January 9, 2003
Traumatic brain injuries: Finding ways to reduce the damage
Each year 1.5 million Americans sustain a traumatic brain injury, according to the Centers for Disease Control and Prevention. This is eight times the number of people diagnosed with breast cancer and 34 times the number of new cases of HIV/AIDS. Of those with traumatic brain injury, 50,000 die and over 80,000 will have a life-long disability because of the injury.
“When someone gets a brain injury, some of the damage is immediate, but other things go wrong over the next days and weeks,” says Dr. Nancy Temkin, professor of neurological surgery and biostatistics. “Nobody understands the broad range of mechanisms that occur as a result of a brain injury. Seizures are one common result of brain injury. Loss of cognitive and functional abilities, such as the ability to hold a job, also occurs frequently. We do longitudinal studies on the occurrence of seizures and how people recover from brain injuries at periods of time between one month and several years.”
Temkin, a statistician, and her colleagues, especially Dr. Sureyya Dikmen, a neuropsychologist, and former colleague Dr. H. Richard Winn, a neurosurgeon, have completed two clinical trials of treatments to lessen the negative consequences of head injury. The completed trials were on medications to prevent the development of seizures and the current trial is enrolling patients for a study of a drug that may help improve functioning, as well as prevent seizures.
“During the first week after someone has received a head injury, they are given phenytoin to prevent seizures,” explains Temkin. “This has been the procedure for quite some time, based in part on the results of the first UW study. Phenytoin is actually very successful at minimizing seizures in the first week. However neither it nor valproate prevent seizures after the first week and phenytoin may have adverse neurobehavioral effects when given over a long period of time.”
The third study Temkin and her colleagues are working on is treating patients with magnesium sulfate, commonly known as Epsom salt. Magnesium sulfate is thought to be a general neuroprotectant, according to Temkin. Magnesium may regulate calcium going into the brain cells and protect the cells from further damage in the week after the injury.
“The pilot data showed that magnesium sulfate had a positive effect on IQ—an area where brain injury can have far-reaching effects,” says Temkin. “If magnesium sulfate significantly decreases the cognitive and functional effects of a brain injury, it could substantially improve the quality of life for those who suffer a head injury. Doctors currently do not have any drugs that have been shown to improve long-term functioning after traumatic brain injury.”
Temkin received a Ph.D. in statistics from the State University of New York at Buffalo in 1970. She was a visiting scientist at the Imperial Cancer Research Fund in London and an instructor of biometrics at the University of Colorado Medical Center in Denver. In 1977 Temkin joined the UW as an acting assistant professor of neurological surgery and biostatistics. She became professor in 2002.
Among her numerous awards, she received the Ciba-Geigy Award for the best controlled trial of the year. She is currently a member of the Centers for Disease Control and Prevention working group on mild traumatic brain injury.