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Science  21 Dec 2012:
Vol. 338, Issue 6114, pp. 1556-1557
DOI: 10.1126/science.338.6114.1556

21 December 2012

Edited by Edward W. Lempinen


Traumatic Brain Injury: New Insight, But Treatment Remains Elusive


He was a veteran professional football player, in his mid-60s when he died, and a paper-thin cross section of his brain tissue taken at the autopsy appears visibly shrunken and atrophied. Perhaps that’s no surprise in an older man who played in an era of more primitive equipment. But neuropathologist Ann McKee has other samples that show similar damage in soldiers and athletes who died far younger. One, a football player, was just 18.

Head injuries among soldiers and athletes are hardly a new discovery, but for decades they were a blind spot. A bullet hole would get you a ticket home; a broken arm or torn ligaments would force you from the game. But until recently, a warrior who sustained a concussion—who'd had his bell rung—would shake it off and then return quickly to the battlefield or the playing field.

Today, there's a growing alarm about the long-term dangers of traumatic brain injury (TBI). And in a discussion at AAAS, researchers described how injuries that show little abnormality on an MRI or CT scan can, years later, have debilitating effects ranging from irritability to rage and dementia. While scientists are learning much about the nature of these injuries, they said, therapies to protect or repair the brain are proving elusive.

The 23 October event, cosponsored by the Dana Foundation and AAAS, came at a critical time: Blast injuries, not bullets, are the dominant risk for soldiers deployed to Iraq and Afghanistan. The National Football League is facing lawsuits from nearly 4000 ex-players, and several current or former players have committed suicide in recent years; safety concerns now extend to community pee-wee football programs. Taken together, those streams represent a seeming TBI epidemic.

Chronic traumatic encephalopathy (CTE) is neuron degeneration that occurs after mild but repetitive traumatic brain injury, more commonly called concussions and subconcussions. James L. Hancock endured three concussions playing football and rugby. Then, while he was a Navy doctor deployed with the Marines at an advance base in Afghanistan's Helmand province, his vehicle hit an improvised explosive device. The blast knocked him unconscious.

Captain Hancock told the AAAS audience that as he recovered, his sense of balance was compromised. He started to have migraines. "My emotions were absolutely flat," he added. "Sleep became a problem."

McKee, who is also a neurologist and director of the Neuropathology Service for the New England Veterans Administration Medical Centers, used images of stained brain tissue to illustrate features of CTE, including unusual deposits of the protein p-tau. Even "without the aid of a can immediately see the abnormalities because they are so profound," she said. There is shrinkage and atrophy in the prefrontal cortex, the hippocampus, the amygdala, and other areas associated with learning, memory, judgment, and emotional control.

The first treatment guidelines for TBI were developed in the 1990s and were simply "to maintain the general physiology to support the brain," said Geoffrey Ling, a retired colonel and program manager at the Defense Advanced Research Projects Agency. Ling played a leading role in developing standard concussion treatment guidelines for the military and the Military Acute Concussion Evaluation tool, which enables frontline medics and junior officers to evaluate TBI.

Visible damage.

Mild but repetitive brain injury can transform healthy brain tissue (left) into the atrophied and deteriorated tissue associated with chronic traumatic encephalopathy (right).


The key medical reason to quickly identify TBI is "second-impact syndrome," Ling said. When a patient sustains a second head injury before fully recovered from the first, he explained, "it leads to an exaggerated response and has a 50% mortality rate."

Because so much remains unknown about the brain and the complex effects of TBI, "for us to try to grapple with all of the variables is impossible," McKee said. She believes that improved treatment will come through understanding the physical changes in the brain that occur at the microscopic and molecular levels when the brain is subject to trauma. And that understanding is only beginning to emerge.


At Mexico Competition, Students Excel at Math and Diplomacy

Math diplomacy.

Emanuel Perez (center) and the AAAS team built significant connections with their Mexican peers during the Olympiad.


