03 December 2021
2 minutes to read
Biography / Disclosures
Odette Harris MD, MPH, is professor of neurosurgery and director of brain injury at Stanford University School of Medicine. She is also Deputy Chief of Staff for Veterans Administration’s Palo Alto Health Care System Rehabilitation and Site Director, Head Injury Center of Excellence.
Disclosures: Harris does not report any relevant financial disclosure.
Most studies of head trauma, particularly with regard to military populations and explosive injuries, have recruited males, primarily or exclusively.
It is not uncommon to find articles on traumatic brain injury (TBI) in which only 5% or 1% of the study cohort were female, without any attempt to analyze whether there were any differences in this small percentage of women compared to the group as a whole.
Without more information, we can make erroneous inferences about the experience and recovery of women after TBI. Our treatment strategies, be it rehabilitative care or emergency neurosurgical procedures, are therefore much less evidence-based when applied to women than to men.
A few years ago, my colleagues and I conducted a literature review to determine what is so far known about gender differences in CBT (Kim et al.). We found that depression was a more common comorbidity in women than in men. In addition, women were significantly more likely than men to report somatosensory deficits, including vestibular, oculomotor and proprioceptive problems related to vision.
Much more work is needed to understand the nuances behind these results. In particular, we need larger retrospective datasets that include more women, as well as prospective data acquisition by sex that assesses both brain structure and function.
My neuroscientist colleague Maheen Adamson, PhD, has researched surrogate markers in the brain that can help us understand the relationship between brain structure and functional changes after TBI. Cortical thickness is one such potential marker that is frequently used in neuroimaging studies of neurologic disease progression, but we do not yet know how reliable it is in tracking acquired brain damage. like a TCC.
In healthy brains, there are gender differences in this marker: women have a cerebral cortex about 6% thicker than men. After a TBI, both men and women experience thinning of the cortex, but imaging studies suggest that female veterans had more severe cortical thinning than their male counterparts.
Ideally, we want to be able to see how these physiological changes in the brain correlate with the symptoms and functional outcomes of patients. We are still in the very early stages of this work, but it holds promise for better understanding and predicting response to treatment.
This work could be applied to subpopulations other than women – older or younger patients or specific types of injuries, for example. It’s not that the TBI literature is wrong, it’s just that it isn’t nuanced enough for us to be able to provide the most accurate care.
I’m glad that many different specialties are starting to notice and fix this problem. Given the ongoing efforts, I’m optimistic that we can develop a more complete picture of how female brains and brain function are affected by TBI so that we can truly do neurosurgery and rehabilitation for women. evidence-based brain damage.
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Odette Harris MD, MPH, is professor of neurosurgery and director of brain injury at Stanford University School of Medicine. She is also Deputy Chief of Staff for Veterans Administration’s Palo Alto Health Care System Rehabilitation and Site Director, Center of Excellence for Head Injury. Harris focuses on collaborative approaches in implementing and streamlining algorithms to improve neurosurgical care outcomes. She is the recipient of a National Medicine Fellowship for Excellence in Academic Medicine and has received numerous other awards for her clinical and research work. She is a past president of Women in Neurosurgery and director of the California Association of Neurological Surgeons.
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