Personality Changes Can Signal Incomplete Recovery After Traumatic Brain Injury

MedicalResearch.com Interview with:

Prof.dr. J van der Naalt PhD Department of Neurology University Medical Center Groningen Groningen, The Netherlands

Prof J van der Naalt

Prof.dr. J van der Naalt PhD
Department of Neurology University Medical Center Groningen
Groningen, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Mild traumatic brain injury occurs frequently and is one of the leading cause of morbidity in adults worldwide. It is a major social-economic problem with one in three patients had persistent complaints several months after injury that interfere with resumption of daily activities and work.

One of the most important questions concerns the finding that some patients recover without complaints and others do not after sustaining a mild traumatic brain injury. In a follow-up study with more than 1000 participants we found that personality factors are a major factor in the recovery process. In particular coping, that is the way patients adapt to persistent complaints, is important next to emotional distress and impact of the injury.

In an add-on study with fMRI we found that in the early phase after injury, the interaction between specific brain networks was temporarily changed. However, when regarding persistent posttraumatic complaints , specific personality characteristics significantly determine long term outcome.

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Traumatic Brain Injuries In Baseball Can Be Catastrophic, and Mostly Preventable With Universal Helmet Use

MedicalResearch.com Interview with:

Michael D. Cusimano MD, FRCSC, DABNS, FACS, PhD, MHPE Adjunct Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital Division of Neurosurgery, St. Michael\'s Hospital Professor of Neurosurgery, Education and Public Health University of Toronto

Dr. Cusimano

Michael D. Cusimano MD, FRCSC, DABNS, FACS, PhD, MHPE
Adjunct Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital
Division of Neurosurgery, St. Michael\’s Hospital
Professor of Neurosurgery, Education and Public Health
University of Toronto

MedicalResearch.com: What is the background for this study?

Response: Baseball is played by millions annually and is traditionally seen as a low risk sport for head injury when compared to sports like American Football, Ice Hockey and Rugby. Over 6 million children and youth are enrolled in formal baseball or softball leagues annually.

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Traumatic Brain Injury Laws Reduce Rate of Recurrent Concussions in High School Athletes

MedicalResearch.com Interview with:

Jingzhen (Ginger) Yang, PhD, MPH Principal Investigator Associate Professor, Center for Injury Research and Policy The Research Institute at Nationwide Children’s Hospital Dept. of Pediatrics, College of Medicine, The Ohio State University Columbus, Ohio 43205

Dr. Yang

Jingzhen (Ginger) Yang, PhD, MPH
Principal Investigator
Associate Professor, Center for Injury Research and Policy
The Research Institute at Nationwide Children’s Hospital
Dept. of Pediatrics, College of Medicine, The Ohio State University
Columbus, Ohio 43205 

MedicalResearch.com: What is the background for this study?

Response: From 2009-2014, all 50 states and the District of Columbia passed their state TBI laws, more commonly known as concussion laws, to mitigate severe consequences of concussions.

These laws often include 3 core components:

(1) mandatory removal from play following actual or suspected concussions,
(2) requirements to receive clearance to return to play from a licensed health professional, and
(3) education of coaches, parents, and athletes regarding concussion symptoms and signs.

Our study aimed to evaluate whether the laws achieve the intended impact.

MedicalResearch.com: What are the main findings?

Response: The main findings showed that:

  • The rates of new and recurrent concussions initially increase significantly after a law goes into effect. This is likely due to more people – athletes, athletic trainers, coaches, and parents – becoming aware of the signs and symptoms of concussion and actually reporting a potential or actual concussion. Lack of knowledge about concussion signs and symptoms may have resulted in underreporting of concussions during the prelaw period. This trend is consistent across sports in our study and other studies looking at youth sports-related concussions.
  • The rate of recurrent concussions shows a significant decline approximately 2 ½ years after the law is in place. This demonstrates that the laws are having an impact. One of the core function of these laws is to reduce the immediate risk of health consequences caused by continued play with concussion or returning to play too soon without full recovery. The decline in recurrent concussion rates in our study is likely the results of the laws requirements of mandatory removal from play or permission requirements to return to play.
  • Football had the highest average annual concussion rate, followed by girls’ soccer and boys’ wrestling. Males had a higher average annual concussion rate than females. However, when comparing the rates in gender comparable sports (basketball, soccer, baseball/softball), females had almost double the annual rate of concussions as males. These results are consistent with findings from other studies. It is possible that girls have higher risk of concussions than boys or are more likely to report injuries. Future studies are needed to look specifically at these disparities.

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New Biomarker Has Potential For Sideline Diagnosis of Traumatic Brain Injury

MedicalResearch.com Interview with:

Dr-Adrian-Harel.jpg

Dr. Adrian Harel

Dr. Adrian Harel, PhD
Chief Executive Officer
Medicortex Finland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Every 15 seconds, someone in the United States suffers a new head injury. Of the 2.5M people treated in hospital emergency rooms each year, 80,000 become permanently disabled because of TBI. Currently, there are no reliable diagnostic tests to assess the presence or severity of an injury on-site, nor are there any pharmaceutical therapies that could stop the secondary injury from spreading. Accurate diagnostics would benefit especially mild cases of TBI (concussions), which, if occurring repeatedly, may cause neurodegenerative conditions such as Chronic Traumatic Encephalopathy (which is typical for athletes in NFL and Ice-hockey).

We have performed extensive preclinical research comparing fluid biopsies from normal and injured lab animals. The results showed some unique biomarkers released as a biodegradation products after head injury. The data served as the basis and confirmation for our patent applications to protect the biomarker concept.

Medicortex has completed a clinical proof-of-concept trial in collaboration with Turku University Hospital (Tyks). Samples from 12 TBI patients and 12 healthy volunteers were collected and analyzed for the presence and for the level of the biomarker in state-of-the-art laboratories. The study demonstrated the diagnostic potential of the new biomarker in humans and it confirmed the prior preclinical findings. This was a significant milestone for Medicortex.

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MRI Biomarkers Track Cognitive Impairment Due to Head Trauma

MedicalResearch.com Interview with:

Virendra Mishra, Ph.D. Department of Imaging Research Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas

Dr. Virendra Mishra

Virendra Mishra, Ph.D.
Department of Imaging Research
Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Repetitive head trauma has been shown to be a risk factor for various neurodegenerative disorders, mood swings, depression and chronic traumatic encephalopathy. There has been a significant amount of research into identifying an imaging biomarker of mild traumatic brain injury (mTBI) due to repetitive head trauma. Unfortunately, most of the biomarkers have not been able to find a successful translation to clinics. Additionally, the quest for the mTBI imaging biomarker especially using Magnetic Resonance Imaging (MRI) techniques has been done by looking at either the gray matter (T1-weighted) or the white matter (Diffusion Tensor Imaging) independently; and both have shown changes that are associated with repetitive head trauma.

Hence in this study, we wanted to investigate if combining gray matter and white matter information enables us to better predict the fighters who are more vulnerable to cognitive decline due to repetitive head trauma. Our method found seven imaging biomarkers that when combined together in a multivariate sense were able to predict with greater than 73% accuracy those fighters who are vulnerable to cognitive decline both at baseline and follow-up. The imaging biomarkers were indeed a combination of gray and white matter measures of regions reported previously in the literature. A key point in our study was we found the regions predicting cognitive decline without enforcing any assumptions on the regions previously reported.

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Chronic Traumatic Encephalopathy Found In Brains of Nearly All NFL Players Examined

MedicalResearch.com Interview with:

Daniel H. Daneshvar, M.D., Ph.D. Chronic Traumatic Encephalopathy Center Team Up Against Concussions | Founder Boston University

Dr. Daneshvar

Daniel H. Daneshvar, M.D., Ph.D.
Chronic Traumatic Encephalopathy Center
Team Up Against Concussions | Founder
Boston University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts. CTE was first described in JAMA in 1928. In the 99 years since, just over 100 cases of CTE have been described in the world’s literature.

This study nearly doubles the number of reported cases of CTE, with 177 cases of CTE in football players. Of note, 110 of the 111 athletes who played in the NFL had CTE. This study represents the largest and the most methodologically rigorous description of a series of patients with CTE ever published. Such a richness of data regarding the clinical and pathological features of CTE has never been previously compiled. As such, this study represents an important advance to the medical literature and an enormous scientific advance in our understanding of  chronic traumatic encephalopathy.

