Commentary Regarding The Brain Injury of America’s “Conceptualizing Brain Injury as a Chronic Disease”
I have read the Brain Injury Association position paper on “Brain Injury” as a chronic disease. The paper, written by Dr. Brent Masel, M.D., a renowned neurologist, and adopted as a position statement of the BIA on February 27, 2009, makes some very solid points on why “brain injury” should be referred to as a chronic disease. There is now a push by the BIA to define “brain injury” as a disease. But “Brain Injury Chronic Disease” may be too broad a term.
The document is sub-category specific. It is a rationale regarding why traumatic brain injury (TBI)should be designated as a disease. However, the title of the document is “Brain Injury as a Chronic Disease.” As stated above, the term “brain injury” is a much broader category.It is used to describe many neurological conditions and disorders. These include birth defect type brain injuries, degenerative neurological disorders, and traumatic brain injuries, and others.Since the position paper deals ENTIRELY with TBI’s, would it not more aptly have been entitled “Traumatic Brain Injury as a Chronic Disease?"
Here are two ways that TBI is currently classified by medical authorities:
1. The National Institute of Neurological Disorders and Stroke has a Disorders Index.
The WHO distinguishes between diseases and consequences of external causes. Diseases of the Nervous System (meningitis, encephalitis, intracranial abscess, hydrocephalus, anoxic brain damage, degenerative diseases such as Alzheimer’s disease, and multiple sclerosis) are all in Chapter VI. In Chapter IX Diseases of the Circulatory System include subarachnoid haemorrhage, nontraumatic intracranial haemorrhage, cerebral infarction, strokes, and aneurysms.The separate chapter XIX is entitled “Injury, poisoning and certain other consequences of external causes” and does not use the word “disease.” This section includes injuries such as fractures. Often (but not always) a head injury includes a skull fracture which is a form of traumatic brain injury. Wouldn’t it be a good idea to get the World Health Organization to agree to this reclassification of traumatic brain injury as a disease prior to enacting any legislation in the United States to that effect?
The premise of the article is that there are many chronic disease issues possible after a TBI, sometimes years after TBI. The doctor cites seizures, endocrine issues, sleep disorders, incontinence, and other medical conditions as potentially developing from the TBI. Thank you, Dr. Masel, for pointing out the chronic conditions that many of us suffer. It is about time someone put it all together as you have, Dr. Masel.
Since the article is talking about things due to or after the TBI (not the TBI itself), might it not be better to name this “Post-TBI Syndrome” or perhaps “TBI Chronic Disease”? Perhaps it could even be named “Masel Syndrome” in the doctor’s honor. Could such a condition then be classified as a disease?