Category Archives: Government/Research

Sex in the Brain: Hypersexuality

During the winter, when the cooler weather keeps people indoors, sex may have a more prominent part in the lives of many couples.  Since the feelings that ultimately result in sex are developed in the brain, they can be altered by a brain injury.  Additionally, since the desire for sex is neurological, if, when and with whom someone wants to have sex can be changed by a brain injury.  Finally, how someone expresses their feelings following a brain injury may be altered.  Today, I present the first of several articles that showcases federal research and other important information regarding the expression of libido in those with brain injuries in an article series titled Sex in the Brain.

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A 43-year-old man was in an auto accident.  The accident left the man in a coma and having seizures for three weeks.  Upon regaining full consciousness, while still in the hospital, he masturbated multiple times a day for the next 2 weeks…. A 33-year-old married woman with children was in a car crash that caused a moderate head injury.  Though it was 2 weeks until she regained full consciousness and though she had aphasia for 4 weeks, X-rays of the skull showed no abnormalities in the brain.  However, while at the hospital, she flashed a female visitor and consistently, “demanded to go home to fulfill her sexual urge.”

The above two stories are some of the clinical data from a 2008 study regarding hypersexuality, also known as compulsive sexual behavior, following brain injury.  Hypersexuality, previously termed nymphomania in men and satyriasis in women, is, “the inability to regulate one’s sexual behavior that is a source of significant personal distress.”  It is about the object of sex, as opposed to the relationship.  Sexual fantasies, urges and behavior become a preoccupation that is difficult to control, causes distress and ultimately has negative effects on one’s health and life.  Its presentation can be in numerous ways, such as through excessive and public masturbation, an excessive number of sexual partners, an excessive use of pornography and/or paying for sex.  If this occurs for over 6 months, it is considered an addiction, specifically a process addiction like gambling, binge eating or compulsive spending.

Also, like any other addiction, hypersexuality has a neurological basis and, therefore, can be either a primary diagnosis or secondary diagnosis caused by another disorder, such as bipolar disorder, dementia or traumatic brain injury, among other disorders, or caused by medication, like dopamine agonist.  Neurologically, it is caused by an injury to the frontal lobe.  Though it may be a sensational topic, it is rare.  (It is more common among those arrested for exhibitionism than it is for the general public.  “Between 5 and 35% of those arrested for exhibition are found to be suffering from organic disorders to which the behavior can be at least partially attributed.”)  Additionally, it is more common in men.

Despite all the federal research to prove it as a unique impulse control issue, when the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) came out in October 2017, hypersexuality was not included.  (Hypersexuality and compulsive sexual behavior both fell under the “sexual disorders not otherwise specified” category in DSM-4.)  That year, though, the NIH did develop a new defining phrase to explain actions that occur due to the disorder: the sexhavior cycle of hypersexuality.

Brain Injury Task Force Loses a Chair

This week, the 116th Congress was sworn in on Capitol Hill.  Unfortunately, that means that the Congressional Brain Injury Task Force lost one of its Chairs, Congressman Thomas Rooney (FL), who did not seek reelection.

Having served in the Army for 4 years in combat and 4 years in the reserve, Rooney accorded special attention to brain injury in the military on the Task Force.  This summer, it was reported, “House Approves Rooney-Requested Funding for Traumatic Brain Injuries.”  (Seen now on the website VoteSmart, this article is a repost first seen on the official Congressional website for Rooney, which is now defunct.)  The requested funding given was $125 million.

As a member of the House Appropriations Committee, Rooney dealt with the financing of government bills and other such actions.  (The House Ways and Means Committee is also focused on financial needs, a Committee that counts co-chair of the Brain Injury Task Force Congressman Pascrell as a member.)  Of this victory, Rooney stated, “The reality is our service members take great risks when they enlist to fight for our country. One of the biggest risks is TBIs, which can lead to severe mental health issues like depression and even suicide. These problems are serious and real and each dollar we spend towards research and treatment puts us one step closer to helping our military.”  (It is important to note that the VA conducts research that benefits all Americans, not simply those in the armed forces.)

Rooney is succeeded in Florida’s 17th District by former State Legislator Greg Steube.  Like his predecessor, Steube is a veteran with 4 years in combat.  Hopefully, Steube will have as much consideration for brain injury as his predecessor, too.

 

Update: Bipartisan Appeal for Reauthorization of TBI Act

On Friday, December 21, 2018, “H.R. 6615, which reauthorizes appropriations for programs and activities relating to the study, prevention, and treatment of traumatic brain injury (TBI),” was signed into law by President Trump.  Officially called the Traumatic Brain Injury Program Reauthorization Act of 2018, the bill previously passed the House with a 353-6 margin and passed the Senate unanimously.  (Reauthorizations were also given to other key health bills, H.R.1222, the Congenital Heart Futures Reauthorization Act of 2017, and H.R. 1318, the Preventing Maternal Deaths Act of 2018.)

