A new and extensive federal report released this week concludes that roughly one in four of our US Veterans of the 1990-1991 Gulf War suffer from Gulf War illness.  According to the 452 page report, “Scientific evidence leaves no question that Gulf War illness is a real condition with real causes and serious consequences for affected veterans.”  

Soldiers diagnosed with Gulf War syndrome have wide-ranging problems including headaches, dizziness and loss of balance, memory problems, chronic fatigue, loss of muscle control and shortness of breath.  It is believed that brain cancer deaths and Lou Gehrig’s disease are also potentially connected to service during the Gulf War.
 
Hopefully, this new study will lead to the necessary treatment that these wonderful veterans certainly deserve.
 

Research on sophisticated diagnostic tests were presented this weekend at the annual meeting of the society for neuroscience in Washington, D.C.  According to a report published in USA Today, researchers from the University of California-San Diego combined “two advanced brain scanning techniques-MEG (Magnetoencephalography) and DTI (Diffusion Tensor Imaging)- that permitted them to detect brain damage in patients with mild traumatic brain injury in which conventional MRI and CT scans had been normal.  Mingxiong Huang, the presenting researcher from this study, stated “More research is needed before the dual technology can be used clinically in patients with such injuries (MTBI).”

Also presenting at the annual meeting were researchers from the University of Miami (Andrew Maudsley) who “reported that they used a new all-brain method of magnetic resonance spectroscopic imaging (MRSI) to detect for the first time widespread brain damage that sometimes fails to show up in conventional brain scans of patients with mild to moderate TBI.

The researchers studied 17 patients admitted to a trauma unit with closed head injuries.  According to USA Today, “They looked at changes in three major brain chemicals and compared them with healthy brain images.  They found the MRSI images picked up diffuse chemical changes in the TBI patients, even in people who had been classified as having very mild injury.”

Clearly, the day is coming when patients with mild traumatic brain injury will have their injuries confirmed by objective diagnostic testing which obviously will have a significant impact on neurolitigation.

At present, the gold standard for objectively proving that an individual sustained a mild traumatic brain injury is through neuropsychological testing.  As we know, standard diagnostic testing such as CT scans, MRIs and EEGs, due to their lack of sensitivity, rarely if ever detect brain abnormalities in patients with mild traumatic brain injury.

However, advances in neuroimaging may soon eliminate the need for neuropsychological testing to diagnose brain damage.  Advances in FMRI and diffusion tensor imaging (DTI) will soon become the gold standard.

I recently read an article published in Brain entitled “Structural Dissociation of Attentional Control and Memory in Adults with and without Mild Traumatic Brain Injury”.  The article by S. N. Niogi et al, noted that executive function such as attention and memory are among the most significant human brain processes impacting overall cognitive function.  The study contained 43 patients prospectively recruited with mild TBI, (28 males, 15 females) who were imaged at least one month post injury and 23 healthy volunteers, (17 males, 6 females).  There was no significant difference in mean age, gender, handedness, or level of education between the mild TBI group and the control group.  Those with a prior history of TBI, a history of neurological or psychiatric illness were excluded.  All subjects underwent diffusion tensor imaging along with conventional MRI.  The study provided clear evidence that DTI may serve as a microstructural imaging biomarker for cognitive dysfunctions and variations within normal cognitive functions.  Hopefully, further research will confirm this finding.  DTI has already been accepted in our courts as a reliable neuroimaging mechanism to detect brain injury from trauma.  Further studies such as this will only strengthen its admissibility.

I have written several times in the past on the validity of Word Memory Testing in diagnosing and treating traumatic brain injuries. A new study calls into question statements continuously made by Paul Green that the SVT measures on the Word Memory Test requires minimal to no cognitive effort.  Reporting in this month’s issue of the Journal International Neuropsychological Society (2008), 14, 1074-1080, Batt et al., from the Department of Psychology McQuarie University, Sydney, New South Wales, Australia, measures the effect of distraction on the Word Memory Test (WMT) and Test of Memory Malingering (TOMM) performance in patients with a severe brain injury. 

According to the paper, the “research compares the performance of a sample of non-litigating participants with severe brain injury on both the WMT and TOMM under conditions of (1) full effort, (2) distraction, or (3) simulated malingering.”  The study included sixty participants with a severe brain injury.  The study revealed that while both tests demonstrated excellent sensitivity, the false positive rates for the WMT were significantly greater than those for the TOMM.  It was concluded that the so-called “effort” components of the WMT required more cognitive capacity than was previously believed.
 
In the discussion portion of the paper, the authors noted that the findings of those participants who failed the WMT had significantly lower estimated pre-morbid intelligence than those who passed, which further supported the notion that the WMT results are influenced by cognitive ability.  The authors also noted:  "In addition to this, false positives on the WMT were unacceptably high, which decreased the specificity of the test to unacceptable level."
 
The authors noted that this unacceptably high rate of false positives may not satisfy Daubert standards.

United States Representative Bill Pascrell, Jr. of New Jersey, the co-founder and co-chairman of the Congressional Brain Injury Task Force, applauded the Department of Veterans’ Affairs for increasing disability payments for veterans diagnosed with mild traumatic brain injury (mTBI). The VA estimates that compensation for mTBI victims will increase from about $117 per month to as much as $600 per month. The VA states that these changes will help roughly 3,500 to 5,000 veterans each year.