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An Ultra-Early Inflammatory Biomarker of Traumatic Brain Injury

MedicalResearch.com Interview with:

Dr Lisa J Hill PhD Institute of Inflammation and Ageing Research Fellow Neuroscience and Ophthalmology Institute of Inflammation and Ageing College of Medical and Dental Sciences University of Birmingham UK

Dr. Hill

Dr Lisa J Hill PhD
Institute of Inflammation and Ageing
Research Fellow
Neuroscience and Ophthalmology
Institute of Inflammation and Ageing
College of Medical and Dental Sciences
University of Birmingham UK 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Traumatic brain injury (TBI) is the leading cause of death and disability among young adults and, according to the World Health Organization, by 2020 TBI will become the world’s leading cause of neurological disability across all age groups.  Early and correct diagnosis of traumatic brain injury is one of the most challenging aspects faced by clinicians. Being able to detect compounds in the blood that help to determine how severe the brain injury is would be of great benefit to patients and aid in their treatment.  Inflammatory markers are particularly suited for biomarker discovery as TBI leads to very early alterations in inflammatory proteins.  The discovery of reliable biomarkers for the management of TBI would improve clinical interventions.

We collected blood samples from 30 injured patients within the first hour of injury prior to the patient arriving at hospital and analysed them. Analysis of protein biomarkers from blood taken within the first hour of injury has never been carried out until now. We used a panel of 92 inflammation-associated human proteins when analysing the blood samples. The analysis identified three inflammatory proteins, known as CST5AXIN1 and TRAIL, as novel biomarkers of TBI.

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Saliva Test Can Predict Concussion Duration in Children

MedicalResearch.com Interview with:

Steven Daniel Hicks, MD, PhD Assistant Professor, Division of Academic General Pediatrics College of Medicine Penn State Health

Dr. Hicks

Steven Daniel Hicks, MD, PhD
Assistant Professor, Division of Academic General Pediatrics
College of Medicine
Penn State Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are about 3 million concussions in the US each year and the majority occur in children. Parents of children with concussions commonly cite length of recovery as a major concern, but pediatricians have no objective or accurate tests for addressing this concern.

Our research group previously identified small regulatory molecules called microRNAs that were altered in both the spinal fluid and saliva in children with traumatic brain injuries. In this study we investigated whether those microRNAs could predict duration of concussion symptoms. In 52 children with concussion we found a set of microRNAs that predict whether concussion symptoms would last beyond one month with over 80% accuracy. This was significantly more accurate than survey based tools such as the sports concussion assessment tool or a modified concussion clinical risk score. Interestingly, the microRNAs with predictive accuracy targeted pathways involved in brain repair and showed correlations with specific concussion symptoms.

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Pre-Clinical Study of Tbit™ System for Detection of Traumatic Brain Injury

MedicalResearch.com Interview with:

Sergey A. Dryga, PhD, MBA Chief Scientific Officer BioDirection, Inc.

Dr. Sergey Dryga

Sergey A. Dryga, PhD, MBA
Chief Scientific Officer
BioDirection, Inc. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: When patients have suffered a head injury, they typically undergo a series of subjective cognitive tests to confirm a diagnosis of a concussion or other traumatic brain injury. In many cases these tests are inaccurate and inconsistent, increasing the risk of misdiagnosis. In other cases, patients may undergo an unnecessary CT scan, which is costly and exposes them to radiation. Early, objective diagnostic testing of patients who have experienced a head injury can support more rapid and appropriate treatment decisions while potentially reducing the use of unnecessary CT scans or other forms of intervention.

We know that protein biomarkers, including S100 calcium binding protein beta (S100β) and glial fibrillary acidic protein (GFAP), are released from the brain into the bloodstream immediately following a concussion or other traumatic brain injury. The Tbit™ System is a new medical device based on a nanotechnology biosensor that rapidly detects and accurately measures these protein biomarkers. The system includes a disposable cartridge and portable analyzer designed for testing using a single drop of blood at the earliest stages of a concussion.

This pre-clinical study was designed to evaluate the ability of the Tbit System to screen traumatic brain injury patients for a CT positive or CT negative test. Frozen plasma samples were collected from a total of 100 patients who had undergone CT scans post hospital admission. The Tbit System demonstrated 100% sensitivity with no false negative results, and a 41% specificity level.

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White Matter Trajectories Diverge In Children After Traumatic Brain Injury

MedicalResearch.com Interview with:

Emily Dennis Postdoctoral Scholar Imaging Genetics Center Mark and Mary Stevens Neuroimaging and Informatics Institute USC

Emily Dennis

Emily Dennis PhD
Postdoctoral Scholar
Imaging Genetics Center
Mark and Mary Stevens Neuroimaging and Informatics Institute
USC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that there is heterogeneity in outcome post-traumatic brain injury (TBI), but we generally think of this as a continuous variable – with most patients falling in the middle and only a few at the extremes in terms of recovery process and outcome.

Our main finding was that interhemispheric transfer time (IHTT – the time it takes for information to move from one hemisphere of the brain to the other) identified 2 subgroups of TBI patients – those with slow IHTT and those with normal IHTT. These two groups show differences in cognitive function and brain structure, with the IHTT slow group showing structural disruptions that become progressively worse while the IHTT normal group seems to be recovering from the injury.

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Female Soccer Players Have High Risk of Concussion

MedicalResearch.com Interview with:

Wellington K. Hsu, MD Clifford C. Raisbeck, MD, Professor of Orthopaedic Surgery Associate Professor of Orthopaedic Surgery Northwestern University Chicago, IL

Dr. Hsu

Wellington K. Hsu, MD
Clifford C. Raisbeck, MD, Professor of Orthopaedic Surgery
Associate Professor of Orthopaedic Surgery
Northwestern University
Chicago, IL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Concussions remains a significant problem in youth sports. The recent enactment of Traumatic brain injury laws have certainly heightened awareness regarding this problem. Our study looked at publicly available data regarding diagnosis of concussion in high school athletes. We found that females are more likely to be diagnosed with a concussion than males. We also concluded that girl soccer players and boys football players are at highest risk for a diagnosis of concussion. Since the neck meant of the Traumatic brain injury state laws, the diagnosis of concussion in this patient group increased significantly past decade.

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Brain–Computer Interface Allows Communication With Locked-In Patients

MedicalResearch.com Interview with:

Dr. Ujwal Chaudhary, PhD Institute of Medical Psychology and Behavioral Neurobiology University of Tübingen Tübingen, Germany

Dr. Ujwal Chaudhary

Dr. Ujwal Chaudhary, PhD
Institute of Medical Psychology and Behavioral Neurobiology
University of Tübingen
Tübingen, Germany

MedicalResearch.com: What is the background for this study?

Response: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disorder which causes an Individual to be in Locked-in state (LIS), i.e. the patients have control of their vertical eye movement and blinking, and ultimately in Completely Locked-in state (CLIS), i.e, no control over their eye muscle. There are several assistive and augmentative (AAC) technology along with EEG based BCI which can be used be by the patients in LIS for communication but once they are in CLIS they do not have any means of communication.  Hence, there was a need to find an alternative learning paradigm and probably another neuroimaging technique to design a more effective BCI to help ALS patient in CLIS with communication.

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When Is It Safe To Drive After a Concussion?

MedicalResearch.com Interview with:

Julianne Schmidt, PhD, ATC Assistant Professor Department of Kinesiology The University of Georgia Athens GA

Dr. Julianne Schmidt

Julianne Schmidt, PhD, ATC
Assistant Professor
Department of Kinesiology
The University of Georgia
Athens GA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Less than half of all people with a concussion intend to reduce their driving at any point.

Current recommendations surrounding concussion focus on when it is safe to return to sport or return to the classroom, but return to driving is usually ignored and has not been studied.
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Many CT Scans Can Be Avoided During ER Evaluation of Head Trauma

MedicalResearch.com Interview with:

Adam L. Sharp MD MS Research Scientist/Emergency Physician Kaiser Permanente Southern California Kaiser Permanente Research Department of Research & Evaluation Pasadena, CA 91101

Dr. Adam Sharp

Adam L. Sharp MD MS
Research Scientist/Emergency Physician
Kaiser Permanente Southern California
Kaiser Permanente Research
Department of Research & Evaluation
Pasadena, CA 91101

MedicalResearch.com: What is the background for this study?

Response: Millions of head computed tomography (CT) scans are ordered annually in U.S. emergency Departments (EDs), but the extent of avoidable imaging is poorly defined. Ensuring appropriate use is important to ensure patient outcomes and limited resources are optimized. A large number of stake holders have highlighted the need to reduce “unnecessary” CT scanning as part of their recommendations for the Choosing Wisely campaign. However, despite calls for improved stewardship, the extent of avoidable CT use among adults with minor trauma in community EDs is not known.

