Traumatic Brain Injury

Increased Risk of Multiple Sclerosis after Traumatic Brain Injury: A Nationwide Population-based Study

Authors: Kang JH, Keller J, Lin HC.

Previous data show conflicting results regarding the association between MS and prior brain trauma. This study aims to investigate the risk for MS following a traumatic brain injury (TBI) using a population-based dataset. This study used data from the National Health Insurance Research Database. In total, 72,765 patients with TBI were included as the study cohort, and 218,295 randomly selected subjects were matched with the study cohort by sex and age as controls. We traced each patient individually for a six-year period from their index health care utilization to identify those who received a subsequent diagnosis of MS. We used the Kaplan-Meier method and the log-rank test to compare the difference in six-year MS-free survival rates between the two groups. Stratified Cox proportional hazard regressions were computed to compare the risk of developing MS for these two cohorts. The incidence rate of MS was 10.51 (95% CI: 7.60-14.16) per 100,000 person-years in patients with TBI and 6.63 (95% CI: 5.30-8.20) per 100,000 person-years in patients without TBI. After censoring cases who died from non-MS causes, stratifying for hospitalization of cases as a proxy for severity, and adjusting for monthly income and geographic region of the community in which the patient resided, the HR of MS for patients with hospital-treated TBI injuries was 1.97 (95% CI=1.31-2.93, p<0.01) that of patients without TBI during the six-year follow-up period after index healthcare use. Our study concludes that patients with TBI are at higher risk for subsequent MS over a six-year follow-up period.

Animal model for sport-related concussion; ICP and cognitive function

Authors: Bolouri H, Säljö A, Viano DC, Hamberger A.

Background -  We have recently developed and characterized a rat model of mild traumatic brain injury which simulates the concussive injuries frequently encountered by players in American professional football. Objectives -  To study the effect of multiple impacts to the head on intracranial pressure, cognitive function, and exploratory behavior. Materials and Methods -  The model was employed to cause concussion. Intracranial pressure, cognitive function, and exploratory behavior were examined following the multiple impacts of a 50 or 100 g projectile at a velocity of 9.3 or 11.2 m/s to the helmet protected head. Results -  Intracranial pressure measured at 6 and 10 h, and 1, 2, 3, 5, and 7 days. It was maximally elevated 10 h after impact and returned to the control levels 7 days later. Morris Water Maze assessment, 48 h after impact, revealed impaired cognitive function. Open field testing 2-4 days and 1 and 2 weeks after impacts indicated consistently reduced spontaneous exploratory activity. Conclusion -  Multiple impacts to the head raise intracranial pressure and impair cognitive function and exploratory activity in this animal model.

Disability 3, 12, and 24 Months After Traumatic Brain Injury Among Children and Adolescents

Authors: Rivara FP, Koepsell TD, Wang J, Temkin N, Dorsch A, Vavilala MS, Durbin D, Jaffe KM.

Objective:To examine disability in children and adolescents after traumatic brain injury (TBI) across the spectrum of injury severity.Methods:This was a prospective cohort study of children younger than 18 years treated for a TBI (n = 729) or an arm injury (n = 197) between March 1, 2007, and September 30, 2008. The main outcome measures were disability in health-related quality of life, adaptive skills, and participation in social and community activities 3, 12, and 24 months after injury compared with preinjury functioning.Results:The health-related quality of life for children with moderate or severe TBI was lower at all follow-up times compared with baseline, but there was some improvement during the first 2 years after injury. Three months after injury, there was a substantial decrease in the level of activities in which children with moderate and severe TBI were able to participate; these activities improved at 12 and 24 months but were still significantly impaired. Communication and self-care abilities in children with moderate and severe TBI were lower at 3 months than at baseline and did not improve by 24 months. Children who met the definition of mild TBI but had an intracranial hemorrhage had lower quality-of-life scores at 3 months.Conclusions:Children with moderate or severe TBI and children with mild TBI who had intracranial hemorrhage had substantial long-term reduction in their quality of life, participation in activities with others, and ability to communicate and care for themselves.

Traumatic Neuroma in Continuity Injury Model in Rodents

Authors: de Villiers Alant JD, Peter Kemp SW, Ong Lopez Khu KJ, Kumar R, Webb AA, Midha R.

