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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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Derek Boogaard: Degenerative Brain Damage from Hits to the Head

posted by SK Brain Injury    |   December 6, 2011 12:00

New York Rangers enforcer Derek Boogaard suffered from chronic traumatic encephalopathy, a degenerative brain ailment related to Alzheimer's disease that is caused by repeated blows to the head, the New York Times reported.

The 28-year-old Boogaard, who died in May of an accidental overdose of alcohol and the painkiller oxycodone, was found to have had CTE -- which can be diagnosed only after the death of the patient, according to the third story of an extensive three-part series on Boogaard posted on the newspaper's website Monday night.

Boogaard's family donated his brain to the Center for the Study of Traumatic Encephalopathy at Boston University's School of Medicine.

Dr. Ann McKee, the director of the centre's brain bank, saw signature brown spots near the outer surface of Boogaard's brain, which are revealing signs of CTE.

Such damage in someone as young as Boogaard was surprising. Symptoms of the condition include memory loss, impulsiveness, mood swings and addiction.

Had Boogaard lived, his condition likely would have worsened into middle-age dementia.

"To see this amount? That's a 'wow' moment," McKee said of the damage to Boogaard's brain tissue. "This is all going bad."

The disease was more advanced in Boogaard than it was in famed enforcer Bob Probert, who died of heart failure in 2010 at 45. He played 16 seasons in the NHL and often struggled with alcohol and drug addiction.

Reggie Fleming, who was 73, and 59-year-old Rick Martin, were other hockey players who were found to have CTE.

Boogaard played parts of five seasons with the Minnesota Wild before signing with the Rangers as a free agent in the summer of 2010.

In 277 career NHL games, the six-foot-eight, 257-pound Saskatoon native recorded three goals, 13 assists and 589 penalty minutes.

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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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Stroke Damage can be Prevented Using Anti-Inflammatory Chemical

posted by SK Brain Injury    |   December 5, 2011 22:51

Drugs that block inflammation in the brain could help patients who have a stroke or a brain haemorrhage, Manchester scientists said today (5 December) at the British Society for Immunology Congress in Liverpool.

Inflammation occurs when a person has a stroke, haemorrhage or trauma. Whilst it is a necessary part of the process to repair the damage to the brain, excessive inflammation causes further damage. Inflammation can be sustained for long periods of time and can contribute to brain degeneration, for example in Alzheimer's, Parkinson's and multiple sclerosis.

A naturally-occurring chemical known as IL-1Ra is used to treat inflammatory conditions such as rheumatism, but until recently scientists thought it could not cross from the blood stream into the brain. However, Professor Nancy Rothwell, a neuroscientist at The University of Manchester, and her colleagues have shown in humans as well as in mice and rats that blocking interleukin 1, the chemical that regulates inflammation, can enter the brain.

“In a series of pharmacokinetic studies, we have looked at what happens to IL-1Ra when it is injected in humans and animals,” said Professor Rothwell. “IL-1Ra is a safe and effective treatment and we now know that it can cross into the brain. Once in the brain, it blocks the interleukin and helps to prevent the long-term damage caused by too much inflammation.”     

IL-1Ra also markedly improves traumatic brain injury in rodents and has shown promise in a Phase II clinical trial in stroke patients.

“The ability of the inflammatory processes to repair, yet cause further damage, is a delicate balance of a cascade of reactions to trauma which we don’t fully understand,” said Professor Rothwell. “However, the results are encouraging, and we are now embarking on trials of IL-Ra in patients who have had a stroke or a brain haemorrhage.”

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"Heading" Soccer Balls Linked to Brain Injury

posted by SK Brain Injury    |   November 30, 2011 11:12

Coaches value players who have their head in the game, but a new study finds that may not be the healthiest thing for soccer players. Those who head the ball most frequently, the study showed, had damage in brain areas similar to that seen in people with concussion. 

 

The brain changes were found in players who headed the ball 1,000 to 1,500 times a year — which amounts to a few times a day — but not in those who did so less frequently. Reporting the findings at the Radiological Society of North America's annual meeting in Chicago this week, the study's author said the effects of heading may be cumulative — appearing not after the occasional header, but building up over time in players who frequently use their heads to play.

 

"I'm not advocating banning heading, but there may be a threshold level, which we defined, that indicates a safe range of heading," said author Dr. Michael Lipton, associate director of the Gruss Magnetic Resonance Research Center at the Albert Einstein College of Medicine in New York City, in a statement.

 

The researchers used a type of brain scan known as diffusion tensor imaging to examine the brain tissue of 38 amateur adult soccer players in New York City, who said they had been playing since childhood. Players reported heading the ball more than 400 times a year on average. Those in the top 25% of heading frequency had an average 1,320 headers in a year, and these players were most likely to show injury in regions of the brain that play a role in cognitive functions, including attention, memory, planning, organizing, physical mobility and high-level visual functions.

 

"These are changes in the brain that are similar to those we see with a concussion or TBI," said Lipton. In previous research, these players also showed lower scores on tests of memory and reaction time.

 

The evidence linking brain injury and heading has been inconsistent so far. For its part, the American Academy of Pediatrics says there isn't sufficient data to recommend that young players abstain from heading, but does suggest that players minimize contact between head and ball.

 

The new study is small and not peer-reviewed, so it must be considered preliminary. But the author said it was a compelling reason to pursue further study; other experts agreed that more study was necessary to determine what the implications might be for soccer players, especially younger ones who may be more vulnerable to brain injury and for those who practice daily, doing frequent heading drills.

 

More than 250 million people play soccer regularly, according to FIFA, the sport's international governing body. In the U.S., at least 18 million people play soccer, 78% of them under age 18.



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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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