When brain cells, neurons, die, their debris need to be quickly and efficiently removed for the surrounding brain tissue to continue to function properly. Elimination of the dead neuron corpses, is accomplished through phagocytosis (Phagocytosis is a specific form of endocytosis by which cells engulf and internalize solid matter). Phagocytosis is carried out by highly specialized cells in the brain called microglia (Microglia are a type of glial cell located throughout the brain and spinal cord. Microglia account for 10–15% of all cells found within the brain. As the resident macrophage cells, they act as the first and main form of active immune defense in the central nervous system). These small cells have many ramifications that are in constant motion and are specially equipped to detect and destroy any foreign element, including dead neurons. Or so it was thought until now.
A new study, published May 26, 2016 in PLOS Biology, investigates, for the first time, the process of neuronal death and microglial phagocytosis in the diseased brain. To this end, scientists collected brain samples from epilepsy patients and from epileptic mice.
It is known that during epilepsy-associated seizures, neurons die. However, contrary to what happens in the healthy brain, during epilepsy, microglia seem to be “blind” and unable to find the dead neurons and to destroy them. Their behavior is abnormal. Therefore, dead neurons cannot be eliminated and accumulate, spreading the damage to neighboring neurons and triggering an inflammatory response that worsens the brain injury.
This discovery opens a new avenue to explore therapies that could alleviate the effects of brain diseases. In fact, the research group that undertook these studies is currently developing drugs, hoping to boost this cleaning process -phagocytosis- and help in the treatment of epilepsy.
This is from the Brain Injury Association of America’s latest legislative update. Note Dr. O’Shanick, Medical Director of the Center for Neurorehabilitation Services, spoke to Congress.
- House Committee Holds Hearing on Youth Sports Concussion Act
Dr. Gregory O’Shanick, President and Medical Director of the Center for Neurorehabilitation Services in Richmond, Virginia and the Medical Director Emeritus of the Brain Injury Association of America testified before the House Energy and Commerce Committee, Subcommittee on Commerce, Manufacturing, and Trade on Tuesday, May 24 to discuss the Youth Sports Concussion Act, H.R. 4460. The hearing, Legislative Hearing on 17 FTC Bills, covered a variety of legislation that will impact the Federal Trade Commission (FTC). The Subcommittee on Commerce, Manufacturing, and Trade is chaired by Congressman Michael Burgess (R-Texas) and the ranking member is Congresswoman Janice Schakowsky (D-Ill.)
The United States Senate Committee on Commerce, Science, and Transportation, chaired by Senator John Thune (R-S.D.) passed the Youth Sports Concussion Act, S. 2508 out of the committee on Wednesday, April 27, 2016. The Youth Sports Concussion Act is sponsored by Senator Tom Udall (D-N.M.) and in the House of Representatives, Reps. Bill Pascrell, Jr. (D-N.J.) and Thomas J. Rooney (R-Fla.), co-chairs of the Congressional Brain Injury Task Force.
The Youth Sports Concussion Act expressed the sense of Congress that the Consumer Product Safety Commission (CPSC) and the Federal Trade Commission (FTC) should review the National Academies’ report on sports-related concussions and future research in such area for any matter that may impact products under the CPSC’s jurisdiction or inform the FTC’s efforts to protect consumers.
The bill makes it unlawful to sell or offer for sale in interstate commerce, or import into the United States for such purposes, athletic sporting equipment for which the seller or importer makes any deceptive claim with respect to the safety benefits of such an item. Violations shall be treated as unfair or deceptive acts or practices under the Federal Trade Commission Act. The bill sets forth the enforcement authority of the FTC. States may bring civil actions in federal court to obtain injunctive relief on behalf of state residents unless a civil or administrative action has already been instituted by the FTC. The FTC may intervene and appeal in state actions.
