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    <recommendedItem id="20100101_19_390"
                     title="Vegetative State May Still Harbor Consciousness (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Neurology/GeneralNeurology/tb/18283?impressionId=1265803258439"
                     
      Researchers in England are reporting they have been able to establish limited communication with a man in a persistent vegetative state by using functional magnetic resonance imaging (fMRI).&lt;br&gt;
&lt;br&gt;The 34-year-old man was able to answer simple Yes or No questions by imagining different types of activity, which caused changes in brain activity that could be seen in the machine, according to Martin Monti, PhD, of the Medical Research Council Cognition and Brain Sciences Unit in Cambridge, England, and colleagues.&lt;br&gt;
&lt;br&gt;The finding shows that at least some patients who are otherwise unresponsive may have some residual awareness, the researchers reported online in the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;The incredible thing is that we could never do something like that at the bedside,&quot; Monti told &lt;em&gt;MedPage Today&lt;/em&gt;. Outside of the fMRI machine, he said, the patient remained unresponsive to standard tests.&lt;br&gt;
&lt;br&gt;The study is likely to arouse controversy, Monti conceded, especially in the light of such high-profile cases as that of Terry Schiavo, which eventually went to the U.S. Supreme Court.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;In the Schiavo case, relatives were bitterly divided on whether to withdraw&lt;strong&gt; &lt;/strong&gt;life support for the woman, who had been in a persistent vegetative state for several years.&lt;/p&gt;
&lt;p&gt;&quot;People will have a tendency to overinterpret this,&quot; Monti said, adding &quot;this finding in one patient does not imply that all patients may or may not have the ability to do this.&quot;&lt;/p&gt;
&lt;p&gt;Indeed, the researchers tested 54 people and found only five who could apparently respond to direction by imagining either motor or spatial activity. Imagining those activities uses different parts of the brain and their activation can be seen by the fMRI scan.&lt;/p&gt;
&lt;p&gt;Several of the responders were already what is called &quot;minimally responsive,&quot; meaning that occasionally they were able to react to external stimuli.&lt;/p&gt;
&lt;p&gt;Of those five, the researchers only tried to communicate with one  --  the man in a persistent vegetative state  --  using his ability to reliably activate different brain areas when asked to imagine either playing tennis or looking around a room in his house.&lt;/p&gt;
&lt;p&gt;While in the machine, he was asked simple questions, such whether his father&apos;s name was Alexander. To answer Yes, he was to imagine playing tennis, while for No he was to imagine looking around the room.&lt;/p&gt;
&lt;p&gt;He was able to answer five out of six questions, the researchers reported, adding it was unclear why he was unable to answer the sixth but no brain activity was seen in response to the question.&lt;/p&gt;
&lt;p&gt;Outside experts also cautioned against overinterpreting the results.&lt;/p&gt;
&lt;p&gt;&quot;The percentage of patients showing a response was low, and longer-term follow-up studies are needed to determine whether such fMRI findings by themselves have meaningful predictive value,&quot; argued Alan Faden, MD, of the University of Maryland School of Medicine in Baltimore.&lt;/p&gt;
&lt;p&gt;&quot;This study may well raise questions for some with regard to medical or legal decisions based upon state of consciousness,&quot; Faden said in an e-mail, &quot;but the findings primarily underscore the limitations of current categorizations for diminished states of consciousness.&quot;&lt;/p&gt;
&lt;p&gt;He said that as technology gets better, it will likely mean that doctors will have to modify their diagnostic categories for what he called &quot;states of diminished consciousness.&quot;&lt;/p&gt;
&lt;p&gt;In an accompanying editorial in the journal, Allan Ropper, MD, of Brigham and Women&apos;s Hospital in Boston, wrote that such research is &quot;easily subject to overinterpretation and sensationalism.&quot;&lt;/p&gt;
&lt;p&gt;He cautioned that brain activation was seen only in a few patients and only in those with a traumatic brain injury, rather than global ischemia and anoxia.&lt;/p&gt;
&lt;p&gt;And, he wrote, the brain activity seen in the patients is not evidence of such things as memory, self-awareness, anxiety, or despair. &quot;We cannot be certain whether we are interacting with a sentient, much less a competent, person&quot; Ropper wrote.&lt;/p&gt;
&lt;p&gt;Despite such caveats, the research is &quot;critically important,&quot; according to Michael DeGeorgia, MD, of University Hospitals Case Medical Center in Cleveland.&lt;/p&gt;
&lt;p&gt;It &quot;illustrates both the complexities of this area and the limitations of our bedside clinical examination,&quot; he said in an e-mail, adding that more research will be needed to figure out how to use the technology and how to interpret the results.&lt;/p&gt;
&lt;p&gt;The research &quot;does raise difficult medical and legal questions,&quot; DeGeorgia said.&lt;/p&gt;
&lt;p&gt;&quot;We always need to be upfront and honest with families about what we know for certain and what we do not know for certain,&quot; he said. &quot;In many of these cases, the honest answer is that we cannot be absolutely 100% certain that their loved one isn&apos;t &apos;in there somewhere.&apos;&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from the Medical Research Council, the European Commission, Fonds de la Recherche Scientifique, the James S. McDonnell Foundation, the Mind Science Foundation, the Reine Elisabeth Medical Foundation, the Belgian French-Speaking Community Concerted Research Action, University Hospital of Liege, the University of Liege, and the National Institute for Health Research Biomedical Research Centre.&lt;/p&gt;&lt;p&gt;The researchers said they had no potential conflicts.&lt;/p&gt;&lt;p&gt;Hopper did not report any conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_353"
                     title="Helmets Linked to Reduced Head Injury Risk in Alpine Sports (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/Neurology/HeadTrauma/tb/18227?impressionId=1265803258439"
                     
