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Treatment of Traumatic Brain Injury

Written by childpsychiatristdenver on . Posted in Dr. Ted's Blog

On March 19, 2014, an international team led by Dr. Theodore Henderson published a comprehensive review of the utility of SPECT neuroimaging in the evaluation and treatment of traumatic brain injury (TBI). This review (Raji CA, Tarzwell R, Pavel D, Schneider H, Uszler M, et al. (2014) Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review. PLoS ONE 9(3): e91088. doi:10.1371/journal.pone.0091088) published in PLos ONE, summarized data derived from research studies conducted over 30 years and involving 2,634 patients. Nineteen longitudinal studies involving 903 patients demonstrated the predictive value of SPECT neuroimaging for the clinical outcome of patients with TBI. The ability of a SPECT at the time of injury to predict persisting symptoms of TBI was 59%, but if the SPECT scan remained abnormal at three months the predictive value rose to 95%. SPECT scans have a high sensitivity for TBI (91%). If a SPECT scan at the time of injury is negative, then this predicts full recovery with an 89% accuracy. The article reviewed 52 cross-sectional research studies involving over 2100 patients and found that the frontal lobe was the most common area of injury occurring in 94% of patients with TBI. The temporal lobe was the second most common area injured (77%).

In studies comparing SPECT to more conventional neuroimaging techniques such as computed tomography (CT scan) or magnetic resonance imaging (MRI), SPECT proved far superior in detecting TBI in both the acute and chronic condition. Particularly in the case of mild TBI, also known as concussion, anatomical findings that can be picked up by CT or MRI are rarely present. Nevertheless persons with mild TBI are much greater risk of developing psychiatric symptoms, such as depression anxiety attention problems and impulse control problems. Indeed, many cases of treatment resistant depression proved to be undiagnosed TBI. The desperate need of patients suffering from TBI, concussion, or postconcussive syndrome is clearly illustrated by the shockingly high rate of suicide among soldiers returning from Afghanistan and Iraq. These brave soldiers who often serve their country on multiple tours of duty and often experienced one or more TBI’s did not die on the battlefield, but instead die in their own homes and in their own country by their own hand or as a result of substance abuse, homelessness, depression, and cognitive impairment. This national tragedy deserves to be addressed and the injury to the brains of these fine men and women should be one of America’s top priorities. If you or someone you know struggles with the aftermath of TBI, reach out to Neuro-Luminance for help in identifying and treating the brain injury.

 

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