Ramon R. Diaz-Arrastia, MD, PhD, is a board certified neurologist practicing at Penn Neurology University City. Dr. Diaz-Arrastia directs Penn's Traumatic Brain Injury Clinical Research Center and is Associate Director for Clinical Research, Center for Neurodegeneration and Repair. He is also Presidential Professor of Neurology at the Perelman School of Medicine at the University of Pennsylvania.
A Traumatic Brain Injury (TBI) refers to any time a mechanical energy impacts the head resulting in a neurologic insult. And while not every bonk on the head is TBI, studies indicate the condition is still common.
Traumatic Brain Injury Clinical Research Center at Penn Medicine
"The epidemiology suggests that 30 percent of the population has experienced TBI at some point in their lives," says Ramon R. Diaz-Arrastia, MD, PhD, and Director of the Traumatic Brain Injury Clinical Research Center at Penn Medicine.
"It's one of the top ten reasons for emergency room visits in the U.S. The majority of cases — 85-90 percent — are mild injuries that make a good recovery. The remaining 10-15 percent, unfortunately, do not fare so well."
This population is the one that Penn's Traumatic Brain Injury program is most focused on, shares Dr. Diaz-Arrastia: those who have been hospitalized due to their injury. He explains that one of the biggest concerns facing these patients is post-traumatic dementia or neurodegeneration.
"People with early to mid-life TBI are at increased risk of developing dementia later in life," he explains. "There are estimates that 5-10 percent of the population's dementia burden is due to TBI, so it's one of the main areas we are studying."
Treatment for Traumatic Brain Injury Patients
The clinic's goal is to have all patients admitted to the hospital for TBI to be evaluated by a TBI specialist while here.
"Many of these people are admitted to the neuro ICU, but others are admitted to trauma or orthopaedics," Dr. Diaz-Arrastia explains. "So we want to make sure we cover all hospital admissions."
Patients are scheduled for a follow-up in the TBI clinic where their needs are further evaluated. They may be referred for headache management, rehabilitation services, occupational therapy, physical therapy, speech therapy, or cognitive rehabilitation.
"Our goal is to research and develop new treatments and diagnostics for TBI," says Dr. Diaz-Arrastia. "TBI has been a tough nut to crack with regards to development of therapeutics. All we do currently are symptomatic or supportive treatments. Therapies for protecting or regenerating brain tissue have been the holy grail for a long time."
Traumatic Brain Injury Research
Advancing the treatment of TBI is a familiar effort for Dr. Diaz-Arrastia who has been studying and treating the condition for most of his career.
"When I started in the mid-90s, there were only a handful of neurologists involved in the field," he says. "There was a communication gap between neurosurgeons, neurointensivists, neuropsychologists, and rehabilitation medicine specialists. They didn't know each other or speak the same language." Dr. Diaz-Arrastia explains, "Neurology straddles these fields, so we can bring all sides to the table. TBI is such a common problem and one of the most common causes of neurological morbidity. It's critical for neurologists to get involved."
Research is central to the program's commitment to solving many of the most pressing issues surrounding TBI. At present, it's actively recruiting patients for several observational, biomarker, imaging, and interventional clinical trials.
"We just launched a monoclonal antibody therapy study targeting an isoform of phosphorylated tau — it's very exciting," shares Dr. Diaz-Arrastia. "And I'd be remiss if I didn't mention Danielle Sandsmark, MD, PhD, and Andrea Schneider, MD, PhD, are both part of the program and have committed their careers to TBI," he continues. "Dr. Sandsmark has been working on some exciting projects looking at a novel class of identifying biomarkers and micro-RNA. And Dr. Schneider, who received her PhD in epidemiology from Johns Hopkins — there are very few epidemiologists in TBI and neurocritical care — is doing terrific work on the epidemiology of long-term outcomes of TBI."
Additional Traumatic Brain Injury Resources