Dr. Ronald Poropatich told members of The American Legion’s TBI/PTSD Committee on Feb. 22 in Washington, D.C., that treatments for traumatic brain injury and post-traumatic stress disorder needed to be more individualized and tailored to the specific symptoms of each patient.
“There have been about 30 studies with TBI patients that provided half of them with drug therapy and the other half with a placebo,” Poropatich said. “We know now that’s not the right way to treat traumatic brain injury. It’s not one size fits all.”
Poropatich, executive director of the Center for Military Medicine Research at the University of Pittsburgh, said important imaging advancements have been made that go beyond a regular MRI scan. Broken nerve fibers in the human brain, caused by an IED explosion or some other force, can now be seen. “It allows us to treat that individual, knowing where those fibers are broken," he said.
In the treatment of TBI and PTSD, Poropatich said doctors need to look at the “individual trajectories” of patients. Some will have post-concussive headaches, some will have significant sleep problems, which may lead to anxiety and depression, while others will have significant cognitive challenges. Some patients may suffer from ocular motor disturbance, which makes it difficult to look at something close up such as a computer screen and then look at something far away.
“And then there’s vestibular balance problems,” Poropatich said. “You can’t expect someone who has an ocular motor problem with their eyeballs to be treated with a vestibular drug.”
The American Legion’s TBI/PTSD Committee can help heighten awareness of individualized treatments, Poropatich said. “We need to realize that TBI and post-traumatic stress – you have to focus on the individual patient, find out what’s wrong within that patient, and target your therapy specifically. Is it a balance issue? Is it an eye muscle issue? Is it a sleep issue?
“They may have all three of those. Then you have to sequence the treatment. I can’t fix your ability to think and to make decisions until I fix your sleep. I can’t fix your thinking if you’ve got eye problems.”
The key to successful TBI/PTSD therapies, Poropatich said, is the proper sequencing of treatments and following a patient’s progress in the long term.
At the Center for Military Medicine Research, each patient is assigned a clinical coach and a military coach who help make sure that recommended treatments are followed.
Poropatich, a consultant for the Legion’s committee, asked the members to consider “how we might want to sharpen our message to take to senior leaders” in the Departments of Defense and Veterans Affairs “that explains the way we used to look at treating and studying (these conditions), and ways that we should pivot our thinking – that includes not just an imaging modality but also the treatment.”