Research on head injury, carried out in Beaumont Hospital, has broken new ground. Eoin Burke-Kennedyreports
Doctors in Dublin's Beaumont Hospital have made a significant breakthrough in the treatment of people with brain injuries.
A team of physicians from the Department of Neurosurgery and Endocrinology have identified previously undetected hormone deficiencies in patients with moderate or severe head trauma.
The research, which was presented to the Society of British Neurological Surgeons in April, found approximately 25 per cent of brain injury patients had evidence of pituitary gland damage.
Headway, the Irish national association for acquired brain injury, estimates there are up to 30,000 people living in Ireland between the ages of 16 and 65 with long-term problems caused by brain trauma.
The gland, which is located at the base of the skull, secretes several vital hormones that assist in regulating various bodily functions.
Damage to the pituitary can result in any combination of an under-active thyroid, growth hormone deficiency and low levels of natural steroids. Symptoms may be physical, such as excessive tiredness and weight gain, or neuropsychiatric, in the form of depression, poor concentration and memory loss.
The condition is, however, easily treated with hormone replacement therapy, which has a low side-effect profile.
As a result of the team's research, an under-active pituitary is now accepted internationally as a major, but often undiagnosed, complication of head injury.
The research was prompted by consultant neurosurgeon Jack Phillips, who noticed that some of his head injury patients shared similar symptoms to those he had treated for pituitary tumours.
Phillips says patients with bad head injuries often had lethargic or depressed personalities, a phenomenon traditionally attributed to post-concussional syndrome.
"But in many cases, there did not appear to be enough structural injury to the brain to explain this," he says.
Phillips, together with Prof Christopher Thompson and Dr Amar Agha, from the hospital's Endocrinology Department, set up a study to test for pituitary dysfunction in survivors of head trauma.
"We analysed a large cohort of patients that came in to the intensive care of Department of Neurosurgery at Beaumont, taking serial estimations of their hormone levels after their head injuries," says Phillips. "We found approximately a quarter of patients that were in a coma after their head injuries suffered pituitary damage."
The results have subsequently been corroborated by other studies in Europe and North America.
The public health implications of the findings are significant, considering Traumatic Brain Injury (TBI) is the most common cause of death and disability in young adults in industrialised countries.
Recent studies suggest between 180 and 250 persons per 100,000 die or are hospitalised as a result of TBI annually in industrialised countries.Although there is no specific data for Ireland, it is estimated that approximately 10,000 people a year suffer traumatic brain injuries, the majority of which are as a result of road accidents and falls.
Although most patients make a full recovery, a significant cohort suffer persistent cognitive, physical and emotional problems, often seriously diminishing their quality of life.
A recent US study estimated that some five million people are living with disabilities caused by TBIs at a lifetime cost of $600,000 to $1.9 million per person.
Agha, who now leads Beaumont's Head Trauma Pituitary Investigation Team, explains that during head trauma, patients can suffer a shearing injury to the brain.
"This can damage the nerve fibres and blood vessels which supply the pituitary, resulting in what we call 'pituitary gland infarction'.
"So far, our studies have focused on patients with severe or moderate head injury but we don't know if patients with mild head trauma develop pituitary dysfunction," he says.
Agha believes the post-traumatic pituitary dysfunction is significantly "underidentified and undertreated" in Ireland, considering how common head injury is.
He wants to see a screening programme established to test all head trauma patients for signs of the condition.
Such programmes have already become standard in Germany and Scandinavia as a result of the research done by the team at Beaumont.
"At the moment, because of limited resources, we only see a very selective number of patients that are referred to us because they are failing to rehabilitate satisfactorily and this not ideal," Agha says.
Headway wants the Health Service Executive (HSE) to conduct an epidemiological survey of TBI and to set up a tracking system to monitor the progress of patients.
The group's senior clinical neuropsychologist Dr Salvatore Giangrasso believes it is impossible to provide adequate services for people struggling with the effects of brain injury in the absence of proper data.
Giangrasso believes the situation in Ireland is "catastrophic", with many patients being misdiagnosed and ending up in psychiatric institutions, receiving inappropriate care.
He also believes many sufferers succumb to addiction or end up in prison because they are falling through the cracks in the system.
Giangrasso believes a significant portion of the prison population are behind bars due to inappropriate behaviour caused by "an organic deficit" as a result of a brain injury.