The Canadian CT Head Rule (CCHR) is perhaps the most studied of many validated decision instruments designed to assist providers in evaluating patients with minor head trauma. This study aims to describe the scope of overuse of CT imaging by ED providers in cases where application of the CCHR could have avoided imaging.

Secondarily, we sought to describe the extent to which avoidable CTs, if averted, would have resulted in “missed” intracranial hemorrhages requiring a neurosurgical intervention.

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Early Participation in Physical Activity Following Acute Concussion in Children

MedicalResearch.com Interview with:

Roger Zemek, MD, FRCPC Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario Ottawa, ON

Dr. Roger Zemek

Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa
Director, Clinical Research Unit,
Children’s Hospital of Eastern Ontario
Ottawa, ON

MedicalResearch.com: What is the background for this study?

Response: While current concussion protocols endorse the conservative view that children should avoid physical activity until completely symptom-free, there is little evidence beyond expert opinion regarding the ideal timing of physical activity re-introduction. In fact, while rest does play a role in concussion recovery, protracted physical rest may actually negatively impact concussion recovery. Further, physiological, psychological, and functional benefits of early physical rehabilitation are observed in other disease processes such as stroke (which is an example of a severe traumatic brain injury). Therefore, our objective was to investigate the relationship between early physical activity (defined within 7 days of the concussion) and the eventual development of persistent post-concussion symptoms at one month.

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Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury

MedicalResearch.com Interview with:
Eman S. Mahdi, MD, MBChB
Pediatric Radiology Fellow

Catherine Limperopoulos, PhD Director, Developing Brain Research Laboratory Co-Director of Research, Division of Neonatology Diagnostic Imaging and Radiology Children’s National Health System Washington, DC

Dr. Catherine Limperopoulos

Catherine Limperopoulos, PhD
Director, Developing Brain Research Laboratory
Co-Director of Research, Division of Neonatology
Diagnostic Imaging and Radiology
Children’s National Health System
Washington, DC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Premature birth is a major public health concern in the United States affecting 1 in 10 infants each year. Prematurity-related brain injury is very common and associated with a high prevalence of brain injury and accompanying lifelong neurodevelopmental morbidities.

Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. The extent to which cerebral blood flow (CBF) is disturbed in preterm birth is poorly understood, in large part because of the lack of monitoring techniques that can directly and non-invasively measure cerebral blood flow.

We report for the first time early disturbances in global and regional cerebral blood flow in preterm infants following brain injury on conventional magnetic resonance imaging (MRI) over the third trimester of ex-uterine life using arterial spin labelling images. In terms of regional differences, we saw a marked decrease in blood flow to the thalamus and the pons, regions known to be metabolically active during this time.

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Longitudinal Study of Post-Concussion Syndrome: Not Everyone Recovers

MedicalResearch.com Interview with:
Dr. Charles Tator, Neurosurgeon

Toronto Western Hospital and Director
Canadian Concussion Centre 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The main findings of this study are that the number of symptoms of post-concussion syndrome (PCS) are related to how long PCS lasts. Furthermore, physicians need to be more vigorous in their treatment of PCS symptoms and use the treatments that exist for each symptom where possible such as headache, vertigo, anxiety. The sooner sufferers of PCS receive treatment for their symptoms, the better.

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Postconcussion Symptoms Negatively Impact Pediatric Quality of Life

MedicalResearch.com Interview with:

Roger Zemek, MD, FRCPC Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario Ottawa, ON

Dr. Roger Zemek

Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion
University of Ottawa
Director, Clinical Research Unit
Children’s Hospital of Eastern Ontario
Ottawa, ON

MedicalResearch.com: What is the background for this study?

Response: Concussion remains a major public health concern in children. Approximately 30% of affected children experience persistent post-concussive symptoms (PPCS) for at least one month post-injury. These symptoms may negatively impact their health related quality of life. Examples may include cognition, memory and attention affecting school attendance and performance, mood and social engagement, as well as physical performance. Prior to this study, there was little evidence that examined the relationship between PPCS and quality of life following concussion. This was important to better understand in order to provide appropriate interventions, expectation management and ultimately a better standard of care to affected patients and their families.

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Depressive disorders are the most frequent neuropsychiatric complication of TBI

MedicalResearch.com Interview with:

Ricardo E. Jorge MD Professor of Psychiatry and Behavioral Sciences Director Houston Translational Research Center for TBI and Stress Disorders Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Michael E DeBakey VA Medical Center Baylor College of Medicine

Dr. Ricardo Jorge

Ricardo E. Jorge  MD
Professor of Psychiatry and Behavioral Sciences
Director Houston Translational Research Center for TBI and Stress Disorders
Senior Scientist  Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry
Michael E DeBakey VA Medical Center
Baylor College of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depressive disorders affect between one-third and one-half of patients with traumatic brain injury. Once established, these disorders are difficult to treat and frequently follow a chronic and refractory course.

Depression has a deleterious effect on TBI outcomes, particularly affecting the community reintegration of TBI patients.

In this randomized clinical trial that included 94 adult patients with TBI, the hazards for developing depression for participants receiving placebo were about 4 times the hazards of participants receiving sertraline treatment.

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Sertraline May Prevent Depression Following Traumatic Brain Injury

MedicalResearch.com Interview with:

Ricardo E. Jorge MD Professor of Psychiatry and Behavioral Sciences Director Houston Translational Research Center for TBI and Stress Disorders Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Michael E DeBakey VA Medical Center Baylor College of Medicine

Dr. Ricardo Jorge

Ricardo E. Jorge MD
Professor of Psychiatry and Behavioral Sciences
Director Houston Translational Research Center for TBI and Stress Disorders
Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry
Michael E DeBakey VA Medical Center
Baylor College of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depressive disorders affect between one-third and one-half of patients with traumatic brain injury (TBI). Once established, these disorders are difficult to treat and frequently follow a chronic and refractory course.

Depression has a deleterious effect on TBI outcomes, particularly affecting the community reintegration of TBI patients. In this randomized clinical trial that included 94 adult patients with TBI, the hazards for developing depression for participants receiving placebo were about 4 times the hazards of participants receiving sertraline treatment.

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Return to Normal Activity After Concussion Does Not Worsen Symptoms For Most Patients

MedicalResearch.com Interview with:

Danny G. Thomas, MD, MPH Department of Pediatrics, Emergency Medicine Children’s Hospital of Wisconsin Corporate Center Milwaukee, WI

Dr. Danny Thomas

Danny G. Thomas, MD, MPH
Department of Pediatrics, Emergency Medicine
Children’s Hospital of Wisconsin Corporate Center
Milwaukee, WI

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was a secondary analysis of a randomized controlled trial of strict rest after concussion published last year. We wanted to find out how mental and physical activity levels related to symptom spikes or sudden increases in concussion symptoms. We found that one in three patients had symptoms spikes in recovery. Patients who had symptom spikes tended to have higher symptoms in the emergency department and throughout recovery. Most symptom spikes were not associated with an increase in physical and mental activity level the day prior. We did find that a sudden increase in activity like returning to school did increase the risk of having a symptom spike, but the good news is these symptom spikes seemed to resolve the following day and did not impact recovery by 10 days.

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Single Head Injury Linked To Parkinson’s but Not Alzheimer’s Disease

MedicalResearch.com Interview with:

Paul K. Crane, MD MPH Professor Department of Medicine Adjunct Professor Department of Health Services University of Washington

Dr. Paul Crane

Paul K. Crane, MD MPH Professor
Department of Medicine Adjunct Professor
Department of Health Services
University of Washington

MedicalResearch.com: What is the background for this study?

Response: The background is that the most common experience of head injury with loss of consciousness is an apparent recovery. Sometimes this is very fast, sometimes it takes somewhat longer, but typically people return to their prior baseline. Nevertheless there is concern that the head injury may have set in motion processes that would lead to late life neurodegenerative conditions. Previous research has focused especially on Alzheimer’s disease. A more limited research has focused on Parkinson’s disease.

We used data from three prospective cohort studies that included more than 7,000 people to study the relationship between head injury with loss of consciousness and subsequent risk of Alzheimer’s and Parkinson’s disease. We collected head injury exposure data at study enrollment, at a time when we administered cognitive tests and knew they did not have dementia, so our exposure data are not biased. Each of these studies also performed brain autopsies on people who died, and we evaluated data from more than 1500 autopsies.