Earlier this month, Congressman Pascrell spoke of the bill in House, “Mr. Speaker, I rise to support H.R.6615… I would like to thank Chairman Walden and Ranking Member Pallone for their work to move this important legislation forward.”  Following being signed into law, Chairman Greg Walden (OR) said, “These bipartisan bills… represent a continuation of the hard work [the House Energy and Commerce Committee] has done this Congress to protect and improve the health of all Americans.  From reauthorizing programs so we can better treat and understand congenital heart defects to increasing our understanding of traumatic brain injury, to improving maternal health outcomes… these bipartisan bills will have a profound effect of the lives of children, families, and communities all across the country.”

 

Government Studies Brain Injury in the Bible

America is, and should be, a country of religious freedom.  The roots of the winter holiday season, though, are based on the beliefs of Judaism and Christianity expressed in the Bible.  (Currently, more than 70 percent of Americans consider themselves either Christian or Jewish and all but two of our Presidents have been officially affiliated with some form of Christianity.)

Although the Bible is seen as the word of God by many, according to the American government, “the Bible is not just a religious text.  It is also a historical account.”  Taking this point of view, the government has studied the existence of brain injury in the Old Testament.  In 1995 and 1997, the NIH reviewed, “the death of Sisera by the hand of Jael (Judges 4: 21; 5: 25); the skull fractures of Avimelech incurred at the tower of Tevetz, (Judges, 9: 53, 54); and the slaying of Goliath by David, (Samuel I 17: 49-51).”  In addition, the government studied the child of the Shunammite woman in II Kings 4.  They determined that the child had a subarachnoid hemorrhage, also known as bleeding around the brain.  In 2010, an NIH study titled New insights to the neurological diseases among biblical characters of old testament found evidence of stroke in 1 Samuel, Psalms 137 5-6 and Ezekiel.

Notwithstanding the conclusions of these new studies, the Hebrew and Christian Bibles are ultimately religious books – the government calls them books of love, peace and hope.  Searching through the Bible, I discovered a quote that expresses love, peace and hope to all brain injury survivors: “More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not put us to shame,” (Romans 5:3-5).

Bipartisan Appeal for Reauthorization of TBI Act

The federal Traumatic Brain Injury Act provides many benefits to survivors.  For example, much of the research that I reference on this website is done by organizations funded through the Act.  When it was originally signed into law in 1996, the TBI Act defined its goals as to “identify methods of preventing traumatic brain injury; expand biomedical research efforts to prevent or minimize the severity of dysfunction as a result of such an injury; and to improve the delivery and quality of services through state demonstration projects.”  More than 20 years later, the basic goals of the bill remain the same.  However, every few years reauthorization is required, and new amendments are added.

This year, Congressman Bill Pascrell presented H.R. 6615 to the House for this reauthorization on July 26, 2018.  (Rep. Pascrell is the co-chair of the Congressional Brain Injury Task Force.  The bill was co-sponsored by the other co-chair of the Task Force Rep. Thomas Rooney (FL), and by Rep. Brian Fitzpatrick (PA), Rep. Eleanor Holmes (DC), Rep. Steve Cohen (TN) and Rep. Brian Higgins (NY).)  “I am proud to introduce this critical bipartisan, bicameral reauthorization of the Traumatic Brain Injury Act,” Pascrell said.  In particular, the bill is seeking a $186,000 increase in the annual budget of the National Concussion Surveillance System.  (From $6,564,000 each fiscal year from 2015 through 2019 to $6,750,000 each fiscal year from 2019 through 2023, to perform aspects of data collection and evaluation.)  Established in 2016, NCSS seeks to, “determine the prevalence and incidence of concussion,” through such activities as household telephone surveys.  Additionally, the bill aims to increase the budget for state and federal research grants. 

This week H.R. 6615 passed the House and was sent to the Senate.  Termed S. 3657 in the Senate, the Traumatic Brain Injury Program Reauthorization Act of 2018 is sponsored by Sen. Orrin Hatch (UT).  (The fact that the main sponsor of the bill was Rep. Pascrell, a Democrat, in the House and Sen. Hatch, a Republican, in the Senate is further proof of its bipartisan appeal.)  As Hatch said, “We know TBI is a serious problem, but we fail to grasp its severity and scope. Our bill will change that… our legislation will extend important research, education, and advocacy efforts to help us better understand the nature of brain trauma and reduce the prevalence of these injuries going forward.”

TBI Beyond the Brain: Intestinal Impact

The brain maintains executive function over the entire body.  As we have all learned, when someone has the flu, it’s really the brain that “tells” them that their stomach hurts.  However, what happens when the brain and its functioning therein are injured?