The Youth Sports Concussion Act is an important piece of legislation because it will protect our nation’s youth who participate in sports related activities from concussions and other injuries by discouraging false advertising claims regarding protective equipment used in competitive sports. BIAA and NASHIA recently spearheaded a letter of support to the House Energy and Commerce Committee to include the Youth Sports Concussion Act in the next executive session. Thirty six organizations signed on in support of moving this important legislation through the committee process. BIAA thanks Chairman Fred Upton (R-Mich.) and Ranking Member Frank Pallone, Jr. (D-N.J.) for moving this important legislation through the committee process.
- Congressional Report Finds NFL Improperly Attempted to Influence NIH on Brain Injury Research
On May 23, Congressman Frank Pallone, Jr. (D-N.J.), ranking member of the House Energy and Commerce Committee, released a report concluding that the National Football League (NFL) improperly attempted to influence the grant review process for the National Institutes of Health (NIH) brain injury study that the NFL had agreed to fund as part of a $30 million donation. The report states that the integrity of NIH’s grant review process was preserved. The report also concludes the Foundation of NIH (FNIH), a non-profit charitable organization whose mission is to direct funding from public and private donors to NIH projects, did not adequately fulfill its role of serving as an intermediary between NIH and the NFL. You can read the full report here.
- Pediatric Trauma Caucus Launched
House Energy and Commerce Committee members Rep. Richard Hudson (R-N.C.) and Rep. G.K. Butterfield (D-N.C.) officially launched the Pediatric Trauma Caucus on Tuesday, May 24. NASCAR Team Owner, Motorsports Hall of Fame Inductee, and Co-Founder of the Childress Institute for Pediatric Trauma, Richard Childress led the briefing discussion. Other panelist included Bob Gfeller, Executive Director, Childress Institute for Pediatric Trauma, Dr. Valerie Maholmes, Ph.D., Chief, Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Dr. David Adelson, Director, Barrow Neurological Institute, Chief, Pediatric Neurosurgery/Children’s Neurosciences, Phoenix Children’s Hospital, Diana Fendya, R.N., Trauma/Acute Care Specialist, EMSC National Resource Center, Children’s National Medical Center, Dr. Barbara A. Gaines, Clinical Director, Pediatric General and Thoracic Surgery, Children’s Hospital of Pittsburgh of UPMC, Dr. John Petty, Director, Pediatric Trauma Program, Brenner Children’s Hospital/Wake Forest Baptist Health. BIAA thanks Reps. Hudson and Butterfield for taking the lead on this important issue.
Congress will be in recess next week in honor of Memorial Day, Monday, May 30 therefore the next Policy Corner will be released on Friday, June 10.
© 2015 Brain Injury Association of America.
All Rights Reserved
On Wednesday, December 16, 2015, Congress released the Consolidated Appropriations Act of 2016, the fiscal year (FY) 2016 omnibus appropriations bill *, which totals $1.15 trillion in discretionary spending in compliance with the Bipartisan Budget Act of 2015. The bill appropriates $1.067 trillion in base discretionary budget authority, pursuant to the two-year budget agreement enacted in November 2015, including: $548.091 billion in base defense spending; and $518.491 billion in base non-defense spending. The bill funds the government through September 30, 2016.
Today the House and Senate passed the omnibus appropriations bill and sent it to the President. Congress already passed a continuing resolution (CR) which funds the federal government through December 22, 2015.
Congress is also working on a massive $680 billion permanent tax extenders bill, which is also being referred to as a tax cuts package. This bill was released on December 16 and was passed by the House on December 17, by a vote of 318 to 109, with 241 Republicans voting in favor. The Senate passed the tax package today.
Funding for Traumatic Brain Injury Federal programs are listed below:
TBI Act: $9.321 million. This is level funding from Fiscal Year (FY) 2015. The bill also includes specific language to move the program’s funding from the Health Resources Services Administration (HRSA) to the Administration for Community Living (ACL).
- Centers for Disease Control and Prevention, Injury Prevention Center, TBI: $6.75 million. This is an increase from FY 15’s $6.548 million.
- BRAIN Research Initiative: $150 million. This is an increase of $85 million from FY 15.
- Defense Health Program TBI/Psychological Health: $125 million. This is the same funding level as FY 15. The initial Defense Appropriations bill that the House considered earlier this year cut funding for this program to $100 million. Rep. Bill Pascrell, Jr. (D-NJ), co-chair of the Congressional Brain Injury Task Force successfully passed an amendment restoring the funding to $125 million.
