March 21, 2014
SickKids and the Department of National Defence (DND) are two organizations that one would not normally put together. But in hopes of better understanding the growing issue of post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) among soldiers, SickKids and DND have joined forces. Researchers from Defence Research and Development Canada (DRDC), Canadian Forces Health Services (CFHS), and The Hospital for Sick Children (SickKids) have been working together toward a major advance in how PTSD and mTBI could be diagnosed.
According to a study by CFHS, about 5% of Canadian Armed Forces (CAF) personnel who served in Afghanistan were diagnosed with mTBI. About 8% return with PTSD, a figure which rises to about 20% in those who worked “outside the wire,” or outside the confines of a military base. “These statistics as well as other factors have made mental health in general and these conditions in particular a key priority for the Surgeon General and Canadian Forces Health Services,” said Col Rakesh Jetly, MD, Senior Psychiatrist of the Canadian Armed Forces.
Traditionally, doctors have relied on self-reported emotional and psychological symptoms from patients to diagnose these invisible illnesses. These symptoms can vary widely from person to person and are often quite subjective. Doctors know the symptoms of PTSD and mTBI show considerable overlap. Particularly in a military setting, both are often present, making it difficult to distinguish between the two.
Doctors have been looking for a more objective way to diagnose these illnesses. Through this collaboration by DRDC, CFHS and SickKids, scientists are now studying the use of magnetoencephalography (MEG) to do just that.
MEG is an advanced biomedical technology that measures magnetic signals generated by neural transmissions in the brain. It is the only non-invasive neuroimaging technique that shows when and where processing activity occurs in the brain. Conventional neuroimaging like CT and MRI scans are not able to detect real-time brain activity. Through use of the MEG at SickKids, scientists have learned that while outward symptoms can be very similar, brain functioning is very different for PTSD and mTBI. For the first time, MEG results have shown clear differences between patients with PTSD or mTBI and those without either illness. Having the means to make an objective diagnosis means that doctors may be better equipped to quickly treat and manage the patient’s specific illness.
Moreover, doctors hope that MEG will also be able to determine when treatment is complete and the patient may return to work and other normal activities, like participating in sports. “The ultimate goal of providing objective diagnostic testing for PTSD and mTBI is to not only better understand the conditions and make fast, accurate diagnoses, but also to be able to test the individual to determine if he or she has gotten better and can safely return to work,” says Dr. Margot Taylor, co-investigator of the research with Dr. Elizabeth Pang; Dr. Taylor is Director of Functional Neuroimaging in Diagnostic Imaging and Senior Scientist at SickKids; Dr. Pang is Director of Clinical MEG and Associate Scientist in the Division of Neurology.
The results of the MEG pilot study have caught the attention of research counterparts at the US Department of Veterans Affairs, who wish to partner with DRDC for a more definitive human trial.
DRDC has a long history of delivering research to the CAF by partnering with our allies, academia and the private sector. Support through collaboration is helping us deal with problems afflicting members of the armed forces. This pilot project is a prime example of how working together can help deliver impact.
“It is our collective effort that will lead to advances in diagnostic assessment and treatment. This research has been driven by military needs and the health and medical issues that come out of warfare. But these developments are applicable universally, across the country and across society to a number of civilian populations. The Canadian Armed Forces and Canadian citizens in general will benefit from this work,” said BGen J-R Bernier, Surgeon General, , speaking at the recent 2014 Mental Health Research Symposium held at SickKids to highlight this field of study.
Magnetoencephalography, neuroimaging and biomarkers have tremendous potential to advance the diagnosis and treatment of PTSD and mTBI. MEG has the particular advantage of also allowing researchers to understand what anomalies in brain activity produce the various symptoms in these disorders. More work will be done as these technologies are developed through fundamental research and ultimately clinical trials.
While this research aims to benefit military personnel, it is hoped the technology can be widely used in next 4-5 years to assist civilian mental health patients as well. It is definitely worth the effort for the health of Canadians across the country.