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Pediatric Concussions Underestimated as Primary Care Presentations Not Reported

MedicalResearch.com Interview with:

Kristy Arbogast, PhD Co-Scientific Director Center for Injury Research and Prevention The Children's Hospital of Philadelphia Research Professor Division of Emergency Medicine Department of Pediatrics University of Pennsylvania Philadelphia, PA 19104

Dr. Kristy Arbogast

Kristy Arbogast, PhD
Co-Scientific Director
Center for Injury Research and Prevention
The Children’s Hospital of Philadelphia
Research Professor
Division of Emergency Medicine
Department of Pediatrics
University of Pennsylvania
Philadelphia, PA 19104

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Arbogast: The research team looked retrospectively at four recent years of data on children diagnosed with concussion at Children’s Hospital of Philadelphia (CHOP) to determine how children access the health system for a concussion. For those 8,000 kids with a CHOP primary care provider, 82% entered the health system via a primary care location, 12% entered through the ER and 5% through a specialist. One-third of concussion diagnoses were to children under age 12.

Many current counts of concussion injury among children are based on emergency room visits or organized high school and college athletics data. Thus, we are vastly underestimating child and youth concussions in the US.

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Ocular-Motor System Vulnerable to Cumulative Sub-Concussion Injuries

MedicalResearch.com Interview with:

Dr. T. Dianne Langford PhD Associate Professor, Neuroscience and Neurovirology Lewis Katz School of Medicine Temple University

Dr. T. Dianne Langford

Dr. T. Dianne Langford PhD
Associate Professor, Neuroscience and Neurovirology
Lewis Katz School of Medicine
Temple University

MedicalResearch.com: What is the background for this study?

Dr. Langford: The ocular-motor system has been shown to reflect neural damage, and one of ocular-motor functions, near point of convergence (NPC), was reported to worsen after a sport-related concussion (Mucha et al. Am J Sport Med). But the effects of subconcussive head impact, a milder form of head injury in the absence of outward symptoms remains unknown.  Prior to this study, we found that in a controlled soccer heading experimental paradigm decreased NPC function, and even 24h after the headings, NPC was not normalized back to baseline (Kawata et al. 2016 Int J Sport Med). To extend our findings from the human laboratory study, we launched longitudinal clinical studies in collaboration with the Temple football team, to see if repetitive exposure to subconcussive head impacts negatively affects NPC.

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Younger Kids More Likely To Quickly Return to Sports After Concussion

MedicalResearch.com Interview with:

Zachary Y. Kerr, PhD, MPH Sports Injury Epidemiologist Director, NCAA Injury Surveillance Program Datalys Center for Sports Injury Research and Prevention Indianapolis, IN 46202

Dr. Zachary Keff

Zachary Y. Kerr, PhD, MPH
Sports Injury Epidemiologist
Director, NCAA Injury Surveillance Program
Datalys Center for Sports Injury Research and Prevention
Indianapolis, IN 46202

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Kerr: A 2013 Institutes of Medicine report called for more research on concussion in athletes aged 5-21 years.  Although there is much research on the incidence of concussion across this age span, there is less related to outcomes such as symptoms and return to play time, let along comparisons by age.

In examining sport-related concussions that occurred in youth, high school, and college football, we found differences in the symptomatology and return to play time of concussed players.  For example, the odds of return to play time being under 24 hours was higher in youth than in college.  Also, over 40% of all concussions were returned to play in 2 weeks or more.

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Subtle Postural Control Changes In Some Soccer Players After Heading

MedicalResearch.com Interview with:

Jaclyn B. Caccese MS The University of Delaware PhD Candidate Biomechanics and Movement Science

Jaclyn Caccese

Jaclyn B. Caccese MS
The University of Delaware
PhD Candidate Biomechanics and Movement Science 

MedicalResearch.com: What is the background for this study?

Response: Recently, there has been increased concern regarding the adverse effects of repetitively heading soccer balls on brain function. While some studies have shown impaired balance and vision, it is unclear if these deficits are acute or chronic adaptations. Therefore, the purpose of this study was to identify changes in postural control and vestibular/ocular motor function immediately following an acute bout of 12 purposeful soccer headers.

MedicalResearch.com: What are the main findings?

Response: The main finding of this study was that women’s soccer players showed an increase in sway velocity, but no other changes in balance or vestibular/ocular motor function were identified.

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Does Complete Rest In a Dark Room Help or Hurt Concussion Recovery?

MedicalResearch.com Interview with:

Thomas A. Buckley Ed.D Assistant Professor Kinesiology & Applied Physiology 144 Human Performance Lab College of Health Sciences University of Delaware

Dr. Thomas Buckley

Thomas A. Buckley Ed.D
Assistant Professor
Kinesiology & Applied Physiology
144 Human Performance Lab
College of Health Sciences
University of Delaware

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Buckley: The most recent international consensus statement recommends 24 – 48 hours of cognitive and physical rest in the immediate aftermath of a concussion; however, our clinical experience was that patients who were “shut down” for a few days did worse than patients who were allowed to be out and about as tolerated by symptoms.  This was a retrospective study (chart review) comparing symptom reporting among patients who were shut down for 24 hours and those who were not.

The main finding of the study was the addition of a day of cognitive and physical rest (i.e., ‘shut down”) did not improve symptom recovery recovery.  In fact, we were surprised to see that the non-rest group was symptom free 1.3 days sooner than the rest group and this was statistically significant.

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More Concussions When NFL Games Played in Below Freezing Temperatures

MedicalResearch.com Interview with:
Dr. David W. Lawrence, MD
Department of Family & Community Medicine
St Michael’s Hospital, University of Toronto
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Lawrence: The risk of all-cause injury and concussion for NFL athletes is significant. There has been a lot of discussion recently about this risk of injury in the NFL and general player safety, particularly regarding concussions. The first step in improving player safety and lowering that risk is to identify the factors affecting injury rates. Once we can answer those questions, we can begin to modify player exposure.

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Blood Biomarkers Can Help Evaluate Mild Concussion

MedicalResearch.com Interview with:

Linda Papa MD.CM, MSc, CCFP, FRCPC, FACEP Director of Academic Clinical Research Attending Emergency Physician Orlando Regional Medical Center Professor, University of Central Florida College of Medicine Associate Professor, Florida State University College of Medicine Adjunct Professor, University of Florida College of Medicine Adjunct Professor, Department of Neurology and Neurosurgery McGill University

Dr. Linda Papa

Linda Papa MD.CM, MSc, CCFP, FRCPC, FACEP
Director of Academic Clinical Research
Attending Emergency Physician
Orlando Regional Medical Center
Professor, University of Central Florida College of Medicine
Associate Professor, Florida State University College of Medicine
Adjunct Professor, University of Florida College of Medicine and Department of Neurology and Neurosurgery McGill University

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Papa:  The temporal profile of these biomarkers has never been examined in mild TBI/concussion patients before. Research has focused on severe traumatic brain injury (TBI) but not enough work has been done in mild TBI/concussion. GFAP and UCH-L1 had very distinct temporal profiles in this study. It was a very pleasant surprise that GFAP performed so well and performed so consistently throughout the 7 days after injury. This suggests that GFAP could be used for clinical decision making over a week post-injury. The early peak in UCH-L1 was very exciting but its rapid decline will limit its use at later time points.

1-     The biomarkers could be used to detect a mild traumatic brain injury/concussion in patients following trauma acutely (GFAP, UCH-L1) such as in the emergency department or urgent care clinic or perhaps in the prehospital setting. Notably, GFAP could also be used later (up to 7 days) in patients who may not seek immediate medical attention.

2-     The biomarkers could help with determining the need for a CT scan of the brain acutely (GFAP, UCH-L1) or after several days (GFAP). This is particularly important in younger patients who are more sensitive to ionizing radiation. It also has implications for hospitals in rural settings who may not have access to CT scans 24 hours/day.

3-     The biomarkers could help identify patients who may need neurosurgical intervention very early after injury so patients could be transported to facilities where neurosurgical care is always available.

Some specific scenarios in which these biomarkers would be particularly helpful include:

  •    In patients who are intoxicated with drugs or alcohol (because they are cognitively impaired).
  •   In patients with polytrauma who have multiple injuries (other injuries distract from potential brain injury).
  •   In elderly patients who cannot express their symptoms or in children who cannot express their symptoms (we examined children in a separate study published in Academic Emergency Medicine in Nov 2015).
  •   In athletes with head trauma during play.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Papa:  These data focus on mild TBI/concussion patients. Getting blood samples from these patients over time is very challenging but is extremely important because individuals with mild TBI/concussion can present at different times after injury. Some patients do not seek medical attention for several hours to days after their injury. GFAP appears to be useful both early and late after injury. UCH-L1 is only helpful early on. This study captures the real-world setting in which  traumatic brain injury biomarkers would be used by comparing a large number of trauma patients with TBI to a large number of trauma patients without a TBI. This study provides physicians with information about when and how these biomarkers could be used to evaluate trauma patients with suspected mild TBI/concussion.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Papa:    These data provide valuable information on the diagnostic accuracy of GFAP and UCH-L1 at 20 distinct time points over 7 days after head trauma. They reflect severity of brain injury (higher levels indicate more severe injury). As with other blood tests, these biomarkers are tools to complement clinical judgment. 