GUANAJUATO, Mexico—Students from an elite group of 20 young mathematicians trained by AAAS made up the only U.S. team at the Olimpiada Mexicana de Matemáticas. They were up against 196 of the very best high school math students in Mexico, taking tests in a completely unfamiliar setting and trying to comprehend, in Spanish, complex problems that generally require more than an hour to solve.

After participating in AAAS's intensive program to identify and cultivate exceptional math talent among underrepresented minorities and the children of immigrants, the students were confident in their ability to compete. But their performancevand the quality of the international interaction—at the Olympiad reached unexpected heights. David Vargas, a high school senior from Roslyn, New York, came up with a solution to a problem that was so original that none of the other 199 contestants solved the problem in the same way.

Although the four U.S. students were not official competitors, their scores would have qualified for medals: silver for Vargas and Varun Mohan, a junior from Sunnyvale, California, and bronze for Chicago junior Emanuel Perez and Sohail Farhangi, a senior from Fairfax Station, Virginia.

The 11 to 16 November event followed 10 days of training in Washington, D.C., this past summer, where the participants were selected from a pool of nearly 70 U.S. applicants. Four other students from the AAAS training participated in the Pan-African Mathematics Olympiad held in Tunisia in September.

The exceptionally gifted students are "not often celebrated for their talent and ability," said AAAS Olympiad Program Director Florence Fasanelli, "but rather are left out and feel quite alone." Program codirector Mark Saul, who also directs the Center for Mathematical Talent at New York University, said that when they do find a math club or team, it may have no other minority students or advisers.

"This event gives these students a security in the things they do, a confidence in themselves," said José Antonio Gómez, OMM director and professor at the Universidad Autónoma de México. "They come to know themselves and learn that they can do things that they didn't know they could do."

The Mexican competition, which selects national contestants for the International Mathematics Olympiad, involved six problems solved over 2 days. During activities surrounding the testing, the students and their mentors, including University of Texas–San Antonio Professor Eduardo Dueñez, found time to make significant connections with their Mexican counterparts, practicing an informal "math diplomacy" that added a valuable dimension to the trip.

After the testing ended, the U.S. and Mexican contestants traveled to a remote elementary school outside of Guanajuato, where they shared math-related puzzles, games, and demonstrations with students. The AAAS trainees said that the collegial atmosphere of the competition made it easy to form bonds with their Mexican peers. "It gives it more of a cooperative feeling, rather than a competitive one," said Vargas. "It's like we’re all working together."

14–18 FEBRUARY 2013

Annual Meeting Explores Beauty, Benefits of Science

It's a familiar pathway for many scientists: Their curiosity and drive to understand the world lead to broader benefits. The 2013 AAAS Annual Meeting, which convenes from 14 to 18 February in Boston, will focus on these deep and rich connections between the beauty of scientific knowledge and its often unexpected impact.

The 179th Annual Meeting will feature top scientists, engineers, educators, policy-makers, and science journalists from around the world. More than 150 sessions are scheduled under the theme "The Beauty and Benefits of Science," including symposia in 14 research tracks, career development workshops, and popular public events such as Family Science Days.

Plenary speakers will include molecular biologist Cynthia Kenyon, whose work on roundworm genetics sparked an intensive new interest in the biology of aging, and Harvard astrophysicist Robert Kirshner, who guided two Nobel Prize winners to their discovery of an accelerating universe. Their research demonstrates "the rich and complicated connections between basic and applied research, and how they bring about both practical benefits and the beauty of pure understanding," said AAAS President William H. Press in his letter of invitation.

The Meeting's ambitious program includes topics such as teaching stroke victims to speak again, ensuring food safety in a global marketplace, and reaching a critical turning point in fusion energy research. Other presenters will discuss the draft findings from the U.S. National Climate Assessment, the quiet successes of cybersecurity research, and key international teacher-scientist partnerships.

For registration and program information, see The site will serve as a portal for Annual Meeting news from ScienceNow, Science Update,, AAAS MemberCentral, and EurekAlert! The AAAS Facebook page and Twitter (@AAASmeetings; #AAASmtg) also will feature news from Boston.

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