The medical field has been studying this for some time.  About a decade ago, for example, the NIH concluded that a traumatic brain injury brings an increase in intestinal permeability.*  (Beyond TBI, increased intestinal permeability can be cause by such things as excess alcohol consumption.)  “Intestinal permeability is a barrier feature closely linked to the intestinal commensal microbiota as well as to the elements of the mucosal immune system.”  The term is often used synonymously with “intestinal barrier,” even though the two do not have the same exact definition.

 

In 2015, the NIH found, “Deficits in intestinal permeability may underpin the chronic low-grade inflammation observed in disorders such as depression.”  Depression is, of course, all too common among those with brain injury, so discovering one of the causes and perhaps finding a cure could be of extreme benefit.  Last year, the University of Maryland again studied the correlation between traumatic brain injury and intestinal damage.  (This study only examined the effects in mice.)  To summarize their findings into one sentence, scientists now recognize that, “brain trauma can make the colon more permeable, potentially allowing harmful microbes to migrate from the intestine to other areas of the body, causing infection.”  In essence, they found it to be a two-way street: the brain can “harm” the gastro system and the intestinal system can do the same to the brain.  (At the moment, damage discovery seems to be the only goal.  Perhaps fixing the problem and preventing later brain damage will come next.)

* As interesting as the above results are, traumatic brain injury is so named because it is severe and the resulting health problems likely go beyond the brain.  Other internal and external organs may be affected by the incident.  If the gastrointestinal system is physically harmed, it will no longer function in an optimal manner.  Digestion may no longer be such an easy/painfree activity.   Absorption of all nutrients may no longer be possible.

Mercury on the Mind – 2

Following the posting of my last article, I found additional interesting information about mercury and dentistry (dentistry may not be the primary use of mercury, but it is the most visible one).  Although mercury is no longer toxic once it is absorbed into a compound in a dental filling, laws regarding the use, particularly the dental use, of mercury exist.  For example, in New York, the environmental conservation law was amended in 2002 to state, “no dentist shall use or possess elemental mercury in the practice of dentistry unless such elemental mercury is contained in appropriate pre-encapsulated capsules.”

As it relates to a medical procedure that many brain injury survivors undergo, this summer the journal Radiology published an article: High-Strength MRI May Release Mercury from Amalgam Dental Fillings.  Further study of the possible effects of MRIs and mercury, show that while MRIs on someone who has mercury in their body may not cause or cause harm to a brain injury per se, NIH studies, “provide further support for the noxious effect of MRI (exposure to strong magnetic field) and release of mercury from dental amalgam fillings.”  (Additionally, MRIs can harm implants, such as brain stimulators, which may contain mercury.)

(In relation to the use of the ten chemicals of health public concern, particularly as it relates to dentistry, I would also advice people to be wary of fluoride.  The World Health Organization warns of both inadequate or excess fluoride intake.  Just like mercury, fluoride can help teeth at certain levels, but overexposure can lead to such things as tooth decay and skeletal fluorosis.  Smile! New water fluoridation level called for by government read the title of a CNBC article related to the 2015 federal increase in the amount of fluoride allowed in drinking water.  In fact, all articles I found related to this increase were positive.)

Mercury on the Mind – 1

In Thursday’s article related to brain injury and mercury, I see that some may have found the title derogatory towards dentists.  As someone who had braces in middle school and yearly gets regular checkups, I see the benefit of dentistry.  In addition, I understand that doctors and individuals recognize the benefit of treatment and care with mercury on certain conditions.  For these reasons, I have changed the title of this article.

Mercury Can Cause Brain Damage in Kids read the headline in the Huffington Post earlier this year.  Mercury (Hg) is a naturally-occurring, odorless silver metallic trace element that is liquid at room temperature.  It comes in three forms: elemental mercury, which is the form of mercury found on in teeth fillings, inorganic mercury, and methylmercury, also known as organic mercury found in such things as fish.  Its safety has long been disputed.  For example, while many people have amalgam teeth fillings that contain mercury, batteries, which are filled with mercury, are known to be unsafe. In medicine, it has been used as a purgative, disinfectant, astringent and particular as an antisyphilitics treatment.

Mercury is a neurotoxin.  Ingestion, absorption and fume inhalation of mercury can cause mercury poisoning.  The complications of mercury poisoning are numerous and can happen to people of all ages: weakness, fatigue, headaches, lower back pain, ataxia, slurred speech, tremor, somnolence, and mental disturbances, such as hallucinations and psychosis.  In fetuses and young children, Hg exposure, “may delay developmental milestones,” the NIH found 20 years ago.  For these reasons, mercury has been named one of the ten chemicals of major public health concern by the World Health Organization.  Additionally, its application in medical/dental care and in such products as fertilizers and pesticides has been lessening through the years.  One of the concerns scientists and people, in general, have with consumption of tap water is the possible additional consumption of mercury.

