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 Brain experts said most health services fail to make
the link between traumatic brain injury (TBI) and long-term mental
consequences, meaning patients can fall through the net into
depression, behavioral problems and crime.
While Schumacher, a wealthy and famous former motor-racing driver
well supported by family, friends and doctors, is in a far better
position that most with TBI, he will nevertheless still have a
changed brain and will need to readjust and cope.
"If Schumacher survives he will not be Schumacher. He will be (Mr.)
Bloggs. And his rehabilitation will only be effective if he comes to
terms with being Bloggs — and fulfils what Bloggs can do," said
Richard Greenwood, a consultant neurologist at London's Homerton
Hospital and at the National Hospital for Neurology and
Neurosurgery.
"That's a very, very difficult process to take people through — and
many people don't achieve it."
Greenwood was speaking at a briefing for reporters on the results of
a study into the long-term effects of traumatic brain injuries
caused by blows to the head.
The study, published on Wednesday in the journal JAMA Psychiatry,
found that survivors of TBIs are three times more likely to die
prematurely than the general population, often from suicide or fatal
accidents.
Seena Fazel of Oxford University's Department of Psychiatry, who led
the study, said the exact reasons for the increased risk of
premature death — which in this study was defined as dying before
the age of 56 — are not clear. But he said they may be linked to
damage to parts of the brain responsible for judgment,
decision-making and risk-taking.
TBI survivors are three times more likely to die from fatal injuries
that may be a due to impaired judgment or reactions.
They are also at increased risk of developing psychiatric illnesses
such as depression and anxiety, which can lead to patients having
difficulties dealing with new situations and organizing their lives.
A TBI is a blow to the head that leads to a skull fracture, internal
bleeding, loss of consciousness for longer than an hour or a
combination of these symptoms.
Some 1.7 million people in the United States and one million people
in Europe are hospitalized after TBIs each year.
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Experts say typical causes include road accidents,
falls and sports injuries, and Schumacher's skiing injury — sustained when he slammed his head on a rock while skiing off-piste
in the French Alps — is a an example of this type of injury.
Fazel said current guidelines do not recommend assessments of mental
health or suicide risk in TBI patients, but focus instead on
short-term survival.
"Looking at these findings, it may make more sense to treat some TBI
patients as suffering from a chronic problem requiring longer-term
management just like epilepsy or diabetes," he said. "TBI survivors
should be monitored carefully for signs of depression, substance
abuse and other psychiatric disorders, which are all treatable
conditions."
For their Study, Fazel and fellow researchers from the Karolinska
Institute in Stockholm examined Swedish medical records going back
41 years covering 218,300 TBI survivors, 150,513 siblings of TBI
survivors and more than two million controls matched by sex and age
from the general population.
"We found that people who survive six months after TBI remain three
times more likely to die prematurely than the control population and
2.6 times more likely to die than unaffected siblings," Fazel said.
"Looking at siblings who did not suffer TBIs allows us to control
for genetic factors and early upbringing, so it is striking to see
that the effect remains strong even after controlling for these."
(Editing by Mark Heinrich)
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