Brain Awareness Month and The Importance of Recognizing Brain-Related Injuries

Shae Datta, MD

Traumatic brain injury (TBI) is a global health problem, with an estimated incidence of 64 to 74 million cases per year worldwide and is a leading cause of morbidity and mortality. Large-scale studies of American-style football players and military veteran have shown that prior TBI is associated with multisystem chronic conditions, suggesting that recurrent severe head injuries may be associated with long-term health and functional status. In addition, the development of chronic comorbidities following TBI can result in increased health care costs and mortality.

Each year, in March, the global community comes together to raise awareness for TBI and other brain-related injuries. In the chronic phase of TBI recovery, patients may face an increased risk of cardiovascular and metabolic disorders, as well as epilepsy, stroke, and depression. Additionally, older patients may experience worse treatment outcomes as a result of biological aging and pre-injury comorbidities.

To continue to raise awareness on the significant impacts of TBI, NeurologyLive^® sat down with Shae Datta, MD, a neurologist and headache specialist at NYU Langone Health, who specializes in brain-related injuries. She sat down to discuss some of the complexities with TBI, how they may differ based on age and sex, and how the care for them has improved over the years. Furthermore, Datta spoke on the importance of early recognition in brain injuries and the ways clinicians can empower patients who may feel uncertain about their condition.

NeurologyLive: Wht are some of the main discussion points for brain health awareness and traumatic brain injury specifically?

Shae Datta, MD: The first thing that I would like to dispel is the definition. There's TBI, which stands for traumatic brain injury, which it's a catch-all phrase, and then we hear the words “concussion”, and we hear “mTBI.” It can be very confusing. mTBI is a mild traumatic brain injury, which equals to a concussion. If symptoms of a head injury are lasting more than three months, it's a persistent post-concussive syndrome at that point. If it's after six months to one year, now you have a traumatic brain injury. Or if there's something structural, where you fracture your skull, you end up in the ICU, there's blood in the brain, that's a traumatic brain injury from the get-go. TBI is [usually] mild, there's nothing on the scans. Most of the time, everything checks out. They go to the doctor, everything looks okay, except they just feel terrible.

The common things to be aware of [with TBI] is the timeline, what the risk factors might be, and who may be more predisposed in general. In research, it basically shows that young males aged 20 to 35 are more prone to getting traumatic brain injuries because apparently they take more risks. And that's overall, but if you break it down in sports, you will see that, at times, women are more susceptible because of the shape of their neck and the head mechanics. It's actually quite fascinating why there's like such different breakdowns about it.

How has the field advanced care in recent years?

I think that's a very important thing that there needs to be physicians involved in your care. They can be from a multidisciplinary model like what we have at NYU Langone and many great centers across the country, where there are neurologists like myself, there's sports medicine physicians, orthopedic doctors as well as physical medicine and rehabilitation [specialists] who are seeing these patients initially. Usually, if they're out three months, and they're not getting better, they're going to come to me. It's never really a good thing to see a neurologist. We then employ lots of sophisticated methods to get these patients back to the game or back after injury. We have specific targeted rehabilitation, like physical therapy for the eyes, the inner ears to balance for dizziness, as well as speech and language. Psychiatry is a big component, because a lot of time mood is affected. It runs the whole gamut. Lots of times I'm referring to my sleep medicine colleagues, as well as endocrinology because at times the hormones can be messed up after a traumatic brain injury both in men and women.

From a research perspective, what other areas of TBI need more devoted attention?

If you ask me, I'm a little biased because I'm a woman. But I think we really need to have targeted guidelines for women specifically, because we are not the same as men. Research has already shown that there's differences in presentations of the way that women present and how long their symptoms can last. Every two years a “concussion in sport” group gets together to come up with consensus guidelines for evaluating athletes as well as lay people. But there's never been anything specifically just for women. Women also, in large numbers, get traumatic brain injuries from domestic violence issues. It's a very important topic that I'm passionate about, but it's been slow to get off the ground.

How do we properly treat TBI considering it appears like other head-related injuries?

There's often a lot of overlap between traumatic brain injury and other things. Specifically, if someone has an underlying migraine issue, like a headache issue already or a mood issue. They may not have a mood issue, but they had borderline anxiety, and they did so well to cope with it. All of us type A personalities would do such a good job of setting boundaries and planners, and we're very good at like coping, but once you have a traumatic brain injury that goes out the window, and all of these come to the forefront. A lot of times when physicians or clinicians that see these patients are not trained in traumatic brain injury, they think “it’s just depression, it's just anxiety, you're overthinking it, there's really nothing wrong with you. There's no sleep issue, your sleep is interrupted just because you just bumped your head.” It's unfortunate, they sort of get passed around from place to place and a lot of them are looking for some miracle cure by going to centers that are not really well versed in this or the research. Unfortunately, they will pay out of pocket costs of hundreds dollars and get no answers.

How do we continue to advance the care for TBI going forward?

I see the people that have good support systems, their families come with them and stay on top of their care, and they go into a multidisciplinary center. Getting patients into multidisciplinary systems like NYU that can quickly get them from one place and put all their care together is the key in terms of advancement. I think a lot of it lies in educating the public. Because they don't know, and it's not their fault. There's been so much media hype about it, there's not enough breakdown and awareness of true definitions, as well as timelines. They'll come to me 10 years later and say, “I have a concussion.” You have to educate them at a point and say, “you no longer have a concussion, I have to see what was old and what's new,” which is very hard to tell. It’s much harder to try to treat someone at that point, when it's become so chronic. If someone comes to me within the first three months to six months, is much easier for me to get them over that hump, then let it continue.

Transcript edited for clarity.