This year, the above-mentioned Huffington Post headline continues: Mercury Can Cause Brain Damage in Kids, the EPA Wants to Weaken Rules On Its Emissions.  The article’s title relates specifically to a legal proposal the Environmental Protection Agency sent to the White House that they say would hobble the 2011 Mercury and Air Toxic Standards (MATS) rule.  It specifically refers to the mercury emitted in the production of coal.  (However, the article’s title simplifies the action they are requesting, in a negative manner.  The proposal wants to eliminate co-benefits, in order to save the coal industry billions.)  A win for the coal industry, the article continues, as power plants are the nation’s biggest emitter of mercury.  If the proposal is enacted, there will be additional health costs for the public.  While the financial burden to the public is much less than the current cost of implementation of the rule for the coal industry, is the outcome more important?

I see no legislative follow-up on the proposal.  Additionally, on the EPA webpage dedicated to MATS, it still states that the ruling has prevented thousands of premature deaths a year and has many health benefits, which seems to imply that the basic standards have stayed the same.  However, if the rules regarding mercury are lessened, critics call it a win for the coal industry, as MATS specifically sets limits on the amount of mercury, and other toxins, allowed in coal-fired power plants.

First Snowfall Peril on the Roads

Last week, much of the eastern United States (Illinois, Michigan, Indiana, Kentucky, Ohio, West Virginia, Pennsylvania, New Jersey, Maryland, New York, Connecticut, Rhode Island, Massachusetts. Vermont, New Hampshire) experienced its first snowfall of the year.  Given that winter does not officially begin until December 21, this snowfall was much earlier than expected, just as in March there was snow into the spring.  Because of governmental unpreparedness, states’ transportation systems became essentially paralyzed.  In my state of New Jersey, lack of governmental preparation meant that a trip that should have taken me 20 minutes, took 12 hours.  The government seems not to have been much involved at all, as it was fellow citizens who distributed water and snacks to others and offered their cell phones for use to those in need.

Ambulances, though, were present.  Unfortunately, as it was almost impossible to move one’s car, the ability for ambulances to get through traffic was difficult.  For those who sustained an injury during a snowfall-related accident, I can only imagine how horrific that must have been.  For those who live with brain injuries and were driving or were passengers in a car, the concern was great – would lack of medication result in negative outcomes, would fatigue overcome, etc.?

In 2005, the NIH reported, “To date, only 2 previous studies have examined the effects of the first snowfall of the season,” on collisions, injuries and fatalities.  Research shows that since that time, that number does not seem to have greatly increased.  However, all agree that the first snowfall of the year is substantially more dangerous.

Today, Thanksgiving, while snow may not be in the forecast, “The coldest Thanksgiving in over a century for millions plus traffic troubles,” is anticipated.  Typically, studies and articles that focus on driving difficulties during the holidays address the effects of driving under the influence of alcohol.  Add to that the hazardous effects of snowfall and the risk becomes even greater.

The Big Battle in the Brain

Just as a hematoma is the body’s response to a bump, so does the brain inflame following a TBI.  The cells that cause this inflammation of the nervous system are known as microglia, the brain’s innate immune cells.  The NIH already recognizes, “Innate immune cells clearly play a role in the etiology and disease course of… traumatic brain injury.”  Beyond that though, they say little, as the NIH states that the role of immune cells in brain injury is a “young field”.

The only information I could find on the NIH site related to inflammation and brain injury before 2018 presented disheartening results – “neuroinflammation may contribute to neurodegeneration” and “anti-inflammatory drugs shortly after TBI didn’t help.”  This information, though, comes from NIH findings in 2016.  As this has been a mostly unexplored area of study, it is not a surprise to find new studies that have results that conflict with these earlier findings.  For example, this past October, it was found by professors at the Australian National University and RMIT that seaweed sugar allows the immune system to turn on and off and, therefore, may help recovery from a brain injury.

As those in Australia were having their SUSHI and seaweed salad, in the United States, the Ohio State University published the results of their study: Traumatic brain injury-induced neuronal damage in the somatosensory cortex causes formation of rod-shaped microglia that promote astrogliosis and persistent neuroinflammation.  Specifically, this study focused on the, “formation of rod microglia in cerebral cortex.”  These rod formations that cause the inflammation further harm brain health and become a secondary injury.  As the study states, this secondary injury can persist by as much as a decade or more.  The OSU researchers looked for a drug to rid the brain of or block the activity of microglia.  A drug was found that rid the brain of microglia in mice.  Unfortunately, there is no drug for humans, as of yet.  Scientists at OSU, though, have hope and say, “Understanding the microglial response and relationship to neuronal injury is vital.”