Risks of traumatic brain injury
HAVE you ever fallen off your bike as a kid? There was probably a chance you had a head bump as it hit the ground. This bump may sometimes be referred to as a head injury. However, if this bump causes a jolt to the brain, it will be referred to as a traumatic brain injury (TBI).
TBI affects nearly 64 to 74 million people worldwide, with road traffic accidents comprising most of the TBI cases reported in hospitals. In Malaysia, about 500,000 road traffic accidents occur annually, indicating a high number of possible TBI cases alone. When combined with TBI cases caused by falls, domestic violence and sports injury, the number of cases may even be higher. But why is this alarming?
“TBI has been considered one of the
“TBI has been classified as a persistent disease which may increase the risk of various long-term outcomes in the form of neurological disorders such as Alzheimer’s disease, Parkinson’s disease, epilepsy, depression and others.”
Dr Alina Arulsamy
biggest contributors to global death, disability and health burden. It has been classified as a persistent disease which may increase the risk of various long-term outcomes in the form of neurological disorders such as Alzheimer’s disease, Parkinson’s disease, epilepsy, depression and others. Thus, the term ‘silent epidemic’ was coined by a 2018 paper in the Journal of Neurosurgery,” says Dr Alina Arulsamy from the Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia.
According to Dr Alina, there’s tissue damage, axonal shearing, haemorrhage, blood-brain barrier disruption and possible skull fracture at the point of impact. This is followed by brain oedema, hypoxia and increased brain swelling seconds to minutes later.
“As time passes (minutes to days), brain inflammation is triggered due to immune system activation which helps to recover the damaged tissue and heal the site of injury. However, when these responses end up being prolonged (weeks to years), it may trigger brain toxicity, chemical imbalance and degeneration of the brain, leading to an increased risk towards a range of neurological outcomes, particularly at the chronic stages post-tbi,” she shares.
The risk varies with the severity of the TBI, increasing and sometimes doubling between mild to severe TBI. While not everyone who has sustained a TBI will develop these long-term outcomes, Dr Alina mentions that the risks have been proven to be significant enough that they should not be overlooked.
“Despite TBI’S debilitating long-term outcomes, there are currently no effective therapeutic strategies available to prevent or treat them, especially given the heterogeneity of the brain damage leading to these outcomes,” Dr Alina states.
Dr Alina has taken up the challenge to find a way to ease the health burden faced by TBI patients and improve their quality of life by understanding the basis of TBI and related brain inflammation. Her research focuses on three key aspects of traumatic brain injury – understanding the pathological interaction of TBI and its outcomes, determining the therapeutic targets for post-tbi interventions and elucidating the status of TBI in South-east Asia. She hopes to create significant awareness, which may promote the help-seeking behaviour (treatment and rehabilitation) in TBI patients in these low- to middle-income countries.
The fundamental studies on TBI in the country are scarce, which led Dr Alina to be a part of a niche group of TBI researchers in Malaysia. She intends to collaborate with these researchers to bridge the gap in TBI knowledge and hasten the pace toward preventing and improving long-term outcomes.
“TBI is a highly heterogeneous disorder that varies from person to person and has many factors such as age, gender and lifestyle that may influence it. It is no easy task for just one person to solve this problem but requires a village of researchers from across the country, region and world. Let’s share, collaborate, and reach the therapeutic goal for patients with TBI,” says Dr Alina, who graduated with a PHD from the University of Adelaide, Australia.
Dr Alina is the lead researcher of the TBI arm under the Neuropharmacology Research Strength (NPRS) at Monash University Malaysia. Lead of NPRS, Assoc Prof Mohmad Farooq Shaikh, Dr Alina and their team are currently running various translational TBI projects involving a multidisciplinary approach, such as understanding the dynamic relationship between neuroinflammation, the gut microbiota and Tbi-related epilepsy (posttraumatic epilepsy) and neuropsychiatric comorbidities.
“Accurately mimicking clinical TBI in preclinical settings has proven to be difficult given the multifaceted nature of TBI. Many types of preclinical models are required to understand each facet. We have established one type of model in our lab, but we are actively seeking collaboration with other labs that have different models to answer some of our questions. It’s all about teamwork now,” Dr Alina states.
If you are interested in TBI research or working in the field, email Dr Alina Arulsamy at alina.arulsamy@monash.edu.