Category Archives: Government/Research

Preventing Pesticides from Killing Bugs and Brain Cells

A pesticide is “any substance used to kill, repel, or control certain forms of plant or animal life that are considered to be pests.”  No one denies the harm in ingestion of a pesticide.  However, the legality of using certain chemicals in pesticides has been long debated – at present, the chemical chlorpyrifos is of particular concern.

An active ingredient in some pesticides since 1965, chlorpyrifos is “used primarily to control foliage and soil-borne insect pests on a variety of food and feed crops.”  A Google search shows that it is sold under a variety of brand names.  In the past few years, chlorpyrifos has been a focus of concern because of a government-supported study conducted by the Columbia Center for Children’s Environmental Health at Columbia University.  One of the findings of this study confirms, “Children with high pesticide exposure cluster together to form a distinct behavioral phenotype… Cognitive and behavioral deficits associated with this phenotype may be mapped to alterations in brain regions and function.”

Legislation related to pesticide control was first introduced in Congress over a century ago in the Federal Insecticide, Fungicide, and Rodenticide Act.  Since its enactment in 1910, this legislation has been amended and new legislation regulating pesticide use has passed, such as the Food Quality Protection Act in 1996.  In November 2015, the EPA, with former head Gina McCarthy, proposed a ban on the use of neurotoxic chemical chlorpyifos on all food crops.  What then happened to this proposal is unclear.

During the tumultuous tenure of former EPA head Scott Pruitt, in 2017 and 2018, chlorpyrifos came to the pesticide forefront.  In 2017, Pruitt refused to sign off on a ban of the use of chlorpyrifos as a pesticide on food crops.  This decision, many say, is a sign of Pruitt siding with the “Pesticide Lobby”.  Groups such as the Environmental Working Group (EWG) have denounced and fought against Pruitt’s action, noting that, “The evidence is overwhelming that even small doses of chlorpyrifos can damage parts of the brain that control language, memory, behavior and emotion.”  Finally, last month, Pruitt’s decision was reversed by the United States Court of Appeals for the Ninth Circuit – the EPA now bans the use of chlorpyrifos on food crops.

While the above decision is a victory for food safety, the results of this legislation are not immediate.  Additionally, fruits and vegetables must still be washed before eaten both to eliminate any residual pesticide and to better the taste.  On the positive note, though, the EWG notes that, “the agency [has] put children’s health, strong science and the letter of the law above corporate interests.”

McCain’s Posthumous Charitable Hopes

In 2002, Senator John McCain was instrumental in establishing the Arizona-based nonprofit Translational Genomics Research Institute (TGen),  “a one-of-a-kind genomics research institute.” Unfortunately, the research focus of this institute later became all too important for McCain, as his diagnosis of brain cancer was announced last year.  After losing this year-long battle with glioblastoma*, Senator McCain was laid to rest near the US Naval Academy in Annapolis, Maryland on Sunday, September 2, 2018.  However, his service to America has not ended.

A visit to the memorial webpage of the late Senator provides not only a history of the man and synopses of the moments of honor that have occurred since his death on August 25, 2018, but also gives the visitor an opportunity to donate to two nonprofits specifically selected by McCain: The McCain Institute Foundation and the Translational Genomics Research Institute (TGen).

*According to the NIH, glioblastoma is, “the most common and aggressive malignant brain tumor in adults.”  As previously reported on this site, symptoms of brain malignancy, a.k.a. brain cancer, include headaches, seizures, speech difficulty, weakness and double vision – symptoms that can also be found following a traumatic brain injury.  The question as to whether there is a link between brain injury and brain cancer has been “long-debated”, as was remarked on in a 1979 NIH report.  Today the NIH continues this investigation.  Two years ago, they reported, “Epidemiological studies are equivocal on the possible link between trauma and increased risk of malignant glioblastoma… We propose a putative pathogenesis model that connects post-traumatic inflammation, stem and progenitor cell transformation, and glioblastoma.”

Mitigation for Morality and Murder

In the modern world, our understanding of science changes rapidly.  Law, at large, does not change so rapidly.  What has changed, in the past 20 years, is that defense lawyers have begun, during the trial and/or sentencing phases of court, to use brain damage/injury as a mitigating factor for criminal acts.

Brain injury was first introduced as a defense in 1966 for Charles Whitman, the so-called Texas Tower Sniper.  (Whitman stabbed his mother and his wife, shot to death 16 people at the University of Texas at Austin and shot and injured 31 others.  An autopsy upon his death found a tumor in his brain.)  Since the start of this century, the exploration into the effects of brain injury on what some may see as moral quandaries for those with neurological deficits has broadened.  Generally, what has been found is that head injury, specifically a brain lesion, can hinder executive functioning, which governs the ability to plan ahead, think things through, manage impulse, etc.  However, this is basic knowledge that applies to all brain injury survivors; tests specifically related to the unique brains of those who commit criminal acts are inconsistent.

