Jeff Herman
Mar 6, 2012

Innovations and ethical dilemmas of treating traumatic brain injury

Unlike other diseases and disorders, which may have complex names (Pneumonoultramicroscopicsilicovolcanoconiosis, anyone?), traumatic brain injury (TBI) is a rather straightforward description. TBI includes a wide spectrum of injuries that can occur to the brain in response to an external force, such as a car accident. While the name may be straightforward, our understanding of TBI is not.

Honestly, haven’t we all taken some form of blunt force trauma to head at some point in our life, in the guise of a ball, a rock, or perhaps the pavement, and walked away unscathed, save for a moderate headache and a few shed tears? Yet, nearly every year, we hear the tragic news of child getting hit in the head with a baseball and dying from their brain injury, a few seconds to a few hours later. Why was this child different? 

While we have come a long way from the barbaric techniques of cutting open our skulls to release the insanity from our minds or from the use of lobotomies, our basic understanding of brain physiology is limited. This, combined with a wide spectrum of subtle symptoms, has made the diagnosis and treatment of TBI rather difficult.  With the use of fiber tracking, a promising advancement in MRI technology that allows doctors to follow the activity across neuronal fiber bundles, it is possible to visualize and quantify previously unseen brain damage caused by a TBI event. By understanding the cellular functionality of a brain injury, a more effective treatment schedule may be developed. The military and National Institute of Health are also looking into novel diagnostic mechanisms.

In a recent clinical trial involving nearly two hundred severely disabled TBI patients, researchers found that amantadine, an FDA approved anti-viral and anti-parkinsonian drug, can mediate the healing of TBI. Compared to placebo, patients that received amantadine  exhibited quicker recovery from a coma and showed a marked improvement in cognitive function compared to patients that received a placebo.

TBI is a major problem. It is why we wear helmets when riding a bike, it is why more and more people are wearing helmets when they ski and snowboard. TBI is a major problem for wounded veterans and is thought to play a role in post traumatic stress disorder. For our returning vets, our children and teenagers, as well for anyone else unfortunate enough to suffer through brain trauma, finding better diagnosis and ultimately better treatment for TBI, is of utmost importance. 

Other technological advances, such as “brain to computer interface”  may actually allow severe TBI patients to interact with the world with previously unheard ability. Recent research in the use of functional MRI, allowed doctors to converse with several vegetative patient; however, as exciting as these advances may be, it should be noted that we are treading on shaky ground. Using new technologies on unconscious or severely disabled patients is edging dangerously close to a serious ethical dilemma; should experiments be allowed to be performed on either unconsciousness or cognitively hampered patients, who cannot give proper informed consent? The adoption of an ethical oversight committee regarding TBI is necessary so that we do not forget or repeat the lessons from the past.

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