      Skiers and snowboarders have a significantly lower risk of head injury if they wear helmets, a meta-analysis showed.&lt;br&gt;
&lt;br&gt;In a pooled analysis of nine studies, helmet wearers were 35% less likely to suffer a head injury than those without helmets (OR 0.65, 95% CI 0.55 to 0.79), Brent Hagel, PhD, of the University of Calgary in Alberta, and colleagues reported online in the &lt;em&gt;Canadian Medical Association Journal&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The association was significant for skiers and snowboarders alike.&lt;br&gt;
&lt;br&gt;Although there has been some concern that use of a helmet could increase the risk of neck injury because of the extra weight it adds to the head, especially with children, the studies did not confirm any danger.&lt;/p&gt;
&lt;p&gt;&quot;Based on our findings, we encourage the use of helmets among skiers and snowboarders,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Various reports have estimated that 9% to 19% of injuries that occur on the slopes are head injuries and 1% to 4% are neck injuries.&lt;/p&gt;
&lt;p&gt;Traumatic brain injury is the leading cause of death and serious injury among skiers and snowboarders.&lt;/p&gt;
&lt;p&gt;A recent example was the training accident of U.S. Olympic hopeful snowboarder Kevin Pearce, who suffered a severe traumatic brain injury when he fell and hit his head on the edge of a half pipe on New Year&apos;s Eve. He was wearing a helmet.&lt;/p&gt;
&lt;p&gt;Although injury prevention efforts in alpine activities have focused on helmets, there were no systematic reviews of their effectiveness, the new study&apos;s authors noted.&lt;/p&gt;
&lt;p&gt;So Hagel and colleagues assembled data from 10 case-control studies, one case-control/case-crossover study, and one cohort study, totalling 9,829 participants who were wearing helmets and 36,735 who weren&apos;t. The studies evaluated head injury, neck injury, or both.&lt;/p&gt;
&lt;p&gt;In addition to protecting adults from head injury, the researchers found, helmets also appeared to protect children younger than 13 (OR 0.39, 95% CI 0.23 to 0.65).&lt;/p&gt;
&lt;p&gt;While two of four studies looking at potentially severe head trauma  --  resulting in referral to an emergency physician or hospital for treatment or evacuation by ambulance  --  found a reduced risk in those wearing helmets, the other two found no effect.&lt;/p&gt;
&lt;p&gt;There was some evidence that risk of head injury was reduced for males wearing helmets, but not for females, although sex was not found to be a significant modifier of the relationship between helmet use and injury risk (&lt;em&gt;P&lt;/em&gt;=0.09).&lt;/p&gt;
&lt;p&gt;Helmet use was not associated with risk of neck injury, even among children, which &quot;is consistent with biomechanical data showing no increase in neck loads associated with helmet use in simulated snowboarding falls,&quot; the researchers noted in the journal.&lt;/p&gt;
&lt;p&gt;The meta-analysis had some limitations, they wrote, including the moderate methodologic quality of the included studies, two different approaches for determining control groups (noninjured skiers and snowboarders versus those with injuries not involving the head or neck), the inclusion of English-language studies only, and variations in confounders, definitions of head injury, and places of and personnel involved in diagnosis.&lt;/p&gt;
&lt;p&gt;In addition, the researchers were unable to examine the results in terms of the design, quality, or fit of the helmets for cases.&lt;/p&gt;
&lt;p&gt;&quot;Methodologically rigorous research is required to determine which types of helmets provide the best protection,&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding was received for the study.&lt;/p&gt;&lt;p&gt;Hagel holds the Alberta Children&apos;s Hospital Foundation Professorship in Child Health and Wellness, funded through the support of an anonymous donor and the Canadian National Railway Company. He also holds a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research and a New Investigator Award from the Canadian Institutes of Health Research.&lt;/p&gt;&lt;p&gt;One of his co-authors holds a doctoral studentship from the Alberta Heritage Foundation for Medical Research.&lt;/p&gt;&lt;p&gt;The authors reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_168"
                     title="Concussion Label Can be Confusing (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Neurology/HeadTrauma/tb/18000?impressionId=1265803258439"
                     