In 2015, the NIH published a report, Does TBI Lead to Criminality?.  Their conclusion states, “The results support a modest causal link between traumatic brain injury and criminality.”  Investigations have shown that while brain injury is not a sufficient defense for a criminal act, it may be a mitigating circumstance in the sentencing phase of a trial – treatment versus incarceration.

Since then, brain damage/injury has often been used as a defense, most recently earlier this month: a convicted murderer in Ohio said, during sentencing, “Not everyone is fortunate enough to have a caring family or outside guidance… I am proof [that] a young person – beaten and abused physically, emotionally, and mentally – becomes the abuser.”   Though the defendant now admits to the killing of five women, the testimony of one of two testifying doctors states that because Kirkland MAY have a brain injury, he should not receive the strictest punishment, the death penalty.

Perhaps, though, the “brain injury” defense will relatively soon become a thing of the past.  The above-mentioned NIH report further concludes, “Reducing the rate of TBI… might have benefits in terms of crime reduction.”  (Since this report was released, more defendants have used brain damage as a mitigating factor for criminal acts.)  According to a UK study, approximately 50 to 70% of the incarcerated population has a brain injury.  That percentage is thought to be in the same realm as those imprisoned in America.  Given these astonishing statistics and the continuing government-sponsored and private research on brain injury prevention and recovery, the NIH’s conclusion seems a definite possibility.

(See also Massachusetts General Hospital – Center for Law, Brain & Behavior, “an academic and professional resource for the education, research, and understanding of neuroscience and the law.”)

MS: Cause, Effect or Comorbidity

Multiple sclerosis (MS) is presumed to be an autoimmune disorder, but beyond that, is not fully understood.  What is understood is some of the terrible symptoms that can occur with MS, including: blurred or double vision, muscle weakness, lack of coordination, imbalance, impaired walking/standing, speech impediments, tremors, hearing loss, difficulties with concentration, attention, memory, and poor judgement.  To those who read this blog and/or have personal knowledge of brain injury, the symptoms should be apparent, but for the purpose of this article it is necessary to spell out some of the symptoms of moderate to severe brain injuries: dilations of the pupils, seizures, slurred speech, weakness, loss of coordination, restlessness or agitation, chronic headaches, increased confusion, lightheadedness, dizziness, blurred vision, ringing in the ears, fatigue, behavioral or mood changes and trouble with memory, concentration, attention, and thinking.  As can be seen, even in these abbreviated lists, MS and TBI exhibit many of the same symptoms.  For this reason, it is not a surprise to find that the two may have a connection – however, the results of multiple NIH-funded studies on the subject have not, as of yet, been able to determine what exactly is this connection.

In 2006, for example, in a study titled “Risk of multiple sclerosis after head injury: record linkage study,” the NIH concluded: “There was no significant increase in the risk of MS at either short or long time periods after head injury.”  However, six years later, in 2012, the NIH released a study with the title: “Increased risk of multiple sclerosis after traumatic brain injury: a nationwide population-based study.”  In 2016, a study essentially took the middle-ground, concluding that, “The presence of comorbidities in patients with MS is associated with brain injury.”  (Therefore, they concluded that if someone has another disorder, as well as MS, they may be more likely to have a brain injury.)

The “cause or effect” confusion is recognized by researchers, as in 2017 a scientist at Harvard University remarked, “Some studies suggest that head injuries might be a risk factor for MS… On the other hand, it’s not an easy thing to study because researchers would never intentionally cause head injuries to see if they cause MS.”  However, this Harvard study did find that having a single concussion during childhood gave a person a 22% higher rate of MS and the percent was doubled for those who had more than one concussion.

Whether MS and TBI have a cause-and-effect relationship or not, their similar symptoms may mean that exercise is of particular benefit to those with multiple sclerosis, just as it is to those with brain injury.  To test this hypothesis, the NIH has funded a study at the University of Alabama at Birmingham and at the New Jersey-based Kessler Foundation specifically to determine the benefit of exercise training for cognitive deficits in MS.  The study will see if 3-months of treadmill walking for the participants improves their cognitive processing speed, brain volume, and functional connectivity.  “The study may provide the first Class 1 evidence for the effects of treadmill walking exercise training as a rehabilitative approach to cognitive deficits in people with multiple sclerosis,” says Brain Sandroff, PhD of UAB and principal investigator of the study.

Potential Biomarker of “Bad” Brain Injuries

Rebecca M.