MedicalResearch.com: Is there anything else you would like to add?

Dr. Papa:  Physicians have access to many blood tests for different organ systems in the body such as troponin for cardiac ischemia, creatinine for kidney impairment, TSH for thyroid function, etc…. As of yet, there is no FDA approved blood test for  traumatic brain injury . These results support GFAP as a robust marker for mild TBI/concussion. These blood tests are being commercialized for FDA approval.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Papa L, Brophy GM, Welch RD, et al. Time Course and Diagnostic Accuracy of Glial and Neuronal Blood Biomarkers GFAP and UCH-L1 in a Large Cohort of Trauma Patients With and Without Mild Traumatic Brain Injury.JAMA Neurol. Published online March 28, 2016. doi:10.1001/jamaneurol.2016.0039.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Linda Papa MD (0). Blood Biomarkers Can Help Evaluate Mild Concussion MedicalResearch.com

Clinical Score Improves Prediction of Concussion Outcomes in Children

MedicalResearch.com Interview with:

Roger Zemek, MD, FRCPC Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario Ottawa, ON

Dr. Roger Zemek

Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa
Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario
Ottawa, ON

MedicalResearch.com: What is the background for this study?

Dr. Zemek: The number of concussions have dramatically increased over the past decade.  Not only are children and adolescents are at highest risk for getting concussions, they also take longer to recover.  As part of our background work, our team performed a systematic review (published in JAMA Pediatrics) confirming that validated, easy-to-use prognosticators did not exist for clinicians to identify children with concussion who are at the highest risk for persistent post-concussive symptoms (PPCS) and sequelae.

MedicalResearch.com: What are the main findings?

Dr. Zemek: In this, the largest concussion study in the world to-date, we derived and validated in a large, diverse cohort of children a clinical risk score that is significantly superior to clinicians’ ability to predict future PPCS at the time of ED presentation. Multivariate analysis revealed that age group, female sex, past history of migraine, prior concussion with symptom duration of >1 week, ED presentation with “answering questions slowly”, 4 or more errors on BESS Tandem stance, and the initial symptoms of headache, noise sensitivity and fatigue were all clinically significant and strongly associated with PCS at 1-month.

We assigned points based on the adjusted multivariate odds ratio, and the rule incorporating patient demographic factors, past history, early cognitive deficits, balance (an physical exam finding), and early symptoms.  The rule has a maximum of 12 points.  We selected two cut-off points in order to yield three clinically relevant (low, intermediate and high risk) categories for the development of PPCS at one month.

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Genetic Variation Affects Recovery From Concussion

MedicalResearch.com Interview with:

Dr. Jane McDevitt Temple University in Philadelphia

Dr. Jane McDevitt

Dr. Jane McDevitt
Temple University in Philadelphia

MedicalResearch.com: What is the background for this study?

Dr. McDevitt: During a head impact there is a mechanical load that causes acceleration and deceleration forces on the brain within the cranium. The acceleration and deceleration causes stress to the neurons and initiates a neurometabolic cascade, where excitatory neurotransmitters such as glutamate are released and depolarize the cell.  This triggers protein channels to open and allow ions into and out of the cell.  Increases in calcium persist longer and have greater magnitude of imbalance than any other ionic disturbance. One channel responsible for allowing calcium into the cell is r-type voltage-gated calcium channel.  One of the main proteins within this voltage-gated calcium channel is the CACNA1E protein produced by the CACNA1E gene. This protein forms the external pore and contains a pair of glutamate residues that are required for calcium selectivity.   It is also responsible for modulating neuronal firing patterns. A variation within this gene (i.e,CACNA1E ) that regulates expression levels of CACNA1E could be associated with how an athlete recovers following a concussion injury.

Upwards of 20% of the concussed population fall into the prolonged recovery category, which puts these athletes at risk for returning to play quicker than they should. Variation in recovery depends on extrinsic factors like magnitude of impact, and sport, or intrinsic factors like age or sex. One intrinsic factor that has not been definitively parsed out is genetic variation. Recovery is likely to be influenced by genetics because genes determine the structure and function of proteins involved in the cell’s resistance and response to mechanical stress. Due to CACNA1E’s relationship to calcium influx regulation, a single nucleotide polymorphism (SNP) could modify the expression level of the protein responsible for regulating calcium. Altered protein levels could lead to athlete’s responding to concussive injuries differently. The main objective of this study was to examine the association between CACNA1E SNPs with concussion recovery in athletes.

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Potential New Blood Test For Chronic Traumatic Encephalopathy Measures Plasma Tau Levels

MedicalResearch.com Interview with:

Mr. Jim Joyce Chairman and CEO of Aethlon

Mr. Jim Joyce

Mr. Jim Joyce
Chairman and CEO of Aethlon

MedicalResearch.com: What is the background for this study? What are the main findings?

Mr. Joyce: Our research into the neurodegenerative disease Chronic Traumatic Encephalopathy (CTE), was inspired by the death of Tom McHale, who was a former teammate and the second person diagnosed with CTE by our colleagues at the Boston University CTE Center. CTE is characterized by exposure to repetitive head trauma and at present, can only be diagnosed post-mortem, thus creating a significant need for a non-invasive method to diagnose and monitor CTE in living individuals.

The aim of our study was to examine exosomal tau levels in plasma as a potential CTE biomarker. Our research team originally discovered the presence of exosomal tau in circulation and then established methods to quantify exosomal tau, which we refer to as a TauSome™, which we believe to be the first potential blood test to detect CTE living individuals. For this study, researchers examined 78 former National Football League players and 17 former athletes of non-contact sports, with preliminary findings suggesting that exosomal tau in plasma may be a noninvasive, accurate biomarker for CTE.

The study results, published in the journal of Alzheimer’s disease, can be accessed here: http://content.iospress.com/articles/journal-of-alzheimers-disease/jad151028?resultNumber=7&totalResults=48&start=0&q=exosome&resultsPageSize=10&rows=10.

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Fewer Pediatric Abusive Head Trauma In States With Paid Family Leave

MedicalResearch.com Interview with:

Joanne Klevens, MD, PhD Division of Violence Prevention US Centers for Disease Control and Prevention Atlanta, Georgia

Dr. Joanne Klevens

Dr. Joanne Klevens, MD, PhD, MPH
Division of Violence Prevention
US Centers for Disease Control and Prevention
Atlanta, Georgia

Medical Research: What is the background for this study? What are the main findings?

Dr. Klevens: Pediatric abusive head trauma is a leading cause of fatal child maltreatment among young children and current prevention efforts have not been proven to be consistently effective. In this study, compared to seven states with no paid family leave policies, California’s policy showed significant decreases of hospital admissions for abusive head trauma in young children. This impact was observed despite low uptake of policy benefits by Californians, particularly among populations at highest risk of abusive head trauma.

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Adults With Concussion Have Increased Risk of Suicide

MedicalResearch.com Interview with:

Dr. Donald Redelmeier MD, MSHSR, FRCPC, FACP Senior core scientist at the Institute for Clinical Evaluative Sciences (ICES) Physician at Sunnybrook Health Sciences Centre Toronto, Ontario

Dr. Donald Redelmeier

Dr. Donald Redelmeier MD, MSHSR, FRCPC, FACP
Senior core scientist at the Institute for Clinical Evaluative Sciences (ICES)
Physician at Sunnybrook Health Sciences Centre
Toronto, Ontario

Medical Research: What is the background for this study? What are the main findings?

Dr. Redelmeier: Head injury can lead to suicide in military veterans and professional athletes; however, whether a mild concussion acquired in community settings is also a risk factor for suicide is unknown.

Medical Research: What should clinicians and patients take away from your report?

Dr. Redelmeier: We studies 235,110 patients diagnosed with a concussion and found that  667 subsequently died from suicide. The median delay was about 6 years. This risk was about 32 per 100,000 patients annually, which is 3x the population norm and especially high if the concussion occurred on a weekend (from recreation) rather than a weekday (from employment).
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Chronic Traumatic Encephalopathy Found In Brains of Non-Professional Athletes

Kevin Bieniek

Kevin Bieniek

MedicalResearch.com Interview with:
Kevin Bieniek B.Sc.