      Whether a clinician calls a mild traumatic brain injury a concussion or not appears to influence how serious the injury is considered to be, researchers found.&lt;br&gt;
&lt;br&gt;Among children admitted for a traumatic brain injury, those who were told they had a concussion were discharged significantly earlier (OR 1.49, 95% CI 1.15 to 1.94) and returned to school sooner (OR 2.42, 95% CI 1.56 to 3.73) than those who were not given the label, Carol DeMatteo, MSc, of McMaster University in Hamilton, Ontario, and colleagues reported in the February issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The trends remained significant even after adjusting for the severity of the head injury and the presence of other injuries.&lt;/p&gt;
&lt;p&gt;&quot;We suggest that the [concussion] label itself conveys a message and also directs outcomes,&quot; the researchers wrote. &quot;If we want to encourage full reporting with subsequent adequate management and convalescence, perhaps we should use the term &apos;mild traumatic brain injury.&apos;&quot;


 &lt;p&gt;Disagreeing was Kenneth Perrine, PhD, a neuropsychologist at Hackensack University Medical Center in New Jersey.
    &lt;p&gt;&quot;Granted, concussion is by definition a mild brain injury, but it&apos;s so transient that I think it would be a disservice both to the public and for research to continue to confuse mild traumatic brain injury with concussion,&quot; said Perrine, who was not involved in the study.
    &lt;p&gt;He said a true concussion is characterized by feeling like one is in a fog, fatigue, sensitivity to light and sound, headache, blurred vision or other visual disturbances, and feeling off balance.
    &lt;p&gt;A mild traumatic brain injury, on the other hand, has longer-lasting effects and is not usually accompanied by concussion symptoms. Retrograde amnesia, post-traumatic amnesia, and more severe memory loss would occur, he said.
    &lt;p&gt;&quot;They are two distinct entities both from what we call it and from a prognostic standpoint,&quot; said Perrine, who is also consulting neuropsychologist for the New York Jets.
    &lt;p&gt;But, although the term concussion is used widely in clinical records and has garnered much attention in recent years because of head injuries to athletes at all levels of sports, an accepted definition does not exist, according to DeMatteo and her colleagues.&lt;/p&gt;


&lt;p&gt;&quot;Clinicians may use the concussion label because it is less alarming to parents than the term &quot;mild brain injury,&quot; with the intent of implying that the injury is transient with no signi&amp;#64257;cant long-term health consequences,&quot; they said.&lt;/p&gt;

&lt;p&gt;Commenting on the study, Wendy Wright, MD, a neurologist at Emory University in Atlanta, said in an e-mail, &quot;This study puts a spotlight on the issue that concussion is not always taken as seriously as it should be, partly because concussion encompasses a spectrum of disease.&quot;&lt;/p&gt;
&lt;p&gt;She said parents, coaches, teammates, and the individual with the concussion may not believe the injury is serious because symptoms are transient.&lt;/p&gt;
&lt;p&gt;That perception appears to be held by both clinicians and parents alike. DeMatteo and colleagues noted in the journal that during recruitment of the current study, both groups were heard saying, &quot;He doesn&apos;t have a head injury, he has a concussion.&quot;&lt;/p&gt;
&lt;p&gt;However, Wright said, &quot;it must be noted that concussion means brain injury.&quot;&lt;/p&gt;


&lt;p&gt;To explore how the term is used clinically, DeMatteo and colleagues analyzed the records of 434 children admitted to McMaster Children&apos;s Hospital with a diagnosis of acquired brain injury.&lt;/p&gt;
&lt;p&gt;Of those determined to have a traumatic brain injury, 72.7% had a mild injury according to the Glasgow Coma Scale. Nearly one-third (32.4%) were said to have a concussion.&lt;/p&gt;
&lt;p&gt;The concussion label was more likely to be given to children with a mild injury (&lt;em&gt;P&lt;/em&gt;=0.03), but the association was weak, according to the researchers, and nearly one-quarter (24%) of children with moderate or severe scores were also said to have a concussion.&lt;/p&gt;
&lt;p&gt;&quot;This leads one to question the use of the term as being reflective of mild injury and again supports the existence of confusion about what a concussion really is and how the term should best be used in the care of children,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Our findings, both in the return-to-school data and the phenomenon we experienced during recruitment, suggest that if a child is given a diagnosis of concussion, then the family is less likely to consider it as a brain injury,&quot; the researchers said.&lt;/p&gt;
&lt;p&gt;They acknowledged some limitations of the study, including the fact that data from medical charts may have had missing information and a lack of control over the validity of measurements and that their use of only a single center might influence the results.&lt;/p&gt;
&lt;p&gt;Further, they wrote, some measures, such as CT frequency, might be inflated because only children who were admitted to the hospital were included in the study. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by a research grant from the Ontario Neurotrauma Foundation. The &lt;em&gt;CanChild&lt;/em&gt;&lt;em&gt;&lt;/em&gt; Center for Childhood Disability Research is supported by the Ontario Ministry of Health and Long-Term Care.&lt;/p&gt;&lt;p&gt;The authors reported that they had no relevant financial disclosures to make.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_8_426"
                     title="Ear Damage After Roadside Blasts May Be Marker of Neurologic Injury"
                     score="-0.006"
                     href="