TBI Diagnosis and Treatment
The diagnosis of Traumatic Brain Injury, TBI, is NOT new.
Treating TBI with neurosteroids is new!
Approximately 5.3 million US citizens are currently living with disability secondary to TBI. A 2010 report showed “a brain injury occurs every seven seconds and results in death every 5 minutes representing approximately 4.3 million brain injuries and 53,000 deaths a year.”
Treatment Modalities for TBI
For centuries, treatment of TBI was the same. The patient was told to rest, was watched and one would wait to see what the outcome would be. Hyperbaric oxygen was the first real “treatment” for TBI along with various rehabilitation therapies, none of which work well.
Most TBI patients have experienced trying 20 different therapies, all of which are great therapies, but they just don’t end up working no matter how great they are. Many patients try multiple therapeutic modalities from neuro-optometric rehabilitation, vision therapy, functional neurology to spinal adjustments, but do not notice improvement. If improvement does occur, it is transient and the patient reverts back to a dysfunctional state after hours to days. Therapies may be necessary for patients, but they don’t “stick.”
The reason being, inflammation in the brain needs to be tamed first to allow the brain to accept changes of therapy. This inflammation cannot be tamed without replenishing neurosteroids.
It was not until Mark L. Gordon, MD, through hours of journal reading and working with military soldiers presenting with TBI, whether it be mild or severe, had a presentation similar to the symptoms caused by deficiencies of neurosteroid hormones. Those same neurosteroids were insufficient or deficient in TBI. When the neurosteroids were repleted, TBI patients started getting better.
These neurosteroids include growth hormone, pregnenolone, DHEA, progesterone, estrogen, testosterone, and thyroid. Dr. Gordon went on to prove, through his own clinical trials, these neurosteroid deficiencies seen in TBI can be treated and when they are, brain inflammation decreases and magic happens, restoring a more normal life to TBI patients who otherwise would have no hope of recovering.
Misdiagnosis and Mistreatment of TBI Patients
Contrary to general belief, the majority of TBI cases are classified as mild and never seek medical treatment. However, even these “mild” cases chronically progress to neuropsychological changes from the injury over time leading to severe disabling symptoms. By the time subtle neuropsychological changes start occurring, association between the TBI and symptoms is lost. These people are often treated for their symptoms with drugs which can worsen their condition further.
In addition to TBI from injury, other brain injuries such as stroke, hypoxia, severe hypoglycemia, radiation, and prolonged surgical procedures can lead to the same neurosteroid deficiencies changing the patient’s personality and cognitive function similarly seen in blunt force trauma to the brain.
Brain Trauma and Neuroendocrinology
Neuroendocrinology is the study of medicine relating to interactions between the endocrine system and nervous system. This focuses on the hormone activity throughout the body regulated by the brain.
Neurosteroids are hormones synthesized by the brain and regulate growth of neurons, and the connections and communicating system between the neurons. Neurosteroids act in target glands throughout the body such as the thyroid, adrenal glands and gonads.
There is a primary and a secondary injury following brain trauma.
- The primary injury leads to cellular damages, vascular damages, ischemia (restricted blood flow) and metabolic crisis.
- The secondary phase is riddled with complex processes, a toxic symphony leading to a highly inflammatory state in the brain.
The secondary effects from this inflammatory process can present as symptoms decades later, and by that point the brain injury may have been lost as a possible cause, resulting in long-term suffering. Without identifying the underlying cause, healing potential is limited and inflammation continues.
Hormone Regulation by The Hypothalamic-Pituitary Axis
The pituitary gland and hypothalamus are key players in hormone regulation. These two areas are easily impacted, and therefore, highly vulnerable to brain injury.
- The hypothalamus resides between the pituitary gland and the inner brain, connecting the endocrine and nervous systems.
- The pituitary gland resides at the base of the brain and is considered the “master gland” as it plays a central role in the endocrine system.
- The hypothalamic-pituitary axis is the system that intertwines the central nervous system with the endocrine system. TBI can lead to dysfunction of this axis, causing various hormonal abnormalities. In research, it is estimated:
- 50–76% of TBI patients show some loss of pituitary neurosteroid function
- 58% with pituitary hormone deficiencies may recover after one year
- 52% may develop new deficiencies one year after the initial injury
Neurosteroid Deficiencies and/or Insufficiencies in TBI
Neurosteroid hormone deficiency or insufficiency (low “normal” range) is a hallmark of TBI. Neurosteroid deficiencies include: growth hormone, pregnenolone, DHEA, progesterone, estrogen, testosterone, and thyroid.
These hormone insufficiencies are the underlying cause of prolonged symptoms in patients with TBI. Growth hormone insufficiency is the most common hormone insufficiency. Properly identifying and treating underlying hormone deficiencies can often lead to patients being able to reclaim their health and their lives.
Growth hormone is highly important as it is found in all cells in the body and directs organ function. If the level declines, the functions of the body start to decline too. Growth hormone is responsible for overseeing: mood, stress, motivation, energy, memory, sleep, immune system, sex, circulation, bones, joints, weight, skin and hair.
Symptomatology resulting from neuroendocrine dysfunction is the same symptomatology resulting from post-concussion syndrome. Symptoms include memory loss, attention difficulties, insomnia, impaired cognition, fatigue, mood disturbance.
Underlying Cause Missed in TBI Patients
Instead of screening for and identifying the underlying neurosteroid insufficiency, a patient may be labeled with post-concussion syndrome, depression, anxiety or PTSD and continue to suffer with many symptoms for years without proper treatment. The issue is these patients are treated with pharmaceutical medications for their symptoms, but these pharmaceuticals do not address the underlying cause of deficient neurosteroids and can worsen the underlying cause. Patients are not deficient in pharmaceuticals; they are deficient in neurosteroids.
Hormones have been found to affect neuroplasticity, or the brain’s ability to regenerate and grow new connections. If the hormones are depleted, what does this mean for the brain’s ability to heal those damaged areas and neurons? What would the number of post-concussion syndrome (PCS) patients look like if there were a screening process and treatment in place for these hormonal deficiencies? Would there still be up to 60% of patients going on to experience PCS?
Screening for Neurosteroid Insufficiencies
Dr. Mark Gordon has set up teaching programs outlying the physiology of brain trauma and its treatment with neurosteroids and nutraceuticals. He continuously lectures around the world and was instrumental in the production of the award-winning movie, Quiet Explosions, about TBI in our military.
Various recommendations are suggested for screening hormone disturbances following brain trauma though this is not common practice in traditional medicine:
- Screen as soon as possible after TBI as a baseline, followed by hormone panels at 3-, 6- and 12-months post-injury.
- Order a hormone panel 3 months post-injury if symptoms suggest neuroendocrine dysfunction or if there are delayed symptoms at any point in a patient’s life.
Despite thousands of articles available for decades demonstrating the connection between TBI and hormone dysfunction, this is still a very under-diagnosed consequence of brain injury not typically screened for in patients.
By identifying and treating underlying hormone insufficiencies in TBI patients, no matter how far out they are from their injury, inflammation is reduced and the brain can begin to heal.