Newswise — With a new $5.3 million grant from the Department of Defense, researchers at Saint Louis University are launching a study that aims to improve treatment of brain injuries for combat veterans and civilians. By using advanced imaging technology to create better maps of the brain, researchers hope to develop therapies that target areas of the brain that retain function but lack the ability to communicate with the rest of the body.
"We hope that this study will harness the power of technology to come up with the best possible treatment strategy to help combat veterans recover," said Richard Bucholz, M.D., lead investigator of the study and director of the division of neurosurgery at Saint Louis University School of Medicine.
Traumatic brain injury is caused by physical trauma to the head, and symptoms can range from mild, with headaches or nausea, to severe, with seizures or decreased levels of consciousness. In the United States, approximately 1.4 million people suffer traumatic brain injuries each year. Of these, 230,000 are hospitalized and survive, while another 50,000 die. At the same time, combat veterans, now equipped with better body armor and armored vehicles, are thought to be surviving injuries that were once lethal and are returning from war zones with brain injuries rather than fatal wounds.
As imaging technology and knowledge of the brain continue to advance, researchers believe that they can best leverage these developments by combining several types of imaging techniques to get a better picture of how an injured brain is working. For the first time, doctors will combine the results of three types of imaging equipment to create a more complete map of the structure and function of the brain.
"Our ability to image the brain has just undergone a revolutionary change in the last 10 years," said Bucholz. "We can enhance what we know by not limiting ourselves to one method of imaging the brain."
In this study, researchers will examine 200 people, including veterans and civilians with brain injuries, as well as a group of people who are healthy. The study participants will undergo three types of imaging tests, as well as a neurocognitive test. The data that results will be combined to create a full picture of how a patient's brain is working.
Uniquely positioned to carry out this study, Saint Louis University researchers have access to the rare combination of three important types of imaging equipment: 3 Tesla MRI (magnetic resonance imaging), 64 Slice PET/CT (positron emission tomography / computed tomography), and MEG (magnetoencephalography). The MEG, in particular, is used clinically in only a handful of facilities.
While some regions of the brain will continue to function despite injury, if the neural pathways are destroyed, the brain will be unable to communicate with the rest of the body. Scientists once believed that an injured brain was irreversibly damaged and that its function could not be recovered after being lost. It now appears, however, that the brain has the remarkable ability to rewire itself " if one pathway is damaged, another may be able to take over.
In order to take advantage of the brain's capacity to rewire, doctors need to know which areas of the brain continue to function, something they hope the imaging will be able to tell them. By collecting data from several types of imaging equipment and plotting the results together, researchers will have a more complete picture of the state of an injured patient's brain and hope to be able to treat the injury in a more targeted and effective way.
About the Imaging Technology:
3 Tesla MRIThe MRI uses a magnetic field and radio waves to create a digital picture of the brain. The 3 Tesla MRI has twice the strength of traditional MRI scanners and creates an image of the brain's structure.
64 Slice PET/CTThe PET /CT is a combination of two images. In a PET scan, patients are injected with radioactive material, which goes to the most metabolically active parts of the brain. The CT scan uses X-rays to create pictures of the brain. The two, which are often used in conjunction, measure the brain's blood flow and metabolic activity.
MEGHoused in a chamber that keeps out external magnetic waves, the MEG environment is opposite to the MRI's. Instead of using magnetic force, the MEG is a magnetically neutral space. Free of outside forces, the MEG picks up the brain's own magnetic wave activity. When patients are shown sensory images, like a picture, researchers observe which parts of the brain become active and identify the sequence of responses, essentially logging which parts of the brain sequentially react after seeing the image. Researchers distinguish working areas of the brain from low-functioning and abnormal regions. In this way, the MEG measures both brain function and abnormality.
"In the past, head injury has been imaged using structural techniques, like the MRI and CT scan. These images are like a picture of St. Louis at 20,000 feet. We see outlines and highways -- geography," said Bucholz. "But this can't tell you about the function of St. Louis. It can't tell you how things are moving down on the ground, like traffic tie ups and slow downs. This is what the MEG can do."
On the Horizon:
Researchers hope the data from the study will allow them to quantify levels of brain injury, which in turn may help to limit the damage of cumulative injuries, as when combat veterans or football players suffer multiple concussions. Doctors could then make recommendations to patients who may need to steer clear of similar situations in the future to avoid adding to their injuries. The study will also be able to objectively measure brain injury, providing a more definitive diagnosis than existing neurocognitive tests.
Another aim of the study is to make diagnosing brain injuries easier for facilities without advanced imaging equipment. "If the brain injury images correspond to a marker that shows up in a blood test, for example, we may be able to make our diagnosis much more easily, even in facilities without the advanced imaging equipment," Bucholz said.
For those with severe traumatic brain injury, the study may help predict which patients will best benefit from rehabilitation, with treatments that specifically target the injured area of the brain. Researchers also hope this study will help prevent future injury to combat veterans by allowing better protective gear to be designed. Pushing the boundaries of science fiction, scientists already anticipate the day when a combat veteran who has lost a limb will be able to control a robotic prosthesis through thought.
Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease.
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