Traumatic brain injury

Traumatic brain injuries (TBI) are common and often occur in sporting events. Their significance has until recently been under-estimated. Recent research on the frequency of brain injuries in hockey, football and boxing has had some widespread publicity. Because brain injuries can occur in everyday situations and may not be immediately incapacitating it is easy to overlook their significance. Their effects are, however, cumulative so eventually they can have very significant effects on personality, mood and cognitive functioning.

Estimates vary widely on how common these injuries are. The estimates will vary according to definition, population and means of detection. Current estimates are between 100-600 people per 100,000 sustain new brain injuries each year in Canada. Males between the ages of 15 and 24 are at highest risk. Drugs, alcohol, contact sports, skate boarding, cycling, motor vehicle accidents and various other high risk activities are all common in this age group. Interestingly, having one TBI increases the risk of having another one by threefold.

Boxing obviously involves constant blows to the head. Football players can get hit in the head over 200 times a year. In soccer a chemical marker of brain damage was found to correlate with how many times a player “heads” the ball.

Psychiatrists are most likely to see someone with a head injury who is exhibiting emotional symptoms, personality changes or problems controlling their anger. Major depression is a very common consequence of a TBI. Depression is usually treated using the same medications that are used in other forms of depression, but the results are not as good. A brain injury complicates the treatment of any psychiatric disorder. There is convincing evidence that antidepressants enhance neurogenesis so early treatment is desirable.

The lifetime risk of suicide is higher in people with TBI. This can be because of the depression but also because of the difficulty adjusting to changes in function. Those with a TBI may have their education interrupted, lose their jobs or have difficulty in their close relationships. They are no longer the same person and adjustments are required by everyone. They may experience a great loss of former dreams and possibilities.

Bipolar-like symptoms may also appear; not just depression but mood swings from high to low. It is not always clear if this is a true bipolar illness or something that is occurring purely secondary to the TBI. For practical purposes it may not matter; we tend to treat them the same as we would treat a bipolar disorder. Many of the drugs used for bipolar disorder are anticonvulsants. In this case they may have double value in treating post-traumatic seizures and mood symptoms.

Poor impulse control, problems with aggression and inattentiveness are relatively common. Here again we treat symptomatically using medications that are known to be effective for these symptoms in other disorders. This can include antidepressants, mood stabilizers, antipsychotic medication and even stimulants such as methylphenidate and dextroamphetamine.

Of course, in addition to these medical treatments intensive rehabilitation programs may be necessary depending on the nature of the head injury and the related symptoms. This can involve occupational therapy, physiotherapy, counselling, group therapy and vocational retraining.

Prevention is clearly the best policy when it comes to TBI. It is very important to continue to develop better helmets and rule changes in sports to reduce the likelihood of head injuries. It is also important for those participating in these activities to be aware of the potential consequences. There are some sports in which it prevention of head injuries may not be possible.

 

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