*An omnibus spending bill is a type of bill that packages the 12 smaller appropriations bills into one large single bill that could be passed with only one vote in the House of Representatives and the United States Senate. There are 12 appropriations bills that need to be passed each year to fund the federal government and avoid a government shutdown, an omnibus spending bill combines these bills into a single bill.
If you’re pondering whether to buy a Windows Phone or an iPhone this holiday season, (I am a Windows Guy), a part of the brain called the dorsomedial prefrontal cortex might ultimately determine your choice. Results of a new study suggest that this region of the brain plays a critical role in making choices.
A New Brain Study by Avinash Vaidya and Dr. Lesley Fellows, researchers at the Montreal Neurological Institute and Hospital (The Neuro), suggest that this region of the brain, dorsomedial prefrontal cortex, plays a critical role in making choices.
Dr. Fellows stated recently “A big question is how and where value information is represented in the brain, and what goes into that representation.” Dr. Fellows is a neurologist and researcher in the expanding field of decision neuroscience. “Our research confirmed what savvy marketers already know: the longer you look at one of two objects, the more likely you’ll choose that object even if you initially valued the other one more. But we went further and identified a region of the frontal lobe that is crucially involved in this phenomenon.”
The study involved 60 participants, half of whom had suffered localized injury to the frontal lobes due to a stroke or tumor. Participants looked at hundreds of different pieces of art and rated their desire for each of them. This provided an estimate of the subjective value that each piece held. In a later test, the participants chose between pairs of these artworks. Participants were inclined to select the artwork that they examined longer even if in the earlier test they gave a higher value rating to the other object. Participants behaved as though the value of an option increased the longer it was observed. Seeing is believing!
Participants with damage to a particular sector of the frontal lobe, the dorsomedial PFC, showed an exaggerated tendency to be drawn to the object at hand. The study shows that the dorsomedial PFC plays a critical role in mediating the balance between prior value assessment and an object’s immediate appeal.
So as you shop this Holiday, remember there is more to your choices than meets the eye.
The Brain Injury Association of America has asked me to forward this message on to my reader
Affordable Care Act Consumer Survey
The Brain Injury Association of America is conducting a survey to better understand whether the Affordable Care Act (ACA) is meeting the needs of individuals with brain injuries. If you have health care coverage through private insurance provided by your employer or by one of the health care marketplaces or “exchanges,” please take a moment to fill out the survey here. The survey is also under news and announcements on BIAA’s website, www.biausa.org.
BIAA Comments On NIH Research Priorities
BIAA, along with the Disability Rehabilitation Research Coalition (DRRC) submitted comments on the proposed research priorities of the National Institute of Health’s National Center for Medical Rehabilitation Research (NCMRR). Through basic, translational, and clinical research, the NCMRR aims to foster development of scientific knowledge needed to enhance the health, productivity, independence, and quality-of-life of people with physical disabilities. The NCMRR supports research on the following topics: pathophysiology and management of chronically injured nervous and musculoskeletal systems (including stroke, traumatic brain injury, spinal cord injury, and orthopedic conditions); repair and recovery of motor and cognitive function; functional plasticity, adaptation, and windows of opportunity for rehabilitative interventions; rehabilitative strategies involving pharmaceutical, stimulation, and neuroengineering approaches, exercise, motor training, and behavioral modifications; pediatric rehabilitation; secondary conditions associated with chronic disabilities; improved diagnosis, assessment, and outcome measures; and development of orthotics, prosthetics, and other assistive technologies and devices. The comments will be posted to BIAA’s website soon under Legislative Priorities, Research.
BIAA Meets With CDC To Discuss TBI Research
BIAA met with leadership from the Centers for Disease Control and Prevention (CDC), Division of Unintentional Injury Prevention this week as follow up from a letter BIAA sent CDC regarding research priorities which did not include Tier I Research for TBI. BIAA is concerned that the Injury Center is shifting away from research on secondary and tertiary prevention of traumatic brain injury (TBI), as reflected in the Injury Center’s Research Priorities for the next 3-5 years.
