Lesson from D.C. lockdown -- brain injury is a public health crisis

Leaders in the White House and on Capitol Hill woke up Friday morning to a continued government shut down.  Tragically, 1-year-old, Erica Carey woke up without a mother – Miriam Carey was shot dead Thursday during a bizarre episode in our nation’s capitol.

Will the White House and Capitol Hill learn anything from this tragedy?

We’ve learned a few things about Miriam Carey:

1. She suffered a traumatic brain injury two years ago after falling down a flight of stairs while she was pregnant with Erica.


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2. Her family reports she had post-partum depression following Erica’s birth.

3. She began exhibiting psychotic breaks from reality over the past year.  Her life completely changed after her brain injury and it doesn’t take Sherlock Holmes to put the pieces together:

Her employer for eight years prior to her brain injury, Dr. Steven Oken said, “I would never in a million years believe that she would do something like this. It's the furthest thing from anything I would think she would do, especially with her child in the car.  I am floored that it would be her.”

And her employer after her brain injury, Dr. Brian Evans, said she “had a temper,” was quick to anger and “she tended to go against the grain a bit.”

We know trauma occurs in approximately 7% of all pregnancies and is the leading cause of death for pregnant women with closed head injury and hemorrhage accounting for 85% of these deaths. Behind motor vehicle crashes, falls are the second-most common mechanism of injury during pregnancy.

Based on Dr. Donald Stein’s research at Emory University and his current national clinical trial, the hormone, progesterone, has shown to be a neuroprotector following a brain injury and women have about an 800% increase in progesterone during pregnancy. However, immediately after birth, a new mother’s progesterone drops dramatically and may not return to normal levels for a few months.

Is it possible Miriam Carey’s post-partum depression diagnosis really masked the effects of her traumatic brain injury?  Is it possible other new mothers with post-partum depression are really exhibiting the long-term effects of trauma during the pregnancy?  Can this explain the difference between mild and severe post-partum depression?

Since we only know 5% of what we will eventually know about the brain (the same percentage of knowledge about cardiology in the 1850s), we have more questions than answers … but what else do we know?

We know from Drs. Jorge and Starkstein 2005 research in The Journal of Head Trauma Rehabilitation that major depression is present in about 40% of patients hospitalized for a traumatic brain injury and emotional expression and aggressive outbursts are frequently associated with such depression.

In 1993, Drs. Dikmen, Machamer and Temkin studied a group of adults for two years following a brain injury and concluded in the journal, Brain Injury, “that moderate and severe head injuries have a significant long-term impact on psychosocial functioning.”

In a study conducted by Dr. Jonathan Silver and his colleagues, individuals with a history of traumatic brain injury have significantly higher occurrence for psychiatric disorders and suicide attempts in comparison with those without head injury.  They also have a poorer quality of life.

Drs. Simpson and Tate studied 172 TBI survivors and 35 percent had clinically significant levels of hopelessness, 23 percent had suicidal thoughts, and 18 percent had made a suicide attempt post-injury.

According to the Centers for Disease Control and Prevention, brain injury is the #1 leading cause of death and disability for American youth and younger adults.  Over 765,000 American youth up to 25 years of age enter an Emergency Department each year with a new brain injury, over 80,000 are hospitalized and over 11,000 die -- annually! If you compare those numbers to HIV (about 56,000 new cases each year) or autism (about 24,000 new cases each year) you can quickly see how brain injury is a public health crisis.

However, less than $10 million is directed in research for brain injury in youth by our federal government while over $4 billion is directed to HIV/AIDS research.  We have a national plan for HIV/AIDS, we have a national plan for autism, we have a national plan for obesity, we have a national plan for cancer … where is our national plan for brain injury?

The International Advisory Board of The Sarah Jane Brain Foundation already created the National Pediatric Acquired Brain Injury Plan (PABI Plan) and the millions of American families who have a child with a brain injury are waiting for our federal government to begin implementing it.

It is a $2.9 billion, seven-year plan that does not require additional funding from Congress and it does not create an indefinite new federal program.

The PABI Plan will develop a seamless, standardized, evidence-based system of care that is universally accessible for the millions of American families who have a child with a brain injury regardless of where they live.

The lesson Washington should learn from the tragic death of Erica Carey’s mom: how about addressing the leading public health crisis of our time: Brain Injury.