Posted by: Chris Maloney | August 19, 2012

Traumatic Brain Injury: How Well Are We Treating It?

A100319_MAMC_TBI 1

A100319_MAMC_TBI 1 (Photo credit: Joint Base Lewis McChord)

Traumatic brain injury affects athletes, soldiers, and children.  It removes otherwise capable members of our society and turns them into invalids without visible injury.  The diagnosis and treatment of Traumatic Brain Injury needs to be a priority.  So how well are we doing?

We still cannot agree on a definition of the degree of Traumatic Brain Injury.  An Australian study voiced the ongoing confusion.  Doctors “defined mTBI (mild Traumatic Brain Injury) in a variety of ways and described different rules to determine the need for CT scanning and therefore used different criteria to identify high-risk patients.” (Acad Emerg Med. 2011 Aug;18(8):880-9.)

If diagnosed correctly, Traumatic Brain Injury patients are not given appropriate screening.  Most receive an initial CT scan, but many continue to receive scans without evidence.  “Routine follow-up CT scans rarely alter treatment for patients with complicated mild TBI.”  (Emerg Med J. 2012 Jul;29(7):528-32.) Only when the scans are done after neurological deterioration are the scans useful at helping with treatment.

Once a patient has received both correct diagnosis and screening, there is a great deal of confusion about appropriate drug treatment.  We don’t know which medications are the most effective even for helping patients sleep.  (Crit Care Med. 2011 Dec;39(12):2743-51.)

But surely we at least have documented what physical therapy is most helpful?  Not really.  Expert researchers conclude: “It becomes evident that the currently available data on physiotherapy and occupational therapy are very limited.”  (Crit
Care Res Pract. 2012;2012:768456.)

So we currently do not have a clear picture of how to correctly diagnose and screen for Traumatic Brain Injury and its complications.  In treatment we have no conclusive evidence about what drugs or physical treatments are most effective.  We cannot expect patients to not look for alternatives.

What is the evidence of several alternatives?

A Review of Studies about Acupuncture for Traumatic Brain Injury shows:

“Three investigated electro-acupuncture for TBI while one investigated acupuncture for acute TBI. The results seem to suggest that acupuncture is efficacious for these indications, however the low methodological quality of these studies renders the results questionable. No adverse effects of acupuncture were reported in any of the studies.” (Eur J Phys Rehabil Med. 2012 Mar;48(1):71-86.)

Homeopathy for Traumatic Brain Injury shows:

Analysis of covariance demonstrated that the homeopathic treatment was the only significant or near-significant predictor of improvement on DSS subtests (P =.009; 95% CI -.895 to -.15), SRS (P =.058; 95% CI -.548 to.01) and the Ten Most Common Symptoms of MTBI (P =.027; 95% CI -.766 to -.048). These results indicate a significant improvement from the homeopathic treatment versus the control and translate into clinically significant outcomes.”  (J Head Trauma Rehabil. 1999 Dec;14(6):521-42.)

A possible positive side effect for homeopathy in Traumatic Brain Injury might be its effect on other related issues.  “Efficacy was found for the functional somatic syndromes group (fibromyalgia and chronic fatigue syndrome), but not for anxiety or stress. For other disorders, homeopathy produced mixed effects.” (J Clin Psychiatry. 2011 Jun;72(6):795-805.)

We desperately need to find solutions for Traumatic Brain Injury.  In the absence of clear guidelines, patients should be encouraged to utilize any reasonable treatments.

 

 

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