- The Washington Times - Monday, October 13, 2014

The gridiron and the battlefield have little in common, but brain injuries plaguing combat veterans and former football players has doctors and veterans’ advocates eager to bring brain injury research out of the “dark ages.”

It’s too early to determine the similarities and differences of brain trauma between veterans and football players.

In the days immediately after their injuries, both are treated the same way: with rest and treatment of pain and other symptoms.

“We still don’t know what the complete answer is,” said Dr. Ann McKee, the chief of neuropathology in the VA Boston Healthcare System and a professor of neurology and pathology at the Boston University School of Medicine. “I can tell you there are some parallels, and also some differences, but it’s very early on in research.”

Mike Helm, the new national commander of the American Legion, said it’s time for researchers to learn from one another.

He said new Veterans Affairs Secretary Robert McDonald has the same idea.

“He wants to have a summit,” Mr. Helm said. “The veteran population is not the only one suffering from traumatic brain injury and post-traumatic stress. You have your football population, you have any of your athletics deal with that, so it’s not just a veteran population problem, it’s a national problem. And he wants to bring everyone onboard and have a summit of some kind and fix it as well as he can.”

Though no summit is scheduled, Mr. Helm said, he is happy that the VA secretary is making a priority of traumatic brain injury and post-traumatic stress disorder.

Since 2000, more than 300,000 cases of traumatic brain injury have been diagnosed among active-duty troops, according to data from the Defense and Veterans Brain Injury Center, though the rate has fallen from a record 32,000 diagnosed in 2011 to 12,000 in the first half of 2014.

Although a link between the two illnesses hasn’t been proved scientifically, more than 50 percent of veterans with TBI have PTSD, Dr. McKee said.

Even as more brain injuries are diagnosed among military veterans, football leagues at all levels, from children to the pros, are increasingly worried about concussions. President Obama has weighed in on the question of football concussions.

One of the problems, researchers say, is that the study of brain injuries remains in the “dark ages” and that a summit could help answer major questions.

In football, a concussion is usually the result of a helmet-to-helmet collision or a player’s head striking the ground after a hit.

Military troops involved in explosions, however, usually face a combination of injuries, said Dr. Brent Masel, national medical director of the Brain Injury Association of America. An improvised explosive device, for example, could throw a soldier into a doorway or send a piece of debris flying into his head.

The brains of deceased veterans and athletes look different, Dr. McKee said. Veterans who have suffered injuries typically show more damage to the white matter, which includes the neurons that form connections in the brain, as well as more damage to the small blood vessels.

Athletes are more likely to have repeated injuries, leaving them more likely to suffer from chronic traumatic encephalopathy, a degenerative disease. Symptoms include memory loss, confusion and depression and can appear years or decades after the injuries.

Even there, the distinction may be overstated.

Dr. Michael Lipton, a professor of radiology at Albert Einstein College of Medicine, said veterans may suffer daily low-level trauma that accumulates over time — especially troops who use small explosives regularly to clear houses or knock down doors. Their injuries may be similar to those sustained by athletes, he said.

“It’s not a matter of being in the vicinity of an explosion once. It happens repeatedly over a prolonged period of that,” he said. “In a cohort of vets we’ve studied recently, in speaking with these people, they’re exposed, some of them virtually on a daily basis, to blasts which are not anything that knocked them out of commission, but they’re real exposures.”

Researchers said they are sharing information about athletic and battlefield injuries at conferences and through journals. Dr. McKee said all brain injuries have some similarities that could help medical professionals learn a lot from one another.

“Your brain really doesn’t care what the trauma is from. It generally has a fairly standard way of reacting to trauma,” she said. “So we could really learn from each other, and I think that would speed up development of ways to identify the disorder and treat it.”

Dr. Masel said any information sharing would be beneficial only “if the VA could follow up with funding for research” and make the initiative a top priority.

“Just having a conference so everyone can talk about what they’re doing, that’s going on all the time,” he said.

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