Sifting through pseudoscience for reliable research (10/17/19 newsletter)
We are pleased to have Carleton College students and alumni interning with Concussion Alliance. Intern contributors this week:
Editor: Galen Moller
Contributors: Galen Moller, Warren Situ, Julian Szieff, and Katie Taylor.
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Education
Synapse support groups for people with brain injuries
The nonprofit organization Synapse, which provides social support for those suffering a brain injury (including concussion), has a network of chapters at college campuses. The Synapse program includes peer support groups and one-on-one volunteer buddy programs. According to an article in The New York Times, over 700 students (including veterans) are enrolled in 18 college chapters of Synapse. Students can find a college chapter here.
Sports
“Changing Opinions on Concussions in Sports” is now available as a blog post
Cannabis
TBI considered “qualifying diagnosis” for medical marijuana card in Washington State; new financial hardship $100 grants
The Washington State medical marijuana system specifies that traumatic brain injury is a qualifying medical diagnosis for access to medical marijuana. This past month, the nonprofit Washington CannaBusiness Association announced that its Medical Access Fund will accept applications for a $100 one-time grant for cannabis patients who are struggling financially, according to The News Tribune. Patients can apply for the grant here.
Diagnostics
Researchers claim a correlation between Lyme disease and Post-Concussion Syndrome
A new study claims to have found a correlation between Lyme disease and Post-Concussion Syndrome (PCS) lasting more than one year. A team of researchers from The Carrick Institute, Harvard Medical School, and The University of Cambridge published a paper in the Croatian psychiatry journal, Psychiatria Danubina, analyzing data from their clinic in San Francisco. After analyzing data from 87 patients, they found that those with PCS symptoms lasting more than one year tested positive for Lyme disease 37% of the time, while subjects without PCS symptoms tested positive for Lyme disease 27% of the time—a slight but significant difference.
Many caveats go along with this study, including a small sample size, and the potential for false positives and bias in the selection of patients. Nonetheless, this research could be helpful. If Lyme disease is the true cause of some patients' PCS symptoms, then treatment for these symptoms should include a Lyme disease test and then a course of antibiotics.
Intriguingly the correlation is much stronger in men than in women. The authors of this study make a point to emphasize that they don’t know why this correlation exists, but they theorize that the immunosuppression associated with concussions could allow Lyme disease to spread into the brain and cause similar neuro-inflammation problems as those seen in PCS. While this research is only in its preliminary stages, it does suggest that further research into the overlap of Lyme disease and Post Concussion Syndrome is necessary.
Therapies
Hospital explores therapeutic options with virtual reality
Virtual Reality (VR) technology is being included in the Sports Concussion Rehab Program at Wentworth Douglass Hospital to help athletes recover from concussions. Using technologies such as SyncThink and VR Health, patients are transported into new environments such as mountains or lakes, while their rapid eye movements and equilibrium are monitored.
According to an article in Fosters, “such stimuli would normally set back concussion recovery or worsen concussion symptoms.” But the technology makes it possible to gradually ease patients into dealing with noises and light, under controlled supervision. These environments have pleasing stimuli, and patients can feel safe and relaxed, while physical therapists and medical professionals can measure their progress and improve treatment by focusing on specific skills affected by concussion.
Veterans
Hyperbaric oxygen therapy helps politicians more than it helps veterans
In an opinion piece for The Hill, Kayla Williams wrote in opposition to a new bill that would require the Department of Veterans Affairs (VA) to provide hyperbaric oxygen therapy (HBOT) to veterans with traumatic brain injury or post-traumatic stress disorder. She says that while HBOT has legitimate uses such as treating carbon monoxide poisoning, it is not an effective treatment for PTSD or TBI.
Williams cautions readers against equating anecdotal evidence with proof of effectiveness; mTBI symptoms can decrease in severity over time, and PTSD symptoms can change in response to external stimuli, so one person’s story of success after using HBOT could be a coincidence. Meanwhile, multiple studies from reliable sources, including VA and the Department of Defense, have “failed to show any evidence that HBOT improves symptoms of PTSD or mild TBI more than sham treatments.”
As a veteran and the wife of a veteran who sustained a TBI in Iraq and subsequently developed PTSD, Williams understands the allure of providing more treatments for service members. But she believes that those treatments should be supported by evidence instead of anecdote—especially when they come with risks such as ear damage and seizures, as HBOT does.
Mental Health
Risk factors for mental health problems post-mTBI
An investigation by Murray B. Stein et al., published in JAMA Psychiatry, examined risk factors for developing PTSD or major depressive disorder after sustaining an mTBI. The study comprised 1155 patients with mTBI and 230 patients with non-head orthopedic injuries ages 17 years and older. Subjects were given the PTSD Checklist for DSM-5 and Patient Health Questionnaire-9 Item at 3, 6, and 12 months postinjury.
Within the mTBI group, subjects were more likely to develop major depressive disorder and/or PTSD by 6 months if they were less-educated, black, or if they had a self-reported psychiatric history. Patients were also at a higher risk for PTSD at 6 months if their injury occurred because of assault or other violence.
Statistics
Women's Health
Sex Differences in Response to Traumatic Axonal Injury
Our October 3, 2019 newsletter discussed an article published by the International Concussion Society, about differences in female axons and how that might affect concussion vulnerability and recovery. We are following up with this summary of the original research regarding female axons, susceptibility to concussions, and concussion recovery. The study, published in Experimental Neurology and written by Jean-Pierre Dollé et al., discusses sex differences in traumatic axonal injury.
Traumatic axonal injury is a common pathology of concussions where patients with head trauma experience axonal swelling and disconnection due to acceleration, deceleration, and rotational forces in the brain. To study sex differences in axonal strength and reaction to injury, the researchers used human and rat neurons to produce in vitro axons that were either genetically male or female. They found that the female axons were consistently smaller and had fewer microtubules, which are necessary for axonal transport.
Through computational modeling, the researchers determined that these structural differences put female axons at a higher risk of failure from the same level of injury than their genetically male counterparts. Female neurons are more likely to break mechanically, and their negative reactions to stress are more severe than those observed in male axons. These reactions include the physical breaking of microtubules and an influx of calcium after injury. The results of this study suggest that if these axonal differences are indeed present in humans, females could have a more negative reaction to injury than males who sustained the same level of trauma.
Culture
The rise of pseudo-cures in concussion recovery
As public awareness of concussions and CTE has increased, so too has the number of products aimed at TBI recovery. A recent paper in The Lancet Neurology by Bachynski and Smoliga examined the growing prevalence of dubious products claiming to promote recovery or cure concussion. The products often establish their effectiveness through falsified evidence and/or promotions by doctors or professionals with a financial stake in the company. These deceitful businesses take advantage of patients, athletes, and well-intentioned family and friends. Examples of pseudo-cures range from jugular vein compression devices to chocolate milk infused with a neuroprotective molecule.
Thankfully the Federal Trade Commission has been cracking down on companies that make false claims in their advertising. Nonetheless, it’s still important to evaluate the research, financial investment, and safety of any new technology.
Concussion Alliance makes a point of checking the research and safety of all technologies we report on, and we recommend the same for anyone considering a new therapy or technology.
Executive Editor (and Contributor)
Concussion Alliance co-founder Malayka Gormally