behind him, just like the Canadian combat mission in which he was injured. Now he is moving back to CFB Edmonton and preparing to rejoin his fellow soldiers with the Third Batallion of the Princess Patricia’s Light Infantry.

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An Injured Alcoholic Brain

posted by SK Brain Injury    |   November 20, 2011 16:02

Alcoholic brains work harder to accomplish even simple tasks as compared to their sober counterparts, a new study has found.

Chronic drinking is associated with abnormalities in the structure, metabolism and function of the brain, and one of the consequences of these deficits is impairment of motor functioning.

Researchers from Vanderbilt University, using functional magnetic resonance imaging (fMRI) during a finger-tapping exercise, found that the frontal lobe and cerebellum activities were less integrated in alcoholic individuals.

“The relationship was weaker in alcoholic people, even a week after they had stopped drinking,” Baxter Rogers, the lead author said.

Rogers and his colleagues used fMRI to examine 10 uncomplicated chronic alcoholic patients after five to seven days of abstinence and once signs of withdrawal were no longer present, as well as 10 matched healthy controls.

Finger tapping recruits portions of both the cerebellum and frontal cortex, Rogers said, and previous research strongly suggested that both are affected in alcoholism, especially the cerebellum.

“We used fMRI because it measures the function of the entire brain painlessly and non-invasively.

“And it can identify specific brain regions that are involved in tasks, and that are affected in disease,” he said.

The researchers found that alcoholic patients could produce the same number of finger taps per minute as did the normal controls, but employed different parts of the brain to do it.

“This suggests that alcoholics needed to compensate for their brain injury.

“They may need to expend more effort, or at least a different brain response, to produce a normal outcome on simple tasks because they are unable to utilize the brain regions needed in an integrated fashion,” he added.

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100 Former NFL Players Contribute to Neurology Study

posted by SK Brain Injury    |   November 19, 2011 12:07

It is widely known that football players suffer a range of injuries on the field. Recently, brain damage has become the highlighted injury because it builds up over time and its effects are commonly observed years after retirement from the game.

Now, researchers are working with former NFL players, studying their brains to develop methods for better diagnosis of brain function and damage. Currently, the Chronic Traumatic Encephalopathy is working with more than 70 donated brains from athletes who have died, and they hope to enroll living retired players to learn more about the development of later in life conditions. 

For their study, researchers are interested in NFL players who have played on the field and in position with significant contact, indicating higher potential for repeated brain trauma. In general, long football careers ensure an extensive history of injury to the head. However, recorded multiple concussions are not a requirement for the study because in some situations, players do not know when they had a concussion, and brain damage can occur from repeated blows to the head. The brain function and structure of former NFL players are being compared with non-contact sport athletes, such as retired swimmers and tennis players.
 
This brain research is not only helping former player receive treatment, but the results from the study will have major effects on future players. With a documented link between brain damage and the sport, more safeguards and regulations may be put in place to protect the players and reduce injury.In addition, the researchers are interested in learning about the genetics behind Chronic Traumatic Encephalopathy(CTE). It is still unknown why some athletes who receive repeated head blows develop CTE, while others do not develop this condition.
  
The funding grant is also supported by the National Institute of Neurologic Diseases and Stroke, the National Institute on Aging, and the National Institute of Child Health and Human Development. This team of researchers spans over 20 co-investigators, including researchers at Harvard University, University of Pennsylvania and Columbia University.
  
 

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Studies Show a Higher Risk of Brain Injury in Preemies

posted by SK Brain Injury    |   November 19, 2011 12:02

Scientists say they are beginning to understand why brain injuries are so common in very premature infants — and they are coming up with strategies to prevent or repair these injuries.

The advances could eventually help reduce the number of premature babies who develop cerebral palsy, epilepsy or behavioral disorders such as ADHD, researchers told the Society for Neuroscience meeting in Washington, D.C., this week.

Each year more than 60,000 babies are born weighing less than 3.3 pounds. And because of advances in neonatal medicine over the past several decades, most of those babies will survive. But researchers have had less success finding ways to prevent brain damage in these infants.

"That means that overall rates of cerebral palsy and other neurodevelopmental disabilities are on the rise," says David Rowitch, chief of neonatology at the University of California, San Francisco.

The most common cause of brain injury in premature infants is a lack of oxygen in the days and weeks after birth, Rowitch says. The lack of oxygen damages white matter, which provides the "communication highways" that carry messages around the brain and to distant parts of the body, he says.

 

And the babies at greatest risk of this sort of brain damage are those born after as little as six months of gestation, Rowitch says.

"Such a baby would weigh about a pound and would fit into the palm of your hand," he says. "As you can imagine, they're very fragile and vulnerable to stresses."

Those stresses often include periods when an infant's immature lungs are not delivering enough oxygen to the brain, even with help from a mechanical breathing device.

This lack of oxygen appears to damage the most common type of white matter, myelin, which acts like an insulator around the nerve fibers that carry messages in the brain and nervous system. Without enough myelin, short circuits can prevent these messages from getting through, Rowitch says.

He initially found evidence of white matter damage by studying brains from premature infants who died. But since then, he's been able to assess premature infants using a special incubator designed to fit in an MRI scanner.

"We've been able to now take over 250 babies who are very preterm to the MRI scanner safely to show that this is a feasible way to detect white matter injury early on," he says.

Now the question is how to prevent or repair that sort of injury.

Some studies show that it's important to act right away, says Vittorio Gallo from Children's National Medical Center in Washington, D.C.

"There is a very critical developmental time window right after birth," Gallo says. "If development is disturbed during this critical time window then the brain doesn't catch up."

Gallo is part of a team of scientists who have shown that it is possible to intervene — at least in mice. One approach involves giving the mice a drug that speeds up production of myelin, he says.

"We do this intervention right after the injury," he says. "And we found that by targeting specific targets we can recover and regenerate at least part of these cells right after the injury, during that critical developmental time window."

Any drug for people is still years off, Gallo says

But other scientists at the meeting say there are promising treatments available now. These include everything from the magnetic stimulation of certain areas of the brain to temporarily lowering the body temperature of premature infants to protect brain tissue.

And if any of the approaches work, the benefits are likely to extend far beyond infants, says Mark Goldberg of UT Southwestern Medical Center in Dallas.

"This white matter injury happens in perinatal brain injury. It happens in multiple sclerosis. It happens in traumatic brain and spinal cord injury. It happens in stroke," Goldberg says. "So we hope very much that the kind of therapeutic directions that work in one system can be applied directly to another system, another disease."

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