Biology and Psychology
Neuroscience researcher
Mayo Clinic’s campus in Florida. 

Medical Research: What is the background for this study? What are the main findings?

Response:  Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive traumatic brain injury often sustained through contact sports and military blast exposure.  While CTE was first described in boxers in the 1920s, to date many descriptions of CTE have been made in high-profile professional athletes, but the frequency of Chronic traumatic encephalopathy pathology in athletes with more modest contact sports participation is unknown.  For this study, researchers at the Mayo Clinic in Jacksonville, FL examined the Mayo Clinic Brain Bank, one of the largest brain banks of neurodegenerative diseases.  In searching through medical records of over 1,700 patients, 66 individuals with clinically-documented contact sports participation were identified.  Of these 66 former athletes, 21 or 32% had pathologic changes in their brains consistent with CTE.  By comparison, none of 198 control individuals that did not have contact sports documentation in their medical records (including 66 women) had CTE pathology.  These results have been recently published in the December issue of the journal Acta Neuropathologica <<hyperlink: http://www.springer.com/medicine/pathology/journal/401.

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Study Identifies Pathway For Retained Awareness In Vegetative State

Dr-Davinia-Fernandez-Espejo.jpgMedicalResearch.com Interview with:
Dr Davinia Fernández-Espejo PhD
School of Psychology
University of Birmingham
Birmingham 

Medical Research: What is the background for this study? What are the main findings?

Dr. Fernández-Espejo: We have previously shown that a number of patients who appear to be in a vegetative state are actually aware of themselves and their surroundings, and simply unable to show it with their external behavior. In a prior study we demonstrated that a patient who had been repeatedly diagnosed as vegetative state for 12 years was not only fully aware but able to create memories. Notably, this patient was capable to modulate their brain activity in a functional magnetic resonance imaging (fMRI) scanner to answer questions about their condition and preferences for care. In the present study we identified the reason for the dissociation between these patients’ retained awareness and their inability to respond with intentional movement.

First, we used fMRI to demonstrate that a functional connection between the thalamus and the motor cortex is essential for a successful execution of voluntary movements.

Second, we used diffusion tensor tractography, a technique that allows reconstructing and assessing white matter pathways in the brain, to identify damage to such connection (i.e. thalamus and motor cortex) in a paradigmatic patient who produced repeated evidence of covert awareness across multiple examinations, despite clinically appearing as being in a vegetative state.

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Many Adolescents Report Symptoms Mimicking Concussions

Grant L. Iverson, PhD Director, Sports Concussion Program, MassGeneral Hospital for Children Director, Neuropsychology Outcome Assessment Laboratory, Department of Physical Medicine and Rehabilitation, Harvard Medical School Associate Director, Traumatic Brain Injury, Red Sox Foundation and Massachusetts General Hospital Home Base Program Boston, MassachusettsMedicalResearch.com Interview with:
Grant L. Iverson, PhD
Director, Sports Concussion Program
MassGeneral Hospital for Children
Director, Neuropsychology Outcome Assessment Laboratory, Department of Physical Medicine and Rehabilitation
Harvard Medical School
Associate Director, Traumatic Brain Injury
Red Sox Foundation and Massachusetts General Hospital Home Base Program
Boston, Massachusetts

Medical Research: What is the background for this study? What are the main findings?

Dr. Iverson: Health care providers rely heavily on symptom questionnaires to monitor recovery from concussion and make decisions about returning to sport after concussion.

Common symptoms of concussion include headache, fatigue, sleep problems, and difficulty concentrating.

However, many healthy adolescents, that is, with no prior concussions, report these same symptoms. It is fairly common for healthy adolescents have some symptoms in their daily life. Moreover, a subgroup of healthy high school students report multiple concussion-like symptoms, or a cluster of symptoms that look much like what we see after a concussion.

High school girls are more likely than boys to report multiple concussion-like symptoms.

High school athletes with mental health problems such as depression or anxiety, but no recent prior concussion, report a lot of concussion-like symptoms. Other prior health problems, including multiple past concussions and ADHD, had a similar but less strong association with current symptom reporting.

Girls with prior concussions might be more susceptible to the lingering effects of prior concussions. This requires further research.

Medical Research: What should clinicians and patients take away from your report?

Dr. Iverson: Be cautious about attributing symptoms that last many weeks or months following an injury to concussion, particularly in adolescents with pre-injury health problems.

When evaluating adolescents after a concussion, be sure to ask about any prior mental health problems and ADHD.

Appreciate that many factors separate from concussion can cause symptoms such as headaches, fatigue, and concentration problems in high school students.

Understand that it is difficult to know when an athlete becomes “asymptomatic” after concussion. That is, the longer a person has symptoms, the more difficult it can be to determine the extent to which those symptoms are due to the concussion or to other factors.

Citation:

Grant L. Iverson et al. Factors Associated With Concussion-like Symptom Reporting in High School Athletes. JAMA Pediatrics, 2015 DOI: 10.1001/jamapediatrics.2015.2374

Grant L. Iverson, PhD (2015). Many Adolescents Report Symptoms Mimicking Concussions 

Hypothermia Did Not Improve Outcomes After Traumatic Brain Injury

Prof. Peter JD Andrews Honorary Professor Department of Anaesthesia University of EdinburghMedicalResearch.com Interview with:
Prof. Peter JD Andrews
Honorary Professor
Department of Anaesthesia
University of Edinburgh 

Medical Research: What is the background for this study?

Prof. Andrews: Therapeutic hypothermia has shown considerable promise as a neuro-protective intervention in many species and models of cerebral injury in the laboratory. Clinical trials after neonatal hypoxic ischemic encephalopathy and cardiac arrest (global cereal ischemia) show signal of benefit.
The outcome after traumatic brain injury (TBI) has not improved in the last 20 years. Clinical trials of prophylactic therapeutic hypothermia for neuroprotection after traumatic brain injury show a mixed outcome, however, the larger trials are all neutral or have a trend toward harm.

Because traumatic brain injury is a heterogeneous pathology it has been suggest that the therapeutic hypothermia intervention should be adjusted according to response of a biomarker, to maximize benefit and limit any harms. The EUROTHERM3235Trial was a trial of therapeutic hypothermia to reduce brain swelling after traumatic brain injury. Brain swelling was measured by an intracranial pressure (ICP) probe directly inserted into the brain.

Medical Research: What are the main findings?

Prof. Andrews: Hypothermia successfully reduced intracranial pressure, but did not improve outcomes compared to standard care alone, with more than a third achieving a good outcome in the standard care group and one a quarter in the hypothermia group.

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Blood Biomarker Can Identify Patients At Risk of Continued Symptoms After Traumatic Brain Injury

Frederick Korley MD Ph.D Johns Hopkins University School of Medicine Emergency Medicine Baltimore, MarylandMedicalResearch.com Interview with:
Frederick Korley MD Ph.D
Johns Hopkins University School of Medicine
Emergency Medicine
Baltimore, Maryland

Medical Research: What is the background for this study?

Dr. Korley: Each year, millions of Americans are evaluated in emergency departments for traumatic brain injuries. Currently the only test available for diagnosing traumatic brain injury is a brain CT scan. Brain CT scans accurately identify bleeding in the brain from trauma.  However, they are unable to identify damage to brain cells. Approximately 90% of patients with traumatic brain injury have no bleeding in the brain and therefore have unremarkable brain CT scans.  However, these patients typically have damaged brain cells and they continue to suffer headaches, dizziness, attention and memory deficits, sleep problems among others for months after their injury and can’t figure out why. Therefore new tests are needed to identify traumatic brain injury patients with damaged brain cells and especially those who are likely to have persistent traumatic brain injury-related symptoms for months after injury.

Medical Research: What are the main findings?

Dr. Korley: Our study determined that the blood levels of a protein called brain derived neurotrophic factor (BDNF) can help predict whether a patient will continue to have symptoms related to traumatic brain injury at six 6 months after injury, even if they had an unremarkable brain CT scan.

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Biomarker S100B Can Help Rule Out Hemorrhage After Minor Head Injury

Dr. Heinrich Thaler Trauma Hospital Meidling Vienna AustriaMedicalResearch.com Interview with:
Dr. Heinrich Thaler
Trauma Hospital Meidling
Vienna Austria

Medical Research: What is the background for this study?

Dr. Thaler:  An increased prevalence of minor head injuries in elderly patients combined with the frequent use of platelet aggregation inhibitors resulted in increased hospital admissions and cranial computed tomography. We undertook the study with the aim to reduce the workload of medical staff and costs as well as the radiation burden in the management of patients with mild head injuries.

