Table of contents:

02:05 Eric Thelin
07:08 Traumatic brain injury research
08:53 Concussion diagnosis needs to improve
12:05 Concussion awareness

Concussion Stories podcast introduction

[00:00 Melanie] If I say there is hope for complete recovery for people with a concussion, you say…?

[00:07 Professor McCrea] 100%!

[00:08 Professor Maas] And in fact, you didn’t only feel it] you were outside the regular medical system, because they were not interested in you.

[00:16 Professor Sitskoorn] Neuroplasticity actually opens you up to the world. It makes it possible to develop; it makes it possible to rehabilitate.

[00:25 Professor Wilson] Traumatic brain injury has been called a silent epidemic for that reason, because it consists of changes and disabilities that are not obvious to other people.

[00:35 Dr. Zasler] If, as a physician, you felt you had nothing to offer a patient, then I think ethically, you need to say] “I don’t think there’s anything I can offer you. Maybe you should see Dr. M.”

[00:48 Professor Diaz-Arrastia] Historically, we have called these things mild traumatic brain injuries, which implies that, well… It may be a brain injury, but it’s not going to have great consequences, right? And that’s frankly not true.

About the Concussion Stories podcast

[01:05 Melanie] Welcome to Concussion Stories, a Lifeyana podcast series filled with hope. I’m here to let you know that you are not alone in your post-concussion recovery journey. My name is Melanie and I spent six and a half years learning, experimenting, and training in order to find a way to heal myself from post-concussion syndrome.

After making a full recovery by the end of 2018, I embarked on this mission to make the recovery journey easier for you. This is why I started this podcast, wrote detailed blog post and downloadable guides, offer coaching and also the course that I wish I had back when I was recovering — teaching you everything that I needed to know in order to make my recovery happen.

On Concussion Stories, we dig deep while discussing hopeful stories of recovery as well as the hard stuff in the messy middle. Let’s dive right in!

Eric Thelin

In this three-part episode series, you’ll meet Eric Thelin, who specializes in neuro-intensive care after brain injury. He is a resident physician and associate professor at Karolinska University Hospital in Sweden, and he has so much to share about his experience with patients who sustained a concussion or experienced post-concussion symptoms.

In this first episode, Eric will tell a little bit about how he himself tries to balance his work and life as a passionate traumatic brain injury researcher. Eric also explains his focus on specifically diagnosing what is needed for any patient individually. Let’s hear Eric Thelin.

Starting the podcast conversation

I’m glad that you could join!

[02:50 Eric] Thank you.

[02:51 Melanie] How are you doing?

[02:53 Eric] I’m good. I don’t know if I said that, but I’m doing rotations in clinical neurophysiology.

[03:03 Melanie] Yes.

[03:03 Eric] It is part of my residency training in neurology. So actually it’s a good thing, because there is no demand on me to actually produce anything. So it is basically like going back to med school again, where you’re just running around and learning a lot of new things. So it’s good.

[03:20 Melanie] That is good. Yeah, it sounds nice. 

I normally like to open my podcast episodes with a more general question in order for the listeners to get to know you a little bit.

[03:31 Eric] All right.

[03:32 Melanie] And the question I’d like to ask you is: what outside of work gives you joy in life?

Playing video games

[03:40 Eric] I think that historically I would have said video games. I played a lot of video games growing up. I was a Nintendo person. If you can see the background here, you can see the Triforce from The Legend of Zelda series. Here in the bookcase I have a head crab from the Half Life series.

[04:15 Melanie] Wow!

[04:16 Eric] I know. So, it’s definitely something that is a quite extensive part of my life. I mean, after having kids, I must say playing video games is usually something I do between 10:00 pm and 11:00 pm. If you have the time and I’m not sleeping.

[04:38 Melanie] Yeah.

[04:40 Eric] But now my oldest daughter is six years old. So, I am introducing her and we are playing a little bit of guitar. Other than that I love watching movies and shows. I have always been a lot into popular culture in general. 

Swedish sports

And because I am a Swede, I of course also love skiing and cross country skiing. Outdoor activities in general. I have played floorball hockey. It’s not like floorball hockey you are playing in the Netherlands.

[05:16 Melanie] No.

[05:16 Eric] It’s a type of indoor hockey where the ball is hollow.

[05:20 Melanie] Without ice?

[05:21 Eric] No. Well, I played that when I was very little. I don’t have a ball or a stick in this room. But it is a very common activity we do in Sweden with a couple of friends your age. It’s a very good exercise. 

Actually I was out running just an hour ago. So that’s something I used to do to get in shape. I ran marathons and stuff like that. But now I exercise to keep me fit and alive, basically.

[06:03 Melanie] Because probably, you’ve learned that also at work.

[06:10 Eric] Yes. Aerobic activity is good. It has a lot of benefits. Yes.

[06:15 Melanie] Yeah, I get it. 

Work-research balance

You know what, you don’t even need work, right? You have so many activities.

[06:22 Eric] That is partly true. And the kids take up the rest of the time. But yes, this is perhaps a problem that life becomes very intertwined with work, especially if you do a lot of (traumatic brain injury) research. Because you are never really away, are you? Students can always reach you, and you always want to be there for them. 

