A fifth of all service members who served in Iraq and Afghanistan suffered concussions, mainly from being close to explosive blasts from roadside bombs. Doctors often refer to sports injuries to seek treatment options for the so-called signature wound of the long wars.

But new research signals that war-zone concussions are much different from concussions than happen playing football or hockey. Most athletes quickly recover brain function. Most soldiers and Marines do not, according to a study released Wednesday in Brain: A Journal of Neurology.

The findings will likely add to military discussions about who is fit to go back into the fight after suffering a concussion. And perhaps the recognition could lessen the stigma of mental illness in the military.

"We should be paying very careful attention to post traumatic stress disorder and depression-type symptoms immediately after their injuries," said David Brody, an associate professor of neurology at Washington University and co-author of the study.

Done in tandem with the Department of Defense, researchers followed 38 service members who didn't pass field tests after surviving blasts in 2012 in southern Afghanistan. Sent to Camp Leatherneck or Kandahar Air Field for treatment and rest, data were collected from their cases within a few days of injury.

Researchers then followed up after the military personnel had gone back into the field. Uninjured service members were also followed for comparison.

Unlike most athletes, normal brain function didn't return back to normal within six to 12 months of injury for most of those studied. Compared to the controls, those who survived blasts had greater bouts of depression and more severe post traumatic stress.

Brody said this is the first study of its kind done jointly with the military. He said more research is needed to see if the findings hold up.

"It's not the final answer, but it's a very important first step," he said. "If it does hold up, it will be really useful because we will be able to help determine who could benefit from extensive therapy."

Dennis Rivet II, a former active-duty Navy neurosurgeon who helped with the study in Afghanistan, said it could change the way concussions are managed in theater. Concussions, similar to mild-traumatic brain injury, often don't show up in conventional brain scans.

Most service members return to the field even after being exposed to multiple blasts.

"It will enhance our attention or force us to further scrutinize whether a patient has made a complete recovery," Rivet said.

He added that the findings possibly could help lower the stigma of invisible wounds in the military. "As there is clear cut recognition, it could also mean that people are no longer not going to say I got my bell rung," Rivet said.

While it's unclear why blast-induced concussions are different from athletic concussions, it's also unclear if early treatment of PTSD, a common occurrence after exposure to a blast, is effective.

"We think it's logical," Brody said, "because most diseases, if treated early, have better outcomes."

He and other scientists plan to do more research this year about the short-term effects of concussion.

By Jesse Bogan
St. Louis Post-Dispatch
March 5, 2015