Abstract Traumatic neuroma in continuity (NIC) results in profound neurological deficits, and its management poses the most challenging problem to peripheral nerve surgeons today. The absence of a clinically relevant experimental model continues to handicap our ability to investigate ways of better diagnosis and treatment for these disabling injuries. Various injury techniques were tested on Lewis rat sciatic nerves. Optimal experimental injuries that consistently resulted in NIC combined both intense focal compression and traction forces. Nerves were harvested at 0, 5, 13, 21, and 65 days for histological examination. Skilled locomotion and ground reaction force (GRF) analysis were performed up to 9 weeks on the experimental (n=6) and crush-control injuries (n=5). Focal widening, disruption of endoneurium and perineurium with aberrant intra- and extrafascicular axonal regeneration and progressive fibrosis was consistently demonstrated in 14 of 14 nerves with refined experimental injuries. At 8 weeks, experimental animals displayed a significantly greater slip ratio in both skilled locomotor assessments, compared to nerve crush animals (p<0.01). GRFs of the crush- injured animals showed earlier improvement compared to the experimental animals, whose overall GRF patterns failed to recover as well as the crush group. We have demonstrated histological features and poor functional recovery consistent with NIC formation in a rat model. The injury mechanism employed combines traction and compression forces akin to the physical forces at play in clinical nerve injuries. This model may serve as a tool to help diagnose this injury earlier and to develop intervention strategies to improve patient outcomes.

Etiologic features of newly diagnosed epilepsy: Hospital-based study of 892 consecutive patients in West China

Authors: Si Y, Liu L, Hu J, Mu J, Fang JJ, An DM, Zhao LL, Tian LY, Zhou D.

PURPOSE: We evaluated data from a large cohort of newly diagnosed epilepsy patients from the biggest epilepsy center in West China. The aim was to determine the most prevalent etiologic factors in this region.

METHODS: From May 2008 to May 2010, the clinical data of patients with newly diagnosed epilepsy were consecutively, systematically and prospectively recorded in a database. The data were analyzed according to sex, age, seizure type, etiology, and other factors.

RESULTS: The present study examined 892 patients with newly diagnosed epilepsy. Among these patients, 346 (38.8%) were confirmed as symptomatic, with the largest constituent ratio among the elderly (63.2%). In this symptomatic group, central nervous system (CNS) infections and traumatic brain injuries (TBI) were the two most common etiologies. When analyzed according to age bracket, cortical dysplasia, mesial temporal sclerosis, and CNS infection were the most frequent causes among young patients (<18 years). On the other hand, CNS infection and TBI were the two most common causes in patients between 18 and 60 years. Stroke was the most common cause of newly diagnosed symptomatic epilepsy in the elderly (>60 years).

CONCLUSIONS: More than 30% of newly diagnosed epilepsy cases were shown to be symptomatic by medical history as well as careful clinical and laboratory examination. Detailed epilepsy assessments are essential to formulate a therapeutic plan and to improve prognosis. The etiology spectrum found in this large cohort forms a comparative baseline for future studies.

Characteristics of an Explosive Blast-Induced Brain Injury in an Experimental Model

Authors: de Lanerolle NC, Bandak F, Kang D, Li AY, Du F, Swauger P, Parks S, Ling G, Kim JH.

Mild traumatic brain injury resulting from exposure to an explosive blast is associated with significant neurobehavioral outcomes in soldiers. Little is known about the neuropathologic consequences of such an insult to the human brain. This study is an attempt to understand the effects of an explosive blast in a large animal gyrencephalic brain blast injury model. Anesthetized Yorkshire swine were exposed to measured explosive blast levels in 3 operationally relevant scenarios: simulated free field (blast tube), high-mobility multipurpose wheeled vehicle surrogate, and building (4-walled structure). Histologic changes in exposed animals up to 2 weeks after blast were compared to a group of naive and sham controls. The overall pathologic changes in all 3 blast scenarios were limited, with very little neuronal injury, fiber tract demyelination, or intracranial hemorrhage observed. However, there were 2 distinct neuropathologic changes observed: increased astrocyte activation and proliferation and periventricular axonal injury detected with β-amyloid precursor protein immunohistochemistry. We postulate that the increased astrogliosis observed may have a longer-term potential for the exacerbation of brain injury and that the pattern of periventricular axonal injury may be related to a potential for cognitive and mood disorders.

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