In the letter, Susan Connors, president/CEO of BIAA noted that Tier 1 priorities, identified in the CDC Injury Research Agenda 2009-2018, reflect, “the most immediate TBI-related research needs and those that should be supported first as resources become available.”
Improving identification, assessment, and management of TBI;
Developing and applying methods for calculating population-based estimates of the incidence, costs, and long-term consequences of TBI;
Identifying methods and strategies to ensure that persons with TBI receive needed services; and
Developing and evaluating interventions for reducing TBI-related disability.
The Brain Injury Association of America asked me to pass along this new information:
BIAA Meets with Leadership at ACL
As reported in Policy Corner, U.S. Department of Health and Human Services (HHS) Secretary Sylvia Burwell relocated the Federal Traumatic Brain Injury (TBI) State Grant Program from the Health Resources and Services Administration (HRSA) to the Administration for Community Living (ACL). The move took place on October 1, 2015. HRSA and ACL are working together to make a seamless transition. BIAA’s president and CEO, Susan Connors and Amy Colberg, director of government affairs, met with leadership from ACL on Friday, October 23 to discuss the relocation of the Federal TBI State Grant Program, specifically a National plan for brain injury.
Injury Violence and Prevention Meeting
BIAA attended the fall Injury Violence and Prevention (IVPN) Meeting in Washington, D.C. on Thursday, October 22. During the meeting, recent IVPN activities were reviewed and meeting attendees participated in breakout session to plan strategies with policy staff from CDC’s National Center for Injury Prevention and Control. The group worked to identify and prioritize IVPN activities for 2016. BIAA serves on the Injury Violence and Prevention Coalition which meets monthly throughout the year and educates to the Administration and Congress about injury and violence prevention issues and the importance for increased funding.
BIAA Presenting at NASHIA’s State of the State Conference
Amy Colberg, BIAA’s director of government affairs will be presenting at NASHIA’s State of the State Conference, Thursday, October 29 in Denver Colorado. Ms. Colberg will be participating in the This Week in Washington panel at 8:30 am. Please stop by and introduce yourself if you will be attending the NASHIA conference as well.
Mild traumatic brain injury (MTBI), or concussion, accounts for 75 percent of all TBI and represents an important public health problem. Difficulty in working memory is frequently reported in patients after concussion. Now new research suggests that older individuals may have a more difficult time recovering from concussion. However, neuropsychological tests, computed tomography (CT) and conventional magnetic resonance imaging (MRI) generally fail to reveal abnormal findings in these patients. Functional MRI (fMRI) has been increasingly used in assessing patients with MTBI.
According to a new study published online in the journal Radiology, Dr. Chen and colleagues, from the Department of Radiology at Shuang-Ho Hospital, Taipei Medical University, in New Taipei City, Taiwan, used fMRI to evaluate the effect of age on working memory performance and functional activation in the brain after MTBI.
In comparing the patients in initial and follow-up study, the young patients had significantly reduced post-concussion symptom score at follow-up than at the time of the initial exam, but no significant change of the post-concussion symptom score was observed in the older patients.
The researchers hope that these findings might eventually lead to the development of separate management strategies for different age groups following concussion.
For further reading please refer to Chi-Jen Chen, Chih-Hsiung Wu, Yen-Peng Liao, Hui-Ling Hsu, Ying-Chi Tseng, Ho-Ling Liu, Wen-Ta Chiu. Working Memory in Patients with Mild Traumatic Brain Injury: Functional MR Imaging Analysis. Radiology, 2012; 264 (3): 844 DOI: 10.1148/radiol.12112154
American Association for Justice 2016 – Tim Titolo
I am once again honored to be invited to give a presentation at the 2016 Mid-Year American Association for Justice. The conference will be in Boca Raton Florida from February 26 to 29, 2016.
My topic will be “Inadequate Security Involving Third Party Crime.” I wish to thank the folks at AAJ for inviting me to present. Below is more information about the conference.