September/16/2015 | by Dan Musgrave
For many, a knock on the head is just a small pain. Likewise, a bad day may just be a passing mood. They are an inconvenience, if anything. For a significant number of people, especially veterans and service members, the pain and the mood changes can linger and become chronic, indicating that potentially they have suffered a mild traumatic brain injury (mTBI). A new special issue of the research journal Brain Imaging and Behavior, edited by MIMH’s Dr. David Tate, Baylor’s Drs. Elisabeth Wilde and Stephen McCauley, and Harvard Medical School’s Dr. Sylvain Bouix, collects the latest research on mTBI with a specific focus on military personnel and the veteran population. The issue was released on September 11, and shares some of the latest research into the nature and treatment of this elusive and not yet fully understood phenomenon.
“The numbers we’re seeing so far, gathered by the [Defense and Veterans Brain Injury Center] show that nearly 20% of all service members deployed from 2000-2012 suffered some form of TBI,” Tate said, noting the significance of this research. “80% of those were mTBIs.”
TBIs reached a higher level of public awareness following the troop surge of 2007, which correlated with a surge in reported TBIs. A number of popular news features lead to a perception that these injuries were mostly blast or combat related. However, contrary to public perception, of the more than 300,000 TBIs reported, 85% of those were incurred in a non-deployment setting.
“We’re seeing that a lot of this is happening, for example, in garrison, during training, in vehicle accidents,” Tate said.
MIMH’s Dr. David Tate
Even with the high prevalence rate of TBIs found in the most recent reports, there are some who believe the numbers could be higher. One of the most difficult aspects of TBI research and treatment is the lack of a consistent diagnostic framework for discerning an mTBI from a number of other similar and co-occurring conditions, including PTSD.
“The trauma of war is unique and something that sets it apart from similar injuries in sports. The Venn Diagram of PTSD and mTBI is, essentially, overlapping,” Tate says, placing one hand over the other. “There are unique features to each, but things like short term memory and attentional problems, fatigue, energy dysfunction, these are the hallmarks of both conditions.”
“This is very complicated and our current approaches to treatment may not be adequate,” he added. “You have one group here doing this, another group over there doing that. We’re a little disjointed.”
The disparity is easy to understand given the complexities of the conditions. Because TBIs can and do impact any area of the brain, and each injury in unique to the person who sustained it and the event(s) that caused it, generalities have been hard to make about the mTBIs. This does not discourage Tate or the other researchers featured in the journal. They see each discovery and insight is another step toward a potential universal plan of diagnosis and care for practitioners at all levels.
“One of the studies in the journal uses cluster analysis to show the different expressions of mTBI and its comorbidities,” Tate notes. “It shows that there are seven distinct groupings of patients, each with their own unique constellation and comorbidities. It’s very exciting. From there we can develop treatments specific to each cluster.”
The issue features over 12 new research articles and 4 review papers. It can be accessed at: http://link.springer.com/article/10.1007/s11682-015-9445-x. Though the articles are behind a paywall, the issue’s introduction, written by Tate and Wilde, is available for free at that link. The print version of the issue is now available for purchase as well.