It is often quite hard to determine how bad a brain injury is soon after it has happens, yet speed is needed for the best treatment of the injury, in order to have the best chance of recovery.  No one brain injury it quite like another.  Earlier this year, the National Institutes of Health (NIH) funded an important study about advances in the treatment of brain injuries.  Briefly, the study group identified that the brain lipid molecule, a type of fatty acid in brains, known as lysophosphatidic acid (LPA), significantly increased after a TBI in a preclinical animal model.  In general, fatty acids in the brain are thought to be important in brain function, but in excess, they are not healthy.  Moreover, the researchers found that LPA was elevated in areas associated with cell death and axonal injury, both major hallmarks of moderate and severe TBI.  The study was carried out at the David Geffen School of Medicine at UCLA.

If the results of this study holds for humans, it will give doctors a tool to ID right away if they are dealing with a moderate to severe brain injury, and not a mild one.  Though it has only been studied in animals, LPA could possibly be used as a biomarker of TBI, which could be particularly useful in cases when it is not clear if a brain injury has occurred.  (In some cases, such as a very bad car accidents, it is pretty clear that there has been a moderate to severe injury and cell death.  But that is not always the case, as with ABIs and other TBIs, it might less clear how bad the injury is without using a biomarker tool.)

Monitoring the LPA levels of a brain injury patient may allow neurologists to make smart and fast decisions with as many tools as needed medically, rather than having to guess about the severity, based on one factor – the amount of swelling.

New Technology, Same Problems

Last year, I reported on the secondary danger that can arise from using the shoulder-launched heavy artillery Carl Gustaf.  Carl Gustaf has a twin though – heavy artillery known as SMAW…  and, just like with Carl Gustaf, SMAW is strong enough both to blow up a tank and to cause severe brain injury to the shooter in the process.

Late last month, NPR reported on the effects the use of SMAW had on two former soldiers.  After every shot, you felt a “concussive wave”, one soldier said, before continuing to say “it’s an awesome thing”.  Based on this description, as well as these soldiers’ ongoing support for the military, one can see that “blaming” an institution that they love so much for their current deficits is a difficult thing for these soldiers.  For the same reason, many other soldiers find themselves in a conundrum when it comes to their opinion of the military.  (Statistics show, for example, that though enrollment in the military is at a low, retention is up.)  However, it seems that the military recognizes that, in some way, they, specifically their weaponry, are at fault for some injuries, as they keep putting more money into research (e.g. with animal models).  They also have set up a TBI Recovery Support Program and, as a member of that Program states, “If you talk to us in a year… I think we’re going to have exponential growth in our knowledge.”

However, is some of this concern over brain injury just unnecessary worry?  The soldiers NPR quotes in their article ask that question.  (This is very similar to the responses of some players, coaches and parents regarding brain injury in football.)

(Another interesting subject in the above-linked NPR article is the difficulty soldiers, who acquire a brain injury while not in combat, have in getting healthcare coverage for their recovery.)

Virginia Battles BI with Targeted Funds

Being home to the Pentagon, headquarters of the Department of Defense, Virginia has been the center of much brain injury research and treatment.  Having a background in pediatric neurology and a past residency at the Brooke Army Medical Center, a military hospital located in Texas, Governor of Virginia Dr. Ralph Northam has seen the short-term and long-term effects of brain injury.  Given this, Gov. Northam authored a proclamation for Brain Injury Awareness Month in March, stating, “WHEREAS, early, equal, and adequate access to care greatly increases the overall quality of life of Virginians with TBI, enabling them to return to home, school, work, and community.”

From 2014 to the present, “Virginia has received $3,573,485 in Federal TBI Planning, Implementation, and Implementation Partnership Grants. The State has provided $1,785,260 in matching support.”  However, this federal grant is set to expire after 2018.  Last week, Northam awarded a three-year $900,000 grant to the Virginia Department for Aging and Rehabilitative Services (DARS), earmarked for Brain Injury Services Coordination (BISC) Unit.  (Notes DARS Commissioner Kathryn A. Hayfield, this new grant is just another example of Virginia’s support for brain injury services, which has been ongoing since the 1980s.)  As it is, the goal of BISCU is to, “enhance the quality of life and vocational goals of persons with… brain injury.”  The goal of this grant is to go further than this, as the agency continues to enhance the “health, wellness and independence of people with TBI,” by enhancing “access to supports and services,” states Dr. Daniel Carey, Secretary of Health and Human Resources.

Full Recovery May Be on the Horizon

By definition, a traumatic brain injury harms the brain and, therefore, the neurons that reside therein.  In recovery, one is taught how to live effectively with these deficits.  However, “the big issue with treatment after TBI is that there are no drugs that work well on patients to restore memory,” says Bonnie Firestein.  Firestein is the senior author of a decade-long study, led by the Department of Cell Biology and Neuroscience at Rutgers University, that may have found the means to full recovery.

Specifically studied was the protein Cytosolic PSD-95 interactor, also known as Cypin, “the primary guanine deaminase in the brain [that] plays key roles in shaping neuronal circuits and regulating neuronal survival.”  (Guanine is, “an important building block for DNA and RNA in cells.”)

