Progress in research and treatment for brain injury may seem slow, but a closer look will show otherwise.
My name is Dave Hovda. I am a professor of neurosurgery and of molecular and medical pharmacology and the Director of the UCLA Brain Injury Research Center. In a traumatic brain injury, it remains a tremendous public health problem, and a lot of people have been discouraged about how far we've come, or how--what they envision or see as very small increments in what we've been able to accomplish. But I always remind people to think back what it was like 25, 30 years ago when we had no concepts or very few concepts about managing individuals in the intensive care unit, and now, not only are we saving lives after traumatic brain injury, particularly in the United States, but we're not making any more vegetative-state patients or coma patients or long-term problem patients, so we're improved. Not only are we stopping the death, we're reducing the death rate, but we're also improving their general outcome. The frustrating thing is that--I'm quoting other people now-- that the brain is, I think, arguably the most complicated organ in the body, and trauma is the most complicated form of disease. We never know when it's going to happen. It happens in all these different environments, and when it happens, it happens to young people-- most of them are younger people between the ages of 16 and 25. Some of them have got drugs on board. Some of them have been fighting in Iraq and Afghanistan and have not slept in 2 days or are under a lot of stress, so what they bring into the injury is sort of what they take out of it, and every injury is different, and I think it frustrates people who work on the front lines because they're trying to work at an individual case, and it's not until you're able to step back and say, you know--you not only put your finger in the dyke, so that you stopped this leak, you actually have reduced the amount of water behind the dyke, so the pressure is even lesser than it was before, in some countries. In others, there are more challenges because the information is slowly getting out. The resources are not there. So I would say, there is great hope for treatments for traumatic brain injury. What society thinks of a treatment, though, is a cure, and it is difficult to try to put the concept of cure into the brain because people want to think of the brain as the mind. When people recover from traumatic brain injury, they may be able to go back to work, and maybe they'll do very well. But there may be lingering symptoms that they feel has deprived them of the quality of life that they wanted before. A good example is a trial attorney who may have had a head injury at UCLA and recovered very, very, very well, and the thing that he couldn't--he could write briefs. He could do research. He could communicate. He just wasn't as sharp in cross examination as he could, and it sort of took that element of what he enjoyed most of his career out of the picture. Now does that mean that he is long-term disability and his quality of life is horrible? Well, from his perspective, yeah. But from an outsider's perspective, you know you could say, "Well, he's done pretty dog-gone well, you know." It's sort of like Giffords when Giffords was shot, people were devastated that she would probably not live, and not only did she live, she was able to recover quite well. Other people are very depressed because is she going to be able to continue to be a a congresswoman in the United States Congress? Well, that's yet to be determined at this point, and as I've told the press before, personally, I would be very surprised if she's able to do that. I pray that she's able to do that, but I'd be surprised. So is that a failure? Well, no, that's actually a pretty good dog-gone good success rate. So it may be as simple of an analogy of a glass being half full or half empty, but the brain and the mind doesn't allow that. You now have to think about what you are capable, or capacity, of to change as you grow older. People look at children and they say--you know--well, kids grow and then they become mature, and then they kind of level off, and this is kind of their level of function when they become adults. I can tell you my personal experience, and every person can tell you this that their mother or grandmother are still changing. They're still learning. They're still arguing politics with me about who they want to be president of the U.S. So their still changing, so their head injury--even though they will come back quite well, they may not have that same capacity that they used to, and people look at those deficits and focus on those deficits as opposed to focusing on what they can do, and that is sort of one of the tricks that young people are really good at especially the military--the kids that come back from Iraq and Afghanistan with head injuries. For some reason they have such great resilience that they focus on what they can do most of the time--not all the time--as opposed to what they can't do. So your general question about how far have we come and why haven't we come farther, or should the field have progressed further? Well, as a scientist who directs a head injury center, sees patients, and directs biomedical research, we can never come far enough. Of course, I'm going to say we've got a long ways to go, and of course, we're going to say we're going to need more research. But I tend to sleep pretty well at night.
Posted on BrainLine October 18, 2011.
David Hovda, PhD is the director of the UCLA Brain Injury Research Center. He is past president of the National Neurotrauma Society and past president of the International Neurotrauma Society. He has served as chair of study sections for the National Institute for Neurological Disease and Stroke.
Produced by Noel Gunther, Ashley Gilleland, and Brian King, BrainLine.