The silent victims of brain injury

In recent years more and more evidence has been found of the link between head injuries – be it at work, at war or on the sports field – and the onset of neurological conditions several or many years later.

A neuropathologist involved in leading research at the University of Glasgow says the message to those affected is that you can take steps, and you shouldn’t give up hope.

However, Professor Willie Stewart also says he believes that there is one group of people at risk are remaining silent.

For the past half a century, Glasgow has been at the forefront of human tissue research and understanding brain injury.

Central to that was the creation in the early 1970s of the Glasgow traumatic brain injury (TBI) archive – a collection of brain tissue samples.

For many years material was donated by the families of people who had succumbed in the immediate aftermath of a brain injury. In recent years, however, the focus has moved to studying tissue from people, many of them sportsmen, who live for years and decades before becoming unwell.

Dr Willie Stewart is a consultant neuropathologist at Queen Elizabeth University Hospital, where he leads the Glasgow Brain Injury Research Group, and an honorary professor at the University of Glasgow. He says one group of people are generally missing from their research:

“One of the things that often goes unrecognised and is rarely discussed is intimate partner violence or domestic violence. So many things are involved for these people: the physical brain injury, trauma related to blows to the head, the effects of manual strangulation, asphyxiation, and then the mental health that goes along with it. All sorts of things happen, all of which affect brain health in varying ways.

Professor Stewart says he understands why people who have been assaulted by a partner or close family member in the past may not come forward. Equally, others may feel there is no point because there is currently no treatment. But he says he hopes that people won’t be put off by that – and that he himself is “ever the optimist”:

“The answer is there has to be something we can do. It’s just finding what the specific thing we can do is.

“So, what’s the specific pathway that trauma unlocks that drives the adverse brain health outcomes many years later? We haven’t yet identified that. But we’re working really hard on that. Is it an inflammatory pathway and a vascular pathway or something else that’s driving it? At this stage, because we haven’t identified the specific pathway, we don’t have the specific drugs available for a targeted intervention.”

However, he says, there are steps people can take that may reduce their risks of going on to develop the symptoms of a degenerative brain disease:

“What can do is look at the evidence, the experience from degenerative brain disease in a wider context, and try to apply those lessons to this specific circumstance of brain injury.

“So that’s what we’re doing now, with our athletes and with others with brain injury, saying to them ‘okay, we don’t have anything specifically to repair the damage from brain injury or to treat a pathway we’ve identified that is triggered by brain injury, but what we do know is that, if you look after wider risks, like your blood pressure, physical activity, diet, social connectivity, you can hopefully reduce your risk in a general sense and, we hope, benefit you specifically if you have had a brain injury.”

Professor Stewart says one challenge is to help professionals and people to recognise and understand the issue:

“If you take the police, it’s about making them aware of the risks to the 20 to 30% of individuals who are exposed to intimate partner violence. For clinicians, it’s that, if you’ve got somebody in front of you who’s in midlife and concerned about their cognitive health, understanding their story.

“For instance, how much football or rugby or other sports have they participated in? Could that be contributing to this in some way? Have they turned up that day because they have cognitive issues related to a mental health disorder – maybe anxiety created by concerns about their football past. Or are they in later life, somebody presenting with dementia. What happened in their 20s and 30s, did something happen? And, for a woman, could it have been a sport – or could it also be intimate partner violence?”

Professor Stewart is keen that nobody who has had a traumatic brain injury should see themselves as being on an inevitable path to a brain illness:

“One of the things that, sadly, we are seeing in the context of sports is that former athletes are just giving up hope. They believe that the damage is done, there’s nothing they can do there, that they’re on a course which is irreversible and inevitably will lead to adverse brain outcomes.

“Our message to everyone is do not give up hope. Instead, take a step back and look at what else you’re doing in your life and what you could modify that will make a difference to your brain health.

“That might be acknowledging that you may have mental health problems because of, for instance, intimate partner violence – perhaps depression, anxiety that you haven’t talked about – and then seeking advice for those. Because treating that, dealing with that, could actually modify your risk and change the risk going down the line. So don’t give up.”

This article was first published on healthandcare.scot