Medical Research: What are the main findings?

Dr. Thaler:  S 100B is a reliable negative predictor in elderly patients and/or in patients on platelet aggregation inhibitors to rule out an intracranial hemorrhage after minor head injury (S100B is an astroglial derived protein detectable in serum in the case of cerebral tissue damage). The negative predictive value of S100B is 99,6%. We conclude that S100B levels below 0.105 µg/L can accurately predict a normal cranial computed tomography after minor head injury in older patients and those on antiplatelet medication. Additionally we found no increased risk for intracranial hemorrhage in older patients or in patients receiving antiplatelet therapy.

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Compliance With Guidelines Not Linked To Outcomes in Traumatic Brain Injury

Aaron J. Dawes, MD Fellow, VA/RWJF Clinical Scholars Program Division of Health Services Research, University of California Los Angeles Los Angeles, CA 90024MedicalResearch.com Interview with:
Aaron J. Dawes, MD
Fellow, VA/RWJF Clinical Scholars Program
Division of Health Services Research, University of California Los Angeles
Los Angeles, CA 90024

Medical Research: What is the background for this study? What are the main findings?

Dr. Dawes: In the fall of 2013, we formed the Los Angeles County Trauma Consortium, building upon a prior administrative relationship between LA County’s 14 trauma centers. We added health research researchers from UCLA and USC, and shifted the focus of the group from logistical issues to quality improvement. As a first project, our hospitals wanted to know if there was any variation in how traumatic brain injury patients are cared for across the county. Traumatic brain injury accounts for over 1/3 of all injury-related deaths in the U.S. and is the number one reason for ambulance transport to a trauma center in LA County.

When we looked at the data, we found widespread variation in both how these patients were cared for at different hospitals and what happened to them as a result of that care. After adjusting for important differences in patient mix, we found that mortality rates varied by hospital from roughly 25% to 55%. As we tried to explain this variation, we looked into how often hospitals complied with two evidence-based guidelines from the Brain Trauma Foundation, hoping that we could eventually develop an intervention to boost compliance with these recommended care practices. While compliance rates varied even more widely than mortality—from 10 to 65% for intracranial pressure monitoring and 7 to 76% for craniotomy—they did not appear to be associated with risk-adjusted mortality rates. Put simply, we found no connection between how often hospitals complied with the guidelines and how likely their patients were to survive.

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Children With Traumatic Brain Injuries Can Have Poor Sleep Quality

MedicalResearch.com Interview with:
Kimberly Allen PhD, RN Assistant Professor
Center dr-kimberly-allenfor Narcolepsy, Sleep and Health Research
Department Women Children and Family Health Science
Chicago, IL 60612

Medical Research: What is the background for this study?

Dr. Allen: Pediatric traumatic brain injuries (TBI) are a leading cause of morbidity and mortality worldwide.Each year in the United States over 1Ž2 million children are admitted to the hospital for traumatic brain injuries (TBIs). Depending on the severity of the injury and how the individual child responds to the primary injury, a range of medical care may be necessary from an overnight hospital admission for observation to admission in the intensive care unit (ICU) and inpatient rehabilitation facility to re-teach and help to recover skills children once knew. The short- and long-term consequences of traumatic brain injuries include: motor and sensory impairments; cognitive, emotional, psychosocial impairments; headaches, and sleep disruptions.

Medical Research: What are the main findings?

Dr. Allen: The main finding from this pilot study with two groups with 15 children in each group: one of children with traumatic brain injuries and one of typically, developing healthy children was that children with traumatic brain injuries have significantly more daytime sleepiness and worse sleep quality compared to the control group. Additionally, children with TBI also had lower overall  functional scores (e.g, school, social) compared to the controlled children. All of the surveys were completed by the child’s parent.

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NFL Players: Concussions With Loss Of Consciousness Linked To Later Memory Problems and Brain Changes

C. Munro Cullum, PhD, ABPP Professor of Psychiatry and Neurology & Neurotherapeutics Pamela Blumenthal Distinguished Professor of Clinical Psychology Chief of Psychology Director of Neuropsychology Univ. of Texas Southwestern Medical Center Dallas, TX  75390-9044 MedicalResearch.com Interview with:
C. Munro Cullum, PhD, ABPP
Professor of Psychiatry and Neurology & Neurotherapeutics
Pamela Blumenthal Distinguished Professor of Clinical Psychology
Chief of Psychology , Director of Neuropsychology
Univ. of Texas Southwestern Medical Center Dallas, TX

Medical Research: What is the background for this study? What are the main findings?

Dr. Cullum: My colleague and principal investigator of the study, Dr. John Hart and I have been interested in the acute and longer-term effects of traumatic brain injury for years, and because of my roles in the Alzheimer’s Disease Center and the Texas Institute for Brain Injury and Repair at the University of Texas Southwestern Medical Center, it seemed like a natural to begin studying older individuals with and without cognitive disorder who have a history of traumatic brain injury.  Our main findings are two-fold:

First, we demonstrated that a history of concussion with loss of consciousness (which make up only about 10% of all concussions) was associated with smaller memory centers in the brain (the hippocampus) and lower memory results in our sample of retired professional football players. Concussions that did not result in loss of consciousness did not show that same strong association.

Second, our data suggest that patients with a clinical diagnosis of mild cognitive impairment (ie a memory disorder that does not grossly impair overall functioning but may lead to dementia) who also have a history of concussion with loss of consciousness show worse memory results and more brain atrophy than similar individuals diagnosed with mild cognitive impairment in the absence of a history of concussion.

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Extracerebral Biomarkers May Not Be Optimal For Monitoring Sports-Related Concussions

MedicalResearch.com Interview with:
Pashtun Shahim, MD
Departement of Neurosurgery,
University Hospital, Linköping, Sweden
Clinical Neurochemistry Laboratory
Institute of Neuroscience and Physiology
Sahlgrenska University Hospital
Mölndal Sweden

Medical Research: What is the background for this study? What are the main findings?

Response: Visinin-like protein-1 (VLP-1 or VILIP-1) is a neuronal calcium-sensor protein, originally studied as a stroke marker and identified as a marker of neuronal injury in brain injury models. Increased plasma and cerebrospinal fluid (CSF) VILIP-1 hase been reported in Alzheimer’s disease, where CSF VILIP-1 correlates with CSF total tau (T-tau) and with brain volume. Recently, using a novel ultrasensitive method to measure tau in plasma, increased levels of plasma T-tau were found in concussed professional ice hockey players, where the levels correlated with the resolution of post-concussive symptoms and the players returning to play.

The main findings of this study were that VILIP-1 did not increase significantly in serum after sports-related concussion. However, the serum levels of VILIP-1 increased after a friendly game without concussion, signaling extracerebral expression.

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Pre-College Youth Sports Concussions Occur More Often During Practice

Thomas P. Dompier, PhD, ATC President and Injury Epidemiologist Datalys Center for Sports Injury Research and Prevention, Inc Indianapolis, IN 46202 Adjunct Faculty Appointments Ohio University Rocky Mountain University of Health Professions University of South CarolinaMedicalResearch.com Interview with:
Thomas P. Dompier, PhD, ATC
President and Injury Epidemiologist
Datalys Center for Sports Injury Research and Prevention, Inc
Indianapolis, IN 46202
Adjunct Faculty Appointments
Ohio University Rocky Mountain University of Health Professions
University of South Carolina

Medical Research: What is the background for this study?

D: Dompler: Per the Institute of Medicine’s recent recommendations to better describe the incidence of concussion in sport across the entire spectrum of youth sports (5-23 years), this study is the first to provide an apples-to-apples comparison using epidemiologic data provided by healthcare providers (athletic trainers) who attended all practices and games and used the same methodology to report concussions and student-athlete exposure information.

Medical Research: What are the main findings?

D: Dompler:
a.  The main findings are that the risk (how many players out of 100 can expect to suffer at least one concussion during the season) is lowest in the youth, and increases with age.

b. Game concussion rates (how many players out of 1000 exposed during a practice or game, includes multiple concussions to the same player) are highest in college but practice concussion rates are lowest in college during practice.  This suggests more can be done during high school and youth practices to reduce concussion frequency (e.g. limiting how much time can be devoted to full contact, reducing player-to-player contact by teaching proper tackling without using full contact drills such as the Oklahoma drill and others).

c. While the rate is higher, there is still a substantial number of concussions that occur during practice (because there are more practices), therefore sports medicine staff should be available at both if possible (this is difficult at the youth level because of cost, however).

