While research into memory loss after head impacts could eventually provide hope for patients, a call for a “holistic multidisciplinary approach” to the care of patients following a mild traumatic brain injury is less positive, raising concerns that claims could increase as a result.
It was widely believed that repeated impacts to the head resulted in the brain adapting by changing the way that synapses operate, which led to difficulty forming new memories and recalling existing memories.
However, a new study has found that memory loss attributed to head injury is not a “permanent pathological event driven by neurodegenerative disease”, but is actually due to “inadequate reactivation of neurons involved in forming memories”. This suggests there is the potential to clinically reverse cognitive impairment caused by head impact.
Georgetown University Medical Center, in collaboration with Trinity College Dublin, gave two groups of mice a new memory by training them in a test they had never seen before in a study designed to look at memory loss after repetitive low-level head impacts.
One group of mice was exposed to a high frequency of mild head impacts for one week (similar to contact sport exposure in people) and the other were controls not subjected to impacts. The impacted mice were unable to recall the new memory a week later. However, by using lasers to activate the engram cells, researchers were able to reverse the amnesia to allow the mice to remember the lost memory.
Researchers were also able to see the neurons involved in learning new memories and they found that these were present in both the control and the experimental mice.
Although the research gave hope that treatments could be developed to “return the head-impact brain to its normal condition and recover cognitive function” where poor memory is caused by repeated head impacts, the technique used in the study was invasive and not translatable to humans. The findings have, however, opened a window to explore non-invasive techniques to communicate to the brain that it is no longer in danger, which may lead to a return to its former state.
The outcome of such investigations is eagerly awaited as success could positively reduce the value of mild traumatic brain injury claims and associated future losses as a result of memory impairment.
There has been a call this year by a neurology expert for a shift in clinical management following mild traumatic brain injuries (mTBIs) in an attempt to reduce stroke incidence via ongoing surveillance to address both the neurological and vascular implications of concussion. It aims to foster a “holistic multidisciplinary approach to patient care that spans the acute post-injury phase through long-term follow-up”. An elevated incidence of stroke is the result of disruptions caused by mTBI, which initiate a series of vascular changes that may predispose individuals to both ischemic and haemorrhagic strokes.
The expert argues that emerging evidence challenges the “traditional understatement” of long-term effects of mTBIs. However, aside from commenting that analyses of health records suggest that individuals with a history of concussion are at a higher risk of experiencing a stroke compared to those without such a history, no evidence is provided in support of the need or benefit of post-mTBI management. Furthermore, no explanation has been provided as to what a holistic multidisciplinary approach would actually entail.
When dealing with claims, the link between mTBI and strokes has long been recognised and taken into consideration. Following an mTBI, neurological experts are routinely asked to comment on the increased chance of stroke and the reduced risk over time to assist with calculating loss as it is important to be able to accurately assess the value of damages.
When settlement is achieved it is generally ‘full and final’, meaning the claimant is unable to return to seek a further award even where their condition has seriously deteriorated. When the court is satisfied a claimant is more than 50% likely to suffer a specified deterioration in their condition, compensation on the basis that the deterioration will occur will be awarded. But what about cases where there is an increased chance of stroke, where the deterioration, although possible, is less than probable?
In certain limited circumstances, a claimant can be compensated for their injuries with the proviso that if a specified condition occurs in the future they will be allowed to return to court so that further compensation can be awarded, known as ‘provisional damages’. Such an order is routinely requested for the increased risk of dementia and epilepsy in mTBI claims but not for the risk of stroke. If experts are going to argue for an elevated incidence of stroke following an mTBI there may be an increase of claims seeking to make provision for this. Reference to the need for long-term continuous monitoring may also result in claims for additional treatment costs to cover the ongoing “surveillance”.
Either scenario could potentially see an increase in the value of mTBI claims and should be flagged for consideration with a neurological expert if being raised as an issue on a claim.
For more information, please contact: Kayla Rees - Associate
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