Jia-Rui Chong / Los Angeles Times & Michael D. Lemonick / Time Magazine – 2008-12-06 10:21:54
War-caused Brain Injuries’ Long-term Effects
Jia-Rui Chong, Los Angeles Times
LOS ANGELES (December 5, 2008) — Traumatic brain injuries, one of the signature injuries of the wars in Iraq and Afghanistan, can be linked to such long-term problems as seizures, aggression and dementia reminiscent of Alzheimer’s disease, according to an Institute of Medicine report released Thursday.
Even mild brain injuries, the report found, appear to be associated with some of these outcomes.
The report is a wake-up call, said Dr. Michael Yochelson, who specializes in traumatic brain injury at National Rehabilitation Hospital in Washington, and used to work at the National Naval Medical Center.
“We need to be prepared to take care of these people, and we need to be observant,” said Yochelson, who was not involved in the institute’s report.
A recent Rand report Yochelson worked on estimated that 19 percent of the troops returning from Iraq and Afghanistan, or more than 300,000 people, have come back with traumatic brain injuries. It estimated that treatments for such injuries and the loss in productivity have cost the nation, conservatively, about $554 million.
Traumatic brain injuries occur in a variety of ways, predictable and unexpected – gunshot or shrapnel wounds, strikes to the head or even exposure to an energy source. The brain can be harmed even when a person does not lose consciousness, doctors said.
The report by the nonprofit Institute of Medicine was the latest installment in a series of studies commissioned by the Department of Veterans Affairs on the health of veterans from the Gulf War and current conflicts.
The study was intended to aid VA officials in understanding what other conditions they should look out for in brain-injured patients and in determining disability benefits, said Dr. George W. Rutherford, chairman of the committee that wrote the report.
The authors reviewed 1,900 studies on traumatic brain injuries, looking for problems that persisted more than six months. Most of the research focused on civilians.
The report showed a hole in medical knowledge about blast injuries, which have only recently come to doctors’ attention because they are hallmarks of the Iraq and Afghanistan wars, Rutherford said.
“The good news is (that service members) are surviving injuries they had not survived in the past,” Rutherford said. “The bad news is, since they didn’t survive in previous conflicts, we don’t have a lot of background experience.”
The group found there was significant evidence connecting moderate or severe brain injuries to problems such as depression, unemployment and Parkinson’s disease-like tremors.
Officials at the VA said they will review the report. The department has 60 days to determine whether the long-term problems should be connected to brain-injured veterans’ military service.
Military officials said they were aware of the issues cited in the report and have dedicated $300 million in the last two years for research on traumatic brain injury. They also have recently started a long-term study on blast injuries.
“In terms of funding … we have received tremendous support, and as we identify emerging requirements, we will continue to gain the support we need,” said Army Brig. Gen. Loree K. Sutton, who heads the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.
© 2008 Hearst Communications Inc.
War Head Injuries: Long-Term Effects
Michael D. Lemonick / Time Magazine
(January 31, 2008) — It seems obvious that living through the terrors of military combat would increase someone’s risk of developing post-traumatic stress disorder (PTSD). But a new report published in this week’s New England Journal of Medicine suggests that PTSD isn’t a simple psychological reaction to a scary situation.
When researchers at Walter Reed Army Medical Center and the Uniformed Services University of Health Sciences examined the cases of 2,525 soldiers three to four months after serving in Iraq, they found that a remarkable one-sixth had suffered at least one concussion during their yearlong deployment — typically during combat or from a blast. These same soldiers turned out to be at higher risk for PTSD than those who hadn’t had a concussion — about three times higher for soldiers who had been knocked unconscious by concussion, and nearly twice as high for those who had a concussion without blackout.
The study found that soldiers who had suffered concussions were also more likely than soldiers with other injuries to report post-concussive symptoms such as irritability and problems with memory, balance and concentration. But when researchers factored in the soldiers’ higher risk for PTSD, the psychiatric disorder seemed to account for the presence of most of those post-concussive symptoms.
That would suggest, according to an accompanying editorial by psychologist Richard Bryant of the University of New South Wales in Sydney, that “psychological factors play a significant role in post-concussive symptoms” and that the physical and psychological consequences of suffering a concussion may be tightly bound.
That doesn’t mean that every soldier who gets a concussion will develop PTSD, nor, conversely, that concussion is a necessary prerequisite for the disorder. It does mean that doctors should be aware of the potential. People who have suffered even mild concussions in situations where there’s psychological stress are probably at elevated risk for PTSD, and should probably be monitored.
The new finding may also have implications for another, ongoing controversy about head trauma in war. According to a feature story in Science magazine last week, a neurologist named Ibolja Cernak, currently working at Johns Hopkins’ Applied Physics Laboratory, has been arguing for years that soldiers can suffer brain damage even when they haven’t had so much as a concussion.
Cernak first observed these effects in a Belgrade hospital during the Balkan wars of the 1990s, according to the writer, Science staffer Yudhijit Bhattacharjee. Soldiers who had survived blasts, but had no head injury whatever, came to the hospital complaining of typical post-concussive symptoms, including dizziness, difficulty in decision-making, memory problems and sleep deficits.
MRIs revealed physical damage in many cases — and after further research, Cernak and several colleagues came up with a radical new idea: Shock waves from an explosion, they suggested, might ripple through the body and up into the head. A helmet, or even motorcycle-style protective headgear, wouldn’t protect a soldier from brain trauma, according to this theory. Nor would it protect a soldier from the psychological trauma associated with surviving a blast.
While other researchers acknowledge that Cernak might have something, they remain unconvinced about her explanation of exactly how shock waves could be transmitted from the body to the head. Cernak thinks it happens through the vascular system — rapid oscillations in pressure in the blood vessels connecting body to head, induced by blast waves from a nearby explosion. She’s got more research under way to try and bolster that case.
But given her research, and the study in this week’s New England Journal, it’s clear that brain injuries don’t have to be massive to cause significant emotional and mental problems, and that “shell shock,” as it used to be called, may be caused by physical injury or, in turn, cause physical symptoms — it’s not just a reaction to the horrors of war. And if that’s the case, better and earlier medical and psychological intervention, along with better protective armor that shields the body as well as the head, could make life after combat a lot easier to endure.
Copyright © 2008 Time Inc. All rights reserved.
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