Category Archives: Government/Research

Sex in the Brain: Sexual Disinhibition

One of the major negative effects of a TBI is disinhibition, which can manifest itself in many ways.  Social disinhibition, the most common and most discussed, is the result of an injury to the prefrontal cortex, which can be found in the frontal lobe of the brain.  Less discussed, but equally important, is sexual disinhibition, which involves taking action on sexual impulses, such as through the previously-mentioned hypersexuality, as well as through other behaviors.

The biological human need for sex is instinctual, developed in the most primitive part of the brain, the brain stem.  Sexual arousal, however, is formed in the prefrontal cortex, which controls executive functioning.  While most studies begin the summary of their findings by noting that “little research has been done”, many arousal locations have been found: “Activation of numerous frontal regions, including the right prefrontal cortex, anterior cingulate cortex and gyrus and orbitofrontal region has been observed during sexual arousal involving masturbation induced orgasm. Orbitofrontal activation has been interpreted as being related to the representation of pleasant bodily sensations, while dorsal anterior cingulate activation has been attributed to the modulation of skeletomotor activities that characterize sexual arousal and the perceived urge to act.”

Behavior control, including impulse control, is also formed in the prefrontal cortex of the brain.  When you combine increased sexual arousal with decreased self-control, foresight, attention and reasoning, the consequences may include inappropriate, illegal and/or harmful behavior.  Sexually offensive behavior, for example, is always inappropriate and known to appear in 3.5 to 9% of adults affected with brain injury.  A preoccupation with sexual thoughts presumably led two women with brain injuries to become dominatrixes.  “[One woman] began working as a stripper, then as a dominatrix, using the name Sasha Mizaree. She even built a dungeon in her apartment but said she doesn’t have sex with her clients. She was paid $250 an hour to dominate them,” reported ABC News.

While those with TBI may have an increased libido, they also have a decreased sense of self-awareness and awareness of what is appropriate.  One may no longer be able to neurologically control their aggression and other impulsive behaviors like grabbing or compulsive masturbation.  Lack of sexual control can result in such behaviors as attempted rape.  In Australia, a man who had a motorcycle accident, decades ago, was sentenced to jail for 19 years as a pedophile and child rapist.  Interestingly, many of those with TBIs who have extreme sexual behavior report no enjoyment in the activity.

Unfortunately, even with a multitude of studies that reference it, the NIH recently reported that doctors and rehabilitation facilities do not generally know how to treat the thoughts and actions that may come from from sexual disinhibition.

Skiing Into a Head Injury

Gliding down a ski slope at 60 mph, taking a ramp that lifts you up in the air with a heavy board attached to your feet and just snow below, or racing against others while doing both.  These three activities are all part of the winter routine for individuals who enjoy the extreme sports of freestyle skiing, snowboarding or snowcross.  Extreme sports are, by definition, dangerous.  A Google search of snowboarding, for example, found two pages of articles related to snowboarding deaths and accidents this year alone.

First coming into existence either in the 1950s, 1960s or 1970s, depending on which source you reference, extreme sports tap into a person’s sense of adventure.  Head and neck injuries due to winter extreme sports are common, when compared to other sports, partly because, “many extreme sports take place in environments where medical care may not be readily available.”

Throughout the years, extreme sports have become more popular, perhaps as the opportunity for adventure and physical risk of everyday life goes down and mental stress goes up.  Head and neck injuries due to winter extreme sports have also significantly increased through the years.  There is a cost to these injuries, both emotionally for the individual and monetarily for both the individual and the government through evacuation costs, rehabilitation costs and community costs in the future.  This month, the government pays more attention to these risks, as well as the needed research, as January is National Winter Sports Traumatic Brain Injury Awareness Month.

Although finding new means to treat traumatic brain injury in extreme winter sports is very important, “prevention is the top priority”.  The Office of Disease Prevention and Health Promotion reminds people to always wear a helmet and to make sure to watch your surroundings by staying in the boundaries in ski slopes and watching for obstacles and hazards on your path.  Just as importantly, “make sure medical care is close.”  Additionally, Dr. Pickett of the National Intrepid Center of Excellence reminds people that, “It’s important to consider how weather conditions… increase the risk for these injuries.”  While equipment is now safer and access to medical care has improved, prevention should always come first.  If you enjoy the thrill of extreme winter sports, I hope you enjoy it this winter, but know and use all available information to make it safe.

Weighing In On Insomnia

Sleep is crucial for humans to survive and thrive.  “Emerging evidence implicates sleep in the most basic of neurological functions, namely the exchange of metabolic wastes associated with neurological homeostasis…  sleep is integral in the function of the glymphatic system… Natural sleep or anesthesia accounts for an increase in interstitial space that facilitates the subsequent exchange of cerebrospinal fluid (CSF) with interstitial fluid.”  All people have been told to get at least 8 hours of sleep a night.  While this number is actually higher for the young, 7-8 hours is the recommended hours of sleep needed for those 18 and up.  For those with brain injuries, an energized brain is necessary to perform at their best.  However, about 30 to 70 percent of those with brain injuries have sleep disorders including deprivation, deficiency, disruption, etc.  (Although fatigue may be the most obvious side effect of a sleep disorder, “the consequences of disrupted sleep following injury range from deranged metabolomics and blood brain barrier compromise to altered neuroplasticity and degeneration.”)

The above links are all from government studies into brain injury and sleep disorders.  While they may be interesting and informative, methods of curing these sleep disorders are what really matter to those afflicted with them.  So far, many means to induce sleep and reduce the activity of a restless mind have been explored and written about, such as cognitive behavioral therapy, the use of activities, etc.

My advice is to read the results of these studies while you’re in bed, using one of the recommended sleep aids: a weighted blanket.  Weighted blankets have gained popularity in the past few years.  So named because the weight of the blanket equals about 10 percent of the user’s weight, the extra weight that this blanket provides the user is soothing, rather than encapsulating.  They are a form of deep pressure touch stimulation, which can help with one of the more common symptoms of TBI, anxiety, among other things.  (I am not promoting weighted blankets more than cognitive behavior therapy or any other means of ridding one’s self of a sleep disorder, I’m just on the search for a new sleep strategy.)

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.)