Date: Dec. 4, 2008
Contacts: Christine Stencel, Media Relations Officer
Alison Burnette, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail <news@nas.edu>
FOR IMMEDIATE RELEASE
Military Personnel With Traumatic Brain Injury at Risk for Serious Long-Term
Health Problems; More Studies Needed on Health Effects of Blast Injuries
WASHINGTON -- Military personnel who suffer severe or moderate traumatic brain injury (TBI) face an increased risk for developing several long-term health problems, says a new report from the
In addition, the report notes that brain injuries sustained as a result of exposure to the force of an explosion without a direct strike to the head -- one of the most common perils for soldiers in
"Explosive devices and other weaponry have become more powerful and devastating throughout the wars in Iraq and Afghanistan, and we are seeing much higher rates of nonpenetrating traumatic brain injury and blast-induced injury among military personnel who have served in these countries than in earlier wars," said George W. Rutherford, professor of epidemiology and preventive medicine and vice chair, department of epidemiology and biostatistics, School of Medicine, University of California, San Francisco, and chair of the committee that wrote the report. "It is important to identify and understand any long-term health effects of these injuries so that wounded service members do not lose valuable time for therapy and rehabilitation."
As of January, more than 5,500 military personnel have suffered TBIs during the conflicts in
Although recent clinical findings and military experience have shown that short-term and long-term neurologic deficits may result from exposure to the energy of a blast without a direct blow to the head, the prevailing opinion among neurological professionals had been that blast-related impairments were rare because the skull adequately shields the brain. The report recommends that VA and DOD support research on BINT and the development of a good animal model of BINT, which is currently lacking. Without good research data, neurological and behavioral changes in blast victims may be underestimated and undiagnosed, and these individuals may not get timely needed treatment, the report notes.
TBI can be mild, moderate, or severe. The committee's review of the research on TBI at all levels of severity determined that there is sufficient evidence that brain injuries resulting from severe, skull-piercing wounds can cause unprovoked seizures and premature death. Seizures can also be caused by severe, nonpenetrating TBI as well as more moderate brain injury.
Studies link both moderate and severe TBI with other long-term consequences, including increased risk for Alzheimer's-like dementia, symptoms similar to those of Parkinson's disease, and diminished abilities to maintain social relationships. Other data links mild TBI to increased risk for PTSD among Gulf War veterans. The evidence in these cases shows an association, but it is not sufficient to conclude that TBI causes these problems. Likewise, TBI at any level of severity -- even mild -- appears to be associated with increased risk for aggressive behavior, depression, and memory and concentration problems.
TBI may be associated with certain other potential consequences, but the evidence is only suggestive of a link. For example, moderate and severe TBI may put individuals at greater risk for developing diabetes insipidus and psychosis, but the evidence is limited. Some data suggest that mild TBI accompanied by loss of consciousness is linked to the development of symptoms similar to Alzheimer's and Parkinson's disease as well as vision problems and seizures, but the data have significant shortcomings. Likewise, TBI at all levels of severity may be linked to reduced alcohol and drug use within the first few years following the injury, but there is inadequate evidence to be certain.
Due to insufficient evidence, it is not possible to say whether mild TBI can result in neurocognitive deficits or loss of ability to function socially. Also, the evidence does not indicate whether mild TBI that was not accompanied by loss of consciousness could lead to the development of Alzheimer's-like dementia, or whether any TBI is linked to mania, bipolar disorder, multiple sclerosis, or amyotrophic lateral sclerosis.
To develop a fuller picture of the effects of TBI and blast injuries, the committee recommended that DOD conduct pre-deployment neurocognitive tests of all military personnel to establish a baseline for identifying post-injury consequences and that the VA include uninjured service members and other comparison groups in the Traumatic Brain Injury Veterans Health Registry which it is building.
The study was sponsored by the U.S. Department of Veterans Affairs. Established in 1970 under the charter of the National Academy of Sciences, the
Copies of Gulf War and Health: Long-Term Consequences of TBI are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
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[ This news release and report are available at http://national-academies.org ]
Board on Population Health and Public Health Practice
Committee on Gulf War and Health: Brain Injury in Veterans and Long-Term Health Outcomes
George W. Rutherford, M.D. (chair)
Salvatore Pablo Lucia Professor and Vice Chair
Department of Epidemiology and Biostatistics; and
Director
Prevention and Public Health Group
Global Health Sciences
Jeffrey J. Bazarian, M.D., M.P.H.
Associate Professor
Departments of Emergency Medicine and Neurology
Ibolja Cernak, Ph.D., M.D.
Medical Director
Applied Physics Laboratory
John D. Corrigan, Ph.D.
Professor
Department of Physical Medicine and Rehabilitation
Sureyya S. Dikmen, Ph.D.
Professor
Department of Rehabilitation Medicine, and
Adjunct Professor of Neurological Surgery and Psychiatry and Behavioral Sciences
M. Sean Grady, M.D.
Chair
Department of Neurosurgery
Dale C. Hesdorffer, Ph.D., M.P.H.
Associate Professor of Clinical Epidemiology
Jess F. Krauss, Ph.D., M.P.H.
Director
Southern
Professor
Department of Epidemiology
Harvey S. Levin, Ph.D.
Professor, and
Director of Research
Cognitive Neuroscience Laboratory
Department of Physical Medicine and Rehabilitation
Linda J. Noble, Ph.D.
Professor
Departments of Neurological Surgery and Physical Therapy and Rehabilitation Science
Samuel J. Potolicchio, M.D.
Professor
Department of Neurology
Scott L. Rauch, M.D.
Chair
Partners Psychiatry and Mental Health;
President and Psychiatrist in Chief
Professor of Psychiatry
William M. Stiers, Ph.D., ABPP
Assistant Professor
Department of Physical Medicine and Rehabilitation
Carol A. Tamminga, M.D.
Professor
Department of Psychiatry
Nancy R. Temkin, Ph.D.
Professor
Departments of Neurological Surgery and Biostatistics
Marc Weisskopf, Ph.D., Sc.D.
Mark and Catherine Winkler Assistant Professor
Departments of Environmental Health and Epidemiology
Carolyn Fulco, Degree
Study Director