Adi Gaskell, Guest ColumnistServing in the military is unquestionably one of the most dangerous professions in the world today. For instance, various reviews conducted in the aftermath of the Gulf War in 1990 found that up to 25% of returning troops were suffering from a range of health conditions, including the chronic and multi-symptomatic disorder that came to be known as Gulf War syndrome.
While originally this was thought to be a condition caused by the stress of combat itself, this has since largely been debunked. For instance, a review of 34 individual studies into the health of military personnel who had served in Iraq and Afghanistan conducted by King's College London found that servicemen and women were generally speaking no more likely to suffer from conditions such as Post Traumatic Stress Disorder than the general population. This suggests that the military has learned to imbue within serving personnel a degree of resilience that is serving them in good stead against the extremely challenging environment they operate in.
While this is hugely positive, the report went on to conclude, however, that servicemen and women were far from immune to side effects of their profession, with depression and anxiety commonly reported. The authors also revealed that combat troops were around twice as likely to suffer from mild traumatic brain injuries or concussion to you and I.
A Hidden Affliction
Placed alongside PTSD, concussion is perhaps not one of the more prominent problems affecting members of the military today, but as research from the Traumatic Brain Injury Program, Neuroscience, and Rehabilitation Center illustrates, this is a dangerous trap to fall into.
The authors argue that of the 1.6 million or so service members who were deployed in Iraq and Afghanistan since 2001, as many as 35% of them will have sustained a concussion during their deployment.
Many of these concussions occurred as a result of blast exposure and the authors believe that the unique nature of the combat environment requires both; a unique understanding of the circumstances surrounding the injury, and a unique treatment plan for the resulting concussion.
"After receiving a concussion, many service members begin to experience headaches; onset or maintenance of insomnia; changes in their thinking skills; and possible neuropsychiatric issues, such as irritability, anxiety, and anhedonic or dysphoric mood, while still in theater," the researchers explain. "These symptoms can be exacerbated by ongoing experiences during a deployment, including combat involvement and traumatic distress, considerable physical stress and musculoskeletal injuries, sleep disturbance (eg, fragmented, restriction, deprivation, onset or maintenance type of insomnia), which result in circadian dysrhythmia, possible exposure to toxins, chronic hyperarousal, and separation from and disruption of family and social relationships."
Keeping Quiet
Military personnel serving today are commonly screened for a history of possible concussion upon their return from service. These post-deployment health assessments are typically performed at two different time points, but full disclosure is often complicated by the fact that any medical treatment inevitably delays the reunion of the serviceman or woman with their family. This can prompt many to minimize their symptoms during these tests to expedite their return to their family.
The authors highlight that the kind of concussions that result from blast injuries can be highly complex, with the resolution of any cognitive deficits taking anywhere from a few hours to over 90 days.
"At least in civilians, as many as 11%-64% may show a continuance of complaints commonly labeled postconcussion syndrome (PCS), which involves subjective cognitive difficulties accompanied by a myriad of physical (eg, anergia, insomnia, headache, dizziness) and psychological (eg, irritability, anxiety, dysphoria, apathy, changes in personality) symptoms," they explain.
These complaints imply physiological changes to the brain, including reduced metabolism, alteration of neuromodulation, and changes to the regulation of neurochemical transmission. These issues are often compounded by the high serum levels of stress hormones during active service, which can impact both the nature and the severity of the neurologic injury.
Making Improvements
With PTSD and depression both enduring consequences of concussion, there is a clear need to better understand the post-concussion symptoms in the military population. Recent research from the Uniformed Services University of the Health Sciences highlights the potential for repetitive transcranial magnetic stimulation (rTMS) to provide noninvasive help to service members suffering the fallout from concussion.
The authors illustrate the use of rTMS via repeated sessions of magnetic stimulation that is targeted to particular parts of the brain may help patients suffering from depressive disorders. The researchers believe such an approach could also be used for both cognitive issues and PTSD as well.
They urge a degree of caution, however, as there is insufficient data to make lasting conclusions as to the efficacy of the approach on post-concussed individuals. It is a clear sign of the progress being made in treating a problem that we are both more aware of and more exploratory of in terms of effective management and treatment.
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