Traumatic Brain Injury


Seeking Answers to Key Questions About MTBI

 

Stephen Kaminski, MD

Scott Thomas Grafton, MD

 

Neurologists at the Santa Barbara Neuroscience Institute at Cottage Health System are currently enrolling patients in a clinical trial taking place at the University of California Santa Barbara (UCSB) that may significantly impact the treatment of mild traumatic brain injury (MTBI).

 

MTBI, or concussion, is one of the most prevalent neurologic disorders, occurring most commonly as a result of injuries sustained during athletic competition, car accidents or falls. Individuals with MTBI typically experience a brief loss of consciousness or amnesia and will recover within one week.

 

Approximately one in 10 patients, however, continues to complain of symptoms such as inattentiveness,forgetfulness and cognitive deficits, although bedside testing and conventional magnetic resonance imaging (MRI) results appear normal. Researchers at the UCSB Brain Imaging Center are using high-resolution white matter MRI to uncover a potential biomarker that can guide treatment decisions for such patients.

 

“The Network Analysis in Mild Traumatic Brain Injury clinical trial involves performing state-of-the-art imaging of the brain’s white matter using diffusion spectrum imaging,” says Scott Thomas Grafton, MD, director of the UCSB Brain Imaging Center. “We want to model the brain in terms of network properties by looking at structure and function.

 

“Our partners in the physics department at UCSB look at complex systems and model all brain white matter as a large network, allowing us to investigate whether or not anything is wrong with the network as a whole.”

 

 

Scott Thomas Grafton, MD

 

Stephen Kaminski, MD

The Centers for Disease Control and Prevention report that as many as 75 percent of all people who experience injury to the brain sustain mild traumatic brain injuries.

“Functional MRI allows us to see actual disruption of axonal pathways and fiber tracts that may account for the host of  neurologic symptoms seen after MTBI,” says Philip R. Delio, MD, stroke neurologist and medical director of the Stroke Program at Cottage. “This type of data could have tremendous implications for how we manage and treat patients with MTBI, answering questions like ‘When can patients return to work or competitive athletics?,’ ‘What kind of symptoms can they expect after injury?’ and ‘How long will their recovery take?’”

 

Inside the Clinical Trial

Researchers at UCSB are currently recruiting patients across Santa Barbara County for the Network Analysis in Mild Traumatic Brain Injury  clinical trial. Candidates for the trial are individuals who have experienced a concussion leading to loss of consciousness and amnesia and  who have persistent complaints one month after the injury.

 

Participants are screened by telephone and in person at the UCSB Brain Imaging Center, where they also complete a questionnaire about their head injury. Researchers obtain a blood sample from each patient and send it to a biomedical company, where it is examined for brain proteins present in the blood after most injuries as part of the effort to identify a biomarker. Finally, patients spend approximately one hour in a 3-Tesla MRI scanner. Participants receive feedback if researchers discover anything abnormal on conventional scans.

 

“We expect to conclude the study in approximately one year,” Dr. Grafton says. “It is a first step toward finding a biomarker for a common and difficult diagnostic problem. Once we find a biomarker, physicians will be able to use it to steer treatment decisions and monitor a patient over time for changes in his or her condition, as well as utilize it in a medical/legal context. The current guidelines for determining when a patient can return to work or competition after MTB I are based on an American Academy of Neurology recommendation that is more than a decade old. The question is: ‘Can we do better?’ We certainly want to, and that’s what we’re focused on.”

  

Patients do not need a referral to enroll in the Network Analysis in Mild Traumatic Brain Injury clinical trial at UCSB. To do so, they can  call the UCSB Brain Imaging Center at (805) 893-5235 or email beach@psych.ucsb.edu.

 

Important Inquiries

According to Philip R. Delio, MD, stroke neurologist and medical director of the Stroke Program at Cottage, the Network Analysis in Mild Traumatic Brain Injury clinical trial may help fill some gaps in physicians’ knowledge about mild traumatic brain injury (MTBI), answering questions such as:

  • Why do some patients have significant residual neurologic deficits after injury, while others with the same injury make rapid and complete recoveries?
  • What are the best ways to rehabilitate patients who have deficits?
  • Should physicians focus on methods of compensation to teach patients how to accommodate their deficits, or should they try therapies to encourage patients to recover from the deficits?
  • Are there ways to predict who will be affected by MTBI, how long symptoms will last and if the symptoms will be permanent?

“Finding answers to important questions surrounding mild traumatic brain injury — one of the most common disorders neurologists see in patients — will significantly improve patients’ lives by helping physicians better advise them on how to stay safe and when to return to work or play after experiencing the injury. We are pleased to play a part in the important research taking place at the Brain Imaging Center at UCSB.”

 

— Stephen Kaminski, MD, medical director of trauma services and the surgical intensive care unit at Santa Barbara Cottage Hospital

 

 

Data analysis pipeline for converting high-resolution maps of brain diffusion into wiring diagrams of brain connectivity. The imaging research is testing if concussion can lead to the strength of these connections throughout the brain.

 


 

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