We are hearing more and more about Traumatic Brain Injury (TBI) nowadays, primarily as a result of the improvised explosive devices (IED) in Iraq and Afghanistan hurting our troops. But, even the intransigent NFL recognizes the problem (football helmets are not precluding brain trauma). And, last month, a batter’s broken bat knocked out Carlos Ruiz, the Phillies’ fully-helmeted catcher, who was then put on the disability list for 15 days. (He is slowly coming back to full form.)
The real problem with TBI is that we can’t easily diagonose them. [Maybe now is the time to remind you about Natasha Richardson’s untimely death after a (seemingly innocuous) ski fall.] Well, the good news is that we are beginning to find bio-markers that may afford diagnosis, after a simple blood test.
Right now, our knowledge (and treatment) is similar to what we provided for heart attacks until the mid-90’s, when troponin was determined to be a cardiac bio-marker; we developed a critical test to ascertain cardiac arrest, shortly thereafter. The DoD is working with Banyan Biomarkers (formed by University of Florida professors under the direction of Dr.Ronald L. Hayes, founder) in Alachua. The group reported (Journal of Critical Care Medicine and the European Journal of Neuroscience) strong correlation between the presence of certain biomarkers in brain tissue and cerebrospinal fluid (CSF) with the degree of brain injury. (One of these, UCH-L1, demonstrated a 16-fold increase when compared to non-injured brains.) However, it is not clear if this test will be reliable with mild-to-moderate brain injury.
Dr. Hayes has also reported a cascade effect is produced in the brain after injury, that continues for (four) days. Rapid intervention could, therefore, possibly reduce the potential damage to the patient. Should the test yield a positive result, specialists could place intracranial pressure (ICP) monitors (much more sophisticated than the ones I developed in the 70’s and 80’s) and insure that ICP would not destroy brain tissue. We may also be able to reduce or preclude vasospasms that prove just as damaging as the original injury.
The Defense Department (DoD) is providing about $ 17 million to continue this research at 20 hospitals; the study should be complete by the end of 2011. The goal is to perfect a blood test that a medic can use on the battlefield. (The biggest problem is when there is an injury, but there is no loss of consciousness; doctors either fail to prescribe treatment or the wrong treatment is provided.)
In addition to the need by the DoD, there is a substantial civilian market. There are some 1.7 million TBI a year, of whom more than 50,000 die and 275,000 require substantial hospital stays. Other than our troops, this injury affects mostly children: kids under 4 and teens from 15 to 19.