A recent study estimates that up to 320,000 troops who served in Iraq and Afghanistan have suffered from a traumatic brain injury. “I’m pleased that the VA has finally opened its eyes, and more importantly its wallet, to the thousands of veterans and their families who have silently suffered from traumatic brain injury,” stated Representative Pascrell.  “This decision was a long time coming, but marks significant progress.  Unfortunately, there is still long way to go before I am fully satisfied with the services available to America’s brain injured veterans.”

Representative Pascrell is awaiting a response to his September 19, 2008 request for the Department of Defense Secretary Robert Gates to expand TRICARE to cover cognitive rehabilitation therapy for TBI victims.  The letter was supported by a bipartisan coalition of 67 House of Representatives members.

In previous blog entries, I have discussed the recent exposé regarding industry’s payment of money to scientists to publish "research" that is supportive in industry’s defense of defective products.  I just finished an outstanding book entitled "Doubt Is Their Product: How Industry’s Assault on Science Threatens Your Health" by David Michaels.  Dr. Michaels is an epidemiologist and Director of the project on scientific knowledge and public policy at the George Washington University School of Public Health and Health Services.  He previously served as Assistant Secretary of Energy for Environment, Safety and Health under the Clinton administration.

Dr. Michaels illuminating book documents "the way in which product defense consultants have shaped and skewed the scientific literature, manufactured and magnified scientific uncertainty, and influenced policy decisions to the advantage of polluters and the manufacturers of dangerous products."

This book follows product after product, toxin after toxin and how the manufactures of these chemicals, drugs and products have deceived, hidden and misrepresented the known dangers of their products.  For all concerned about the public health and how industry has subverted the legal and regulatory systems, this book is a must.  You can purchase the book online here.

I was honored on October 23, 2008 to be reelected to serve a second three-year term on the Board of Trustees of the Brain Injury Association of New Jersey.

On Thursday, BIANJ held their annual meeting.  Besides the election of new officers, BIANJ presented three awards.  The first award was the Founders award for volunteer service which was given to Michael Barnes, for his hard work in volunteering to assist campers with acquired traumatic brain injury at BIANJ’s summer camp. 

The Silvio O. Conte award for public awareness and education was given to the entire children and adolescents committee of BIANJ for their work not over the past year but for their hard work over the many past years.  Members of the children and adolescents committee who were awarded were:

• Stephanie Bar Am             
• Malia Corde                  
• Connie Domingo, M.D.         
• Lori Kyle                    
• Lenore Laracuente, Esq.      
• Joseph Marcantuono, Ph.D.    
• Thomas McBride, Ph.D.        
• Lois Mishkin, MA.CCC/LDTC    
• Crystal Ramirez, MSW, LSW    
• Sue Stephens, LCSW
• Donna Bogart, Ph.D.  
• Barbara Couvadelli, M.D., Ph.D.       
• Wallace Kyle
• Paula Henry
• Linda Levine
• Janet Margusity
• Keri Meberg
• Susan Paradise, M.Ed.
• Brad Ross, Ph.D.
• Judith Woop, M.Ed., RN

Finally, the James and Sarah Brady award for Public Service was given to Debbie McWilliams and the Timothy C. McWilliams, Jr. Foundation (The Timbo Fund).  Three years ago, Debbie and her family lost their son after a long battle as a result of a severe traumatic brain injury.  Following her son’s death, Debbie began the Timothy C. McWilliams, Jr. Foundation which presents small grants to needy individuals with acquired traumatic brain injury.  In the past year, the Timbo Fund has provided grants in excess of $100,000.  Those who are interested in contributing can find the Timbo Fund at www.timbofund.org.

Not to be forgotten were the numerous service awards given to staff for fifteen, ten and five years of service.  As we all know, an organization is only as good as its staff and BIANJ is blessed with outstanding staff members.  This year receiving awards were Barbara Podgorski (fifteen years), René Carfi and Joanna Boyd (ten years) and Stacy Lyons (five years).

Kudos once again go out to Barbara Geiger-Parker, President and CEO of BIANJ as well as to John Tiene, Chairperson of the Board.

It was late in the third quarter and Penn State was fighting not only to keep its undefeated season alive, but its hopes for a national championship as well.  As Penn State quarterback, Daryll Clark scrambled for a seven-yard gain, he collided with two 300-pound defensive linemen.  Seven snaps later, Penn State officials diagnosed Clark with having sustained a concussion from the collision and pulled him from the rest of the game.  Those watching the game could see that Clark was visibly upset by the decision not to let him return to play.

Not only did Penn State win the game and keep its national championship hopes alive, Penn State demonstrated that the health of its athlete was more important than winning a football game.  Dr. Wayne Sebastianelli, Penn State’s Director of Athletic Medicine, was quoted as saying “We know the stakes are high, but we’re pretty much dedicated to the preservation of an athlete’s well-being.  No one questioned it at all.  We knew we had to find another way to win.  That was it.”

The actions by Penn State’s team doctors and coaches should be a lesson to everyone that players who sustain concussions during sporting events should not be returned to play.  Maybe, just maybe, others will follow this example.

Last Thursday, October 23, 2008, I traveled to New York City to participate in a continuing legal education program on traumatic brain injury sponsored by Lorman Education Services.  My topic at the program was Daubert Issues in TBI Cases.  My presentation focused on the evidentiary requirements for expert testimony and steps that can be taken to keep junk science out of the courtroom.  Besides my presentation, the attendees heard from other outstanding attorneys who specialize in neurolaw as well as from Wilfred van Gorp, Director of Neuropsychology at Columbia Presbyterian Hospital.