Concerns about head injuries have reached the public’s awareness in the past decade largely because they were recognized as the “signature injury” of the Gulf Wars, in addition to growing worries regarding the long-term consequences experienced by professional football players.
What is still underappreciated is the high rate of traumatic brain injury (TBI) in the civilian population owing to motor vehicle accidents, falls, and occupational injuries and assaults, including domestic abuse.
According to the Centers for Disease Control, TBI has a higher annual incidence (2.8 million) than heart attacks (800,000). While there has been a trend toward milder severity over the last few decades, the rate of concussion, or mild TBI, has been steadily increasing.
Importantly, several recent studies suggest that the large majority of people do not fully recover from their concussions, as was previously believed. In fact, it appears very good outcomes occur in only half of all cases, with lingering problems in the other half, often reducing quality of life and vocational ability. Furthermore, a large study conducted at VA medical centers nationally has found that even a single concussion doubles the risk of developing dementia; more severe brain injuries raise the risk to an alarming fourfold increase.
To improve outcomes in brain injuries, the Center for Neurological Studies in Detroit, a nonprofit organization, was founded in 2011. CNS has its roots in the departments of neurology and radiology at Wayne State University and the Detroit Medical Center, where Mark Haacke — a professor of biomedical engineering and radiology — and I co-directed the program in traumatic brain injury research that brought together an interdisciplinary faculty-sharing research interest in brain injury.
Our team developed a more sensitive and accurate way of imaging brain injuries. This development led to the founding of CNS, which has endeavored to leverage a new ability to refine diagnoses and tailor treatments to optimize outcomes for individual patients. Eventually, other types of brain injury were shown to be demonstrable with our advanced imaging methods.
What is still underappreciated is the high rate of traumatic brain injury (TBI) in the civilian population.
CNS is delivering on its mission. With research studies involving former professional football players, Gulf War veterans, and civilian TBI injuries, CNS is able to classify individual patients by pathology and severity at millimeter scale. Demonstrating microhemorrhages as well as tiny tears in the brain’s white matter tracts, the previously undetectable can now be seen and even correlated with neurological impairments.
These advances are even being used in the courtroom to demonstrate injuries in TBI patients who might otherwise be dismissed as malingerers or as having purely psychological issues. Armed with the ability to actually visualize the damage to the brain tissue, CNS has been able to determine when symptoms aren’t caused by injury to brain tissue but are caused by damage to other structures, particularly the pituitary gland or delicate structures of the inner ear. Being able to visualize damage to brain tissue allows clinicians to rule out brain injury and then perform diagnostic procedures for pituitary and inner ear damage, which are typically treatable and even reversible.
CNS is currently investigating the broad positive effects of human growth hormone (hGH) in former NFL players who are deficient in the hormone because of multiple head trauma. While the amelioration in many symptoms with hGH leads to a greatly improved quality of life in most people, we’re investigating the longer-term benefits to cognition, brain structural metrics, and reducing the dementia risk in this high-risk group.
CNS also is beginning a second phase of research involving brain-injured military veterans who are experiencing extreme difficulties reintegrating into civilian life. Using a diagnostic and treatment algorithm developed by CNS, the pilot study demonstrated significant improvement in quality of life and even cognitive measures for veterans.
Insofar as the two studies cited involve high-risk populations, the goal is to apply what is learned to the broader population of persons with TBI. We’ve been evaluating the full range of patients with TBIs, and it’s clear that all patients with a head injury are at risk for any and all of the symptoms, including “non-brain” traumatic injuries, e.g., pituitary and neurosensory.
This capability is more vital now than ever, with the increasing rate of TBI in the U.S. and minimal advances in the management and outcomes of brain injuries in the last several decades. The CNS is changing this paradigm.
Dr. Randall Benson is a nationally regarded behavioral neurologist and imaging neuroscientist. He is a co-founder and medical director of the Center for Neurological Studies.