So you need to establish some sort of work life balance. And I think everyone has to find their own work life balance that fits them. I think that I’m pretty content the way things are now.

[07:03 Melanie] Well, I am happy for you.

[07:04 Eric] Thank you.

[07:05 Melanie] It sounds really good. 

Traumatic brain injury research

How is it for you at work, what are you focusing on mostly?

[07:12 Eric] We are doing a quite extensive study on mild traumatic brain injury (mTBI) in the Stockholm region. (Remember: a concussion is called a ‘mild’ traumatic brain injury at the moment, but this is being changed because it misleads about the severity of the brain injury.) 

CT scan for concussion

Some of you might have had a mild traumatic brain injury and were sent to an emergency room, where you met an emergency room physician. They would then decide if you needed a computerized tomography (CT scan), of your head or not, to see if you had a hemorrhage that would require either monitoring in the local hospital or a transfer to a neurosurgical unit – depending on the severity of the hemorrhage.

[07:49 Melanie] Yeah.

[07:50 Eric] There are currently a lot of traumatic brain injury guidelines to screen and detect all these patients and all these hemorrhages. The problem is that these guidelines are oversensitive. They are built that way, so you will not miss any hemorrhage. However, this results in a lot of unnecessary CT scans being performed.

[08:10 Melanie] Yeah.

CT scans often fail to see concussion

[08:11 Eric] Only 1 in 10 of all CT scans, using the current guidelines, will likely show a brain injury. This means there are a lot of unnecessary costs, there is a lot of unnecessary radiation, and a lot of unnecessary waiting time in the emergency room for a lot of people. 

So, in our traumatic brain injury research project, we are trying to tweak the guidelines in order to create a calculator for emergency room physicians. They can enter some data about the patient and then through machine learning magic, they will know the risk of this patient having a hemorrhage. 

This is also good for low and middle income countries, where there might be 20 patients that need to have a CT scan, and doctors need to triage between them: who should have it first?

[08:52 Melanie] Yes. 

Concussion diagnosis needs to improve

I am very glad that you are working on this because, of course, the diagnostic stage at the ER needs to improve. Also, the tools that doctors have at their disposal in order to accurately – or at all – diagnose mild traumatic brain injury needs to improve.

Concussion symptoms 1 year after injury

[09:27 Eric] Exactly. The other important aspect of this, which I think your listeners might be interested in, is that we plan to do a secondary analysis of this TBI research project in the future, where we research all these patients who have had a visit to the ER one year after. 

Did they in any way seek medical attention for conditions such as headache, pain, vertigo, nausea, sleeping disorders, or any sort of pathology that could be related to post-concussion syndrome? In other words, pathologies that could occur either early on or persist for a while after a more mild traumatic brain injury. 

But this is currently in its infancy. This is something that we will do when we have finished the first step of the study.

[10:21 Melanie] What do you want to do with this data?

Better post-concussion care

[10:24 Eric] We want to create the Stockholm post-concussion syndrome score. If a patient comes into the ER, the doctor will know what the risks are of this particular patient seeking medical attention for some sort of post-concussion syndrome within a year. It could be easy for the emergency room physician to catch these patients early on as a result of our traumatic brain injury research. This will definitely improve post-concussion care.

Risks for post-concussion symptoms

There are a few studies out there that show that patients who sustained a concussion are people with pre-existing conditions, like depression and other psychiatric illnesses. Female gender actually is also a risk factor for a lot of the self-reported post-concussion syndromes. We think there is a 30% risk. 

Concussion clinic referral

So let’s say there is a 30% risk that this patient will need medical attention for post-concussive symptoms within a year. Then you can provide better post-concussion care by writing a referral to a rehab clinic in the emergency room, which today will be impossible. 

We only have a few rehab clinics that are really good in Stockholm. So, we can’t write this referral for everyone. However, if we can catch those patients early on, it could save society and these patients a lot of pain, suffering and money.

[12:03 Melanie] This sounds really good. 

Concussion awareness

Also, if physicians put in all the data, there is a step of awareness added in between. These doctors now know that patients may have lingering concussion symptoms. I think no doctor who ever treated me was aware of the fact that I could be having symptoms for over six years. That is a change that you are going to make with this as well.

[12:41 Eric] I hope so. 

Better management of concussion patients

Like I shared with you in Antwerp: a patient that comes in and has a negative CT scan but does have symptoms, is the worst patient we have. That is because we think that there is nothing that we can do. There is no pill; there is no perfect golden bullet that will solve all of their problems. 

Like you are saying, I think that if these scores can bring attention to these patients in any way, I think that will be a very small but valuable step toward better management of these patients.

Doctor and patient awareness

[13:23 Melanie] Yes. It will indeed create awareness with the doctors, but also with patients themselves. No one ever told me that I could have lingering symptoms for so many years. And had I known it, I would have done other things in the beginning in order to make sure that my recovery would have been faster.

Share your feedback?

Now, I would love to hear from you. What do you take away from this episode? Is there something that you can apply to your life right away? Head on over to lifeyana.com and leave your comment now.

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Support the podcast

If you want to support this podcast, head on over to patreon.com/concussionstories. Thank you for listening to this concussion stories episode by Lifeyana. May you be well, and may you be happy.