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If Schumacher survives, he will not be Schumacher – neurologist

16 January 2014, 13:28

People with severe head injuries like the one that left Michael Schumacher in critical condition have permanently altered brains that make the victims more likely to become mentally ill and die prematurely, scientists said on Wednesday.

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, behavioural 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 Dr. 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."

Premature death
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.

Dr. 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 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 organising their lives.

Suicide risk
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 hospitalised after TBIs each year. 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 backcountry skiing 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.

Psychiatric disorders
"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."

The future for Michael?
Dr Gary Hartstein, Formula 1's official medical delegate from 2005-12, has been following news of Michael Schumacher's head injury closely. He provides in-depth insight into the clinical situation at present (on Michael's Facebook page) and as for saying what's going to happen in the future, he says there's a long, long road ahead. Months at least.

 In the short term, the anaesthetic needs to be lightened when the ICP (intracranial pressure which compresses the tiny blood vessels that nourish the brain) is normal and stable. That's the next big step.


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