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Law Brings More Student Athletes To ER For Sports-Related Concussions

Dr. Pina Violano, RN, PhD Trauma Department, Yale-New Haven Hospital, Injury Free Coalition for Kids of New Haven Yale-New Haven Children’s Hospital New Haven 06510, CTMedicalResearch.com Interview with:
Dr. Pina Violano, RN, PhD

Trauma Department, Yale-New Haven Hospital,
Injury Free Coalition for Kids of New Haven
Yale-New Haven Children’s Hospital
New Haven 06510, CT

MedicalResearch: What is the background for this study?

Dr. Violano: In July of 2012, Connecticut became one of the first states to enact legislation to ensure the safety and appropriate evaluation and management of sports-related concussions (SRC) among High School students. SRCs are a common occurrence in high school sports with their diagnosis increasing over the last decade. While the exact reasons are not known, public health campaign efforts and education may have facilitated improvement in the evaluation and detection of sports-related concussions and may have contributed to increase awareness and treatment.

MedicalResearch: What are the main findings?

Dr. Violano: Evaluation of two emergency department records revealed a marked increase in the frequency of high school student athletes being treated for sports-related concussions after the implementation of Connecticut’s SRC law. This suggests that Connecticut’s legislation is effective in improving the evaluation and detection of sports-related concussions in high school students.

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Peptides May Reduce Brain Injury After Stroke

Bruno Meloni PhD Centre for Neuromuscular and Neurological Disorders The University of Western Australia, Nedlands, Western Australia, AustraliaMedicalResearch.com Interview with:
Bruno Meloni PhD
Centre for Neuromuscular and Neurological Disorders
The University of Western Australia, Nedlands,
Western Australia, Australia


MedicalResearch: What is the background for this study?

A/Prof Meloni: Due to the lack of clinically available neuroprotective drugs to minimize brain injury after stroke we had been working in the neuroprotection field for some years within the Stroke Research Group at the WA Neuroscience Research Institute.

With respect to the latest findings, we were using arginine-rich peptides for several years as delivery vehicles to introduce experimental “neuroprotective peptides” into brain cells and the brain. Peptides are small chains of amino acids and the building blocks of protein.  Arginine is one of the twenty amino acids naturally produced in the body.  Arginine-rich peptides have an unique property in that they can transverse cell membranes and gain entry into cells, and even cross the blood brain barrier, which is unusual as most drugs able unable to do so.

Using in vitro neuronal cell culture stroke models we soon discovered that poly-arginine and arginine-rich peptides on their own possessed potent neuroprotective properties.  Furthermore, we showed that as the length of the poly-arginine peptide increased so did the peptides neuroprotective properties.  Excitingly, the poly-arginine peptides were even more potent than the ”neuroprotective peptides” we had been working with and peptides developed by other overseas researchers.

We have now confirmed using a laboratory animal stroke model that poly-arginine peptides could reduce brain damage when administered up to 1-hour after the stroke. Continue reading

Study Finds No Link Between Head Injuries and Parkinson’s Disease

MedicalResearch.com Interview with:
Line Kenborg, MSc, PhD

Survivorship Unit
Danish Cancer Society Research Center
Copenhagen

Medical Research: What is the background for this study? What are the main findings?

Response: The hypothesis that head injuries increase the risk for Parkinson disease has been examined in many studies during the past decades, but the findings have been highly inconsistent. We have previously examined the hypothesis in a study based on information on head injuries and Parkinson disease from the Danish National Hospital Registry. In this study, we found a positive association between a hospital contact for a head injury in middle or late adulthood and a diagnosis of Parkinson disease. The reported association, however, was almost entirely due to injuries that occurred during the months preceding the first hospital contact for Parkinson disease. Because we used information from registries, we lacked detailed diagnostic information to distinguish Parkinson disease from other types of parkinsonism, and we had no information on milder head injuries and head injuries in early life. So we wanted to study whether head injuries throughout life increased the risk for Parkinson disease in the largest interview-based case-control study to date including patients with a verified diagnosis of Parkinson disease. The main finding of our study is that we do not find any association between head injuries and Parkinson disease.

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Adolescent vs Parental Measurement of Quality of Life After Traumatic Brain Injury May Differ

Ashley Di Battista, Ph.D. Research Fellow Critical Care Medicine| Neurosciences & Mental Health Program The Hospital for Sick Children  Toronto, ON, CanadaMedicalResearch.com Interview with:
Ashley Di Battista, Ph.D.
Research Fellow
Critical Care Medicine| Neurosciences & Mental Health Program
The Hospital for Sick Children  Toronto, ON, Canada

Medical Research: What is the background for this study? What are the main findings?

Dr. Di Battista: Most of what is known about adolescent quality of life (QoL) after traumatic brain injury (TBI) doesn’t come from adolescents – it comes from their parents.  This profoundly non- concordant data (known as the “Proxy Problem”) is drawn from parent reported health-related quality of life (HRQoL) questionnaires (e.g. the PedsQL ™).  Parent report can be influenced by the parents’ own distress after their child’s traumatic brain injury – which results in parents providing poorer estimates of their child’s QoL.  Lack of insight is often purported to explain this difference, in the absence of direct examination of insight, or subsequent data, to support this claim.  HRQoL has been criticized in the broader wellbeing literature as incompatible with the QoL construct– due to the absence of core features of the overall QoL model, and an inherent suggestion that a lack of overt pathology is equivalent to a good outcome.

Proxy reported, HRQoL focused research has generated a polarized view of quality of life after pediatric traumatic brain injury. This misrepresentation is due in part to the way in which we acquire this data (e.g. the tools) and who we ask (e.g. parents). The current study explored the individual adolescent experience of quality of life after traumatic brain injury and whether the tools commonly used to assess quality of life after brain injury are of capturing what adolescents define as relevant to their definition of quality of life.

Our findings revealed that when adolescents did endorse changes in functioning on the PedsQL, they did not consider these changes to be relevant to, or impact on, their self-described QoL. While the PedsQL™ is capable of documenting changes post-injury, it does not seem to capture domains of relevance to the adolescent idea of QoL. The ability of these adolescents to reflect on their own circumstances, engage in pre-to-post injury analysis of their functioning challenges default positioning that lack of insight is the sole determinant for differences in reports between proxies and adolescents on quality of life .

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Novel Eye-Tracking Technology Might Take Guesswork Out of Head Injury Diagnosis

Uzma Samadani, M.D., Ph.D. Assistant Professor; Departments of Neuroscience and Physiology NYU Langone Medical CenterMedicalResearch.com Interview with:
Uzma Samadani, M.D., Ph.D.
Assistant Professor
Departments of Neuroscience and Physiology
NYU Langone Medical Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Samadani: Research dating back as early as 3,500 years ago suggests the eyes serve as a window into the brain, with disconjugate eye movements — eyes rotating in different directions — considered a principal marker for head trauma. Current estimates suggest up to 90 percent of patients with concussions or blast injuries exhibit dysfunction in their eye movements.

We wanted to find a way to objectively track and analyze eye movements following a head injury to measure injury severity and replace the current “state of the art” method of asking a patient to follow along with a finger. CT-scans and MRIs may not necessarily reveal concussion or traumatic brain injury (TBI) in the absence of structural damage, presenting a need for a diagnostic measure of head injury severity.

In a study published earlier this year in the Journal of Neurosurgery, my team at the NYU Cohen Veterans Center tested our novel eye-tracking technology on military veterans, and found our device and tracking algorithm could reveal edema in the brain as a potential biomarker for assessing brain function and monitoring recovery in people with head injuries.

Our latest paper, published January 29 in Journal of Neurotrauma, looked at a civilian population of patients admitted to the Bellevue Medical Center emergency department in New York City, with whom the NYU School of Medicine has an affiliation agreement. We compared 64 healthy control subjects to 75 patients who had experienced trauma that brought them to emergency department. We tracked and compared the movements of patients’ pupils for over 200 seconds while watching a music video.

We found that 13 trauma patients who had hit their heads and had CT scans showing new brain damage, as well as 39 trauma patients who had hit their heads and had normal CT scans, had significantly less ability to coordinate their eye movements than normal, uninjured control subjects. Twenty-three trauma subjects who had bodily or extremity injuries but did not require head CT scans had similar abilities to coordinate eye movements as normal uninjured controls.

Among patients who had hit their heads and had normal CT scans, most were slightly worse at 1-2 weeks after the injury, and subsequently recovered about one month after the injury. Among all trauma patients, the severity of concussive symptoms correlated with severity of disconjugacy.

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