LA-area Jeff Victoroff, M.D. is a Harvard trained neurologist who directed USC's Traumatic Brain Injury/Neuropsychiatry Clinic at Rancho Los Amigos National Rehabilitation Center for more than a decade, is also an award-winning teacher of neurology and one of the five neurologists recruited by former U.S. Surgeon General David Satcher to provide care for concussed, demented, former NFL players.
This is part three of our interview.
What makes concussive brain injury so problematic?
Two things! But it has been hard to get most doctors to wrap their dogmatic heads around either one.
Problem 1
The word "concussion" has nothing to do with the brain. It was derived from a Greek word for "rattling blow." It was first used to describe how a buffeting wind may rattle a sail. Until WWI, medical men used concussion to describe the rattling effects of an external force on the lungs, the spine, or maybe the heart. Attaching a brain-meaning to concussion is a recent semantic deviance.
There are 37 published definitions of "concussion." Not one of them describes a physical mechanism of injury (it's brain rattling). Not one of them as the slightest biological meaning. Ask any two doctors in the world to define concussion; you will never get the same answer. And a total of zero doctors can say what happened to the victim's brain. That literally means that 99% of the tens of thousands of scientific articles published on so-called "concussion" during the 20th century are invalid. None of them--not even one--determined what brain changes had occurred.
Sure, a doctor can say: "Matt got up slow. He seemed confused for 2 minutes, felt a bit dizzy, and complained of a headache for two hours." But do we have a way to determine what happened to Matt's brain? Of his 86 billion neurons, were 3 billion reduced in efficiency by 12% for sixteen minutes? Were 19 billion reduced in efficiency by 34% for 18 days?
Talking about concussion is problematic because 20th century neurologists latched onto a fallacy: that concussions were one thing, a unitary medical problem. Nope. All of the research with animals and humans for the last fifty years shows that every "concussion" has different brain effects. Doesn't it seem, well...kinda dumb to call a momentary ding and a lifetime of permanent brain damage the same disease?
It is high time we retired the scientifically bankrupt word, concussion. To some this sounds radical. To anyone who studied logic, it's logical. The word belongs in the cabinet of medical mistakes and ancient curios along with "the humor of black bile" and "phthisis."
Problem 2:
We live in an awkward moment. We know a lot. We know enough to be scared for our children's entire futures. But we don't know enough. That has divided doctors. Some neurologists say, "Let the kids bang their heads over and over! There's no absolute proof it causes late effects." Others say, "Geez, the trend in the best evidence is scarier and scarier. Let's save kids from banging their heads over and over. Some of them are definitely dooming themselves to permanent brain damage."
What facts are we missing? We don't know what percent. And we don't know who.
Will 13% of our children playing impact sports get early onset dementia and Parkinson's? Or 94%?
Apart from children carrying the allele for Apolipoprotein E epsilon 4, and girls banged during the luteal stage of their menstrual cycle, and kids who were depressed before their injury, or dehydrated at the time of their injury (all are at high risk), we don't know which of our children is at low, medium or high risk. And the National Institute of Neurological Disease and Stroke (NINDS) has declined since 1968 to fund even one methodologically valid study of that question.
Why can kids be hurt even if they haven't received a full-blown concussion?
First, I'm so sorry. How would we identify a "full blown concussion"? We can't even define concussion! We have absolutely no biological definition of such a problem. Let's please talk about something biologically valid: symptomatic versus asymptomatic brain rattling.
Way back in the 20th century, doctors called brain rattling with no symptoms a "sub-concussion." That's silly; it's not a sub anything. The brain is rattled (concussed) in both cases and the damage may be just as bad whether the child has symptoms or not. That fact kind of throws us parents for a loop. If nobody knows that the brain was rattled--not even our own child--how can we keep track of his or her injuries?
More and more data proves that repetitive asymptomatic concussions cause long-term brain damage. The rule is simple: if our child participates in an impact sport (especially football and hockey), his or her brain will be harmed. Some less. Some more.
Jeff Victoroff, M.D. is a Harvard trained, board certified neurologist and psychiatrist, also certified in Behavioral Neurology and Neuropsychiatry. He serves as Associate Professor of Clinical Neurology and Psychiatry at the Keck School of Medicine of the University of Southern California (USC). He directed USC's Traumatic Brain Injury/Neuropsychiatry Clinic at Rancho Los Amigos National Rehabilitation Center for more than a decade. He is an award-winning teacher of neurology and the recipient of an award from the Brain Injury Association of America. He was one of the five neurologists recruited by former U.S. Surgeon General David Satcher to provide care for concussed, demented, former NFL players. His new book, Concussion and Traumatic Encephalopathy: Causes, Diagnosis and Management, is available on Amazon and other fine booksellers.
We live in an awkward moment. We know a lot. We know enough to be scared for our children's entire futures. But we don't know enough. That has divided doctors. Some neurologists say, "Let the kids bang their heads over and over! There's no absolute proof it causes late effects." Others say, "Geez, the trend in the best evidence is scarier and scarier. Let's save kids from banging their heads over and over. Some of them are definitely dooming themselves to permanent brain damage."
What facts are we missing? We don't know what percent. And we don't know who.
Will 13% of our children playing impact sports get early onset dementia and Parkinson's? Or 94%?
Apart from children carrying the allele for Apolipoprotein E epsilon 4, and girls banged during the luteal stage of their menstrual cycle, and kids who were depressed before their injury, or dehydrated at the time of their injury (all are at high risk), we don't know which of our children is at low, medium or high risk. And the National Institute of Neurological Disease and Stroke (NINDS) has declined since 1968 to fund even one methodologically valid study of that question.
Why can kids be hurt even if they haven't received a full-blown concussion?
First, I'm so sorry. How would we identify a "full blown concussion"? We can't even define concussion! We have absolutely no biological definition of such a problem. Let's please talk about something biologically valid: symptomatic versus asymptomatic brain rattling.
Way back in the 20th century, doctors called brain rattling with no symptoms a "sub-concussion." That's silly; it's not a sub anything. The brain is rattled (concussed) in both cases and the damage may be just as bad whether the child has symptoms or not. That fact kind of throws us parents for a loop. If nobody knows that the brain was rattled--not even our own child--how can we keep track of his or her injuries?
More and more data proves that repetitive asymptomatic concussions cause long-term brain damage. The rule is simple: if our child participates in an impact sport (especially football and hockey), his or her brain will be harmed. Some less. Some more.
Jeff Victoroff, M.D. is a Harvard trained, board certified neurologist and psychiatrist, also certified in Behavioral Neurology and Neuropsychiatry. He serves as Associate Professor of Clinical Neurology and Psychiatry at the Keck School of Medicine of the University of Southern California (USC). He directed USC's Traumatic Brain Injury/Neuropsychiatry Clinic at Rancho Los Amigos National Rehabilitation Center for more than a decade. He is an award-winning teacher of neurology and the recipient of an award from the Brain Injury Association of America. He was one of the five neurologists recruited by former U.S. Surgeon General David Satcher to provide care for concussed, demented, former NFL players. His new book, Concussion and Traumatic Encephalopathy: Causes, Diagnosis and Management, is available on Amazon and other fine booksellers.
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