To summarize the study’s findings, the abstract on the NIH site states, “Administering either cypin activator directly into the brain one hour after traumatic brain injury significantly reduced fear conditioning deficits 5 days after injury, while delivering the cypin inhibitor did not improve outcome after TBI. Together, these data demonstrate that cypin activation is a novel approach for improving outcome after TBI and may provide a new pathway for reducing the deficits associated with TBI in patients.”  Though this tactic of recovery has only been tested on mice, as of yet, the similar neurological structure of mice to humans makes it possible that this newly found method of treatment would work in humans, as well.

At Home Brain Care

Last week, the University of Arkansas for Medical Sciences received a three-year, $450,000 grant from the U.S. Department of Health and Human Services Administration for Community Living, in addition to the $75,000 annual gift they are receiving from the Arkansas Department of Health.  The federal grant is to be applied to the University’s Traumatic Brain Injury State Partnership Program State Funding Opportunity.  “Among the goals of the program… are incorporating telemedicine and other technologies into TBI services to survivors, raising awareness of clinical and educational services for survivors, caregivers and families…”  Telemedicine increases healthcare access for all, particularly those is rural areas and others that cannot easily visit medical facilities, such as those with tbi who need aid in transportation.

Although it may seem to be a relatively modern invention, forms of telemedicine have been in existence since man could verbally communicate.  The more modern view of telemedicine, involving both verbal and visual communication with the medic, was first seen in 1924 in, “an imaginative cover for the magazine Radio News foreshadowed telemedicine in its depiction of a ‘radio doctor’ linked to a patient not only by sound but also by a live picture.”  Though at the time, the ideas of television and telemedicine were merely fantasies, the first television transmission occurred only 3 years later.  Video communication between doctor and patient, however, is usually first dated to 1959.  1959 is also the year of the first neurologic examination through telemedicine, occurring at the University of Nebraska.  Five years later, means to treat patients with brain injury and neurological disorders were found, as, “they established a telemedicine link… to provide speech therapy, neurological examinations, diagnosis of difficult psychiatric cases, case consultations, research seminars, and education and training.”

The above paragraph primarily comes from information in a 1996 article that can be found on the site of the National Academy of Sciences.  In 1996, the government recognized that there was a vast need for telemedicine, since its envisionment to the present day.  With both new technology and increased forms of communication, telemedicine has gone far above what could have been imagined 22 years ago.  For example, a 71-page report penned by the Undersecretary of Defense to the House Chair of the Committee of Armed Services, states that, “the Department of Defense views telemedicine as an important set of tools to improve access to Psychological Health and TBI care services in both deployed and non-deployed settings.  In June 2018, the FDA approved the distribution of MindMotion GO, a type of mobile therapy that focuses on speech and task therapies.  As far as brain injury diagnosis, while CT scans and other such tests may need to occur at medical facilities, medical professionals are now using communication technology to diagnose another neurological disorder (autism) and to evaluate others (computerized concussion assessment).
 

Alexa and Her Friends Promote Independence

The new technology of smart homes has sparked the interest of all Americans, as they imagine Alexa and other such tools closing the blinds, turning off the stove and other such activities at a specific time.  For those with a brain injury and/or other disabilities, the possibilities are even greater, allowing them to, “independently plan, organize and complete everyday activities.”

Nearly a decade ago, in 2009, the government saw the potential of smart homes for the disabled, when it concluded, “more outcomes-based research and collaboration among stakeholders is essential in order to establish guidance for designing, selecting and implementing individualized smart home solutions for those with neurological disability.”  To identify both the needs of those with brain injuries, as well as their caregivers and their rehabilitation and home healthcare providers in smart homes, the government conducted such studies, as that in 2016.  To condense the findings of this study, it found that “to meet participation needs of people with ABI, the design of smart homes must consider all categories of daily and social activities.”  More so, the VA found that smart homes actually aid in cognitive rehabilitation, as VA smart homes send technological reminders when someone goes “off track”.  The VA has stated smart homes have been described as a ‘cognitive prosthetic‘, telling someone when to take their medication and even such things as notifying someone how long they have been shaving.

Last month, the Gary Sinise Foundation, an organization whose mission is to “serve our nation by honoring our defenders, veterans, first responders, their families, and those in need,” built a smart home in Wildwood, Missouri for a veteran who lost both his legs and suffered a brain injury after stepping on an IED in Afghanistan.  This month, the Gary Sinise Foundation gave a smart home that they built in Richland County, Ohio to a former Army Sergeant who also suffered a traumatic brain injury and leg injuries while serving in Afghanistan.  As smart homes become more available, for both individual residence and community living, further independence can be known to many more with brain injuries.