1
|
Delang N, Irwin C, Peek AL, McGregor IS, Desbrow B, McCartney D. The effect of contact/collision sport participation without concussion on neurometabolites: A systematic review and meta-analysis of magnetic resonance spectroscopy studies. J Neurochem 2023; 167:615-632. [PMID: 37908148 DOI: 10.1111/jnc.16000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/22/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
The aim of this study was to systematically review prior research investigating the effects of contact/collision sport participation on neurometabolite levels in the absence of concussion. Four online databases were searched to identify studies that measured neurometabolite levels in contact/collision sport athletes (without concussion) using proton (1 H) or phosphorus (31 P) magnetic resonance spectroscopy (MRS). All study designs were acceptable for inclusion. Meta-analytic procedures were used to quantify the effect of contact/collision sport participation on neurometabolite levels and explore the impact of specific moderating factors (where sufficient data were available). Narrative synthesis was used to describe outcomes that could not be meta-analysed. Nine observational studies involving 300 contact/collision sport athletes were identified. Six studies (providing 112 effect estimates) employed longitudinal (cohort) designs and three (that could not be meta-analysed) employed case-control designs. N-acetylaspartate (NAA; g = -0.331, p = 0.013) and total creatine (tCr; creatine + phosphocreatine; g = -0.524, p = 0.029), but not glutamate-glutamine (Glx), myo-inositol (mI) or total choline (tCho; choline-containing compounds; p's > 0.05), decreased between the pre-season and mid-/post-season period. Several moderators were statistically significant, including: sex (Glx: 6 female/23 male, g = -0.549, p = 0.013), sport played (Glx: 22 American football/4 association football [soccer], g = 0.724, p = 0.031), brain region (mI: 2 corpus callosum/9 motor cortex, g = -0.804, p = 0.015), and the MRS quantification approach (mI: 18 absolute/3 tCr-referenced, g = 0.619, p = 0.003; and tCho: 18 absolute/3 tCr-referenced, g = 0.554, p = 0.005). In case-control studies, contact/collision sport athletes had higher levels of mI, but not NAA or tCr compared to non-contact sport athletes and non-athlete controls. Overall, this review suggests that contact/collision sport participation has the potential to alter neurometabolites measured via 1 H MRS in the absence of concussion. However, further research employing more rigorous and consistent methodologies (e.g. interventional studies with consistent 1 H MRS pulse sequences and quantifications) is required to confirm and better understand the clinical relevance of observed effects.
Collapse
Affiliation(s)
- Nathan Delang
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Christopher Irwin
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Aimie L Peek
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Iain S McGregor
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben Desbrow
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Danielle McCartney
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Echemendia RJ, Burma JS, Bruce JM, Davis GA, Giza CC, Guskiewicz KM, Naidu D, Black AM, Broglio S, Kemp S, Patricios JS, Putukian M, Zemek R, Arango-Lasprilla JC, Bailey CM, Brett BL, Didehbani N, Gioia G, Herring SA, Howell D, Master CL, Valovich McLeod TC, Meehan WP, Premji Z, Salmon D, van Ierssel J, Bhathela N, Makdissi M, Walton SR, Kissick J, Pardini J, Schneider KJ. Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review. Br J Sports Med 2023; 57:722-735. [PMID: 37316213 DOI: 10.1136/bjsports-2022-106661] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6). DATA SOURCES Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation. ELIGIBILITY CRITERIA (1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC. DATA EXTRACTION Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool. RESULTS Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children. CONCLUSION Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes. PROSPERO REGISTRATION NUMBER CRD42020154787.
Collapse
Affiliation(s)
- Ruben J Echemendia
- Concussion Care Clinic, University Orthopedics, State College, Pennsylvania, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Simon Kemp
- Sports Medicine, Rugby Football Union, London, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christopher M Bailey
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Gerry Gioia
- Depts of Pediatrics and Psychiatry & Behavioral Sciences, Children's National Health System, Washington, District of Columbia, USA
| | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - David Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Neil Bhathela
- UCLA Health Steve Tisch BrainSPORT Program, Los Angeles, California, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, School of Medicine, Richmond, Virginia, USA
| | - James Kissick
- Dept of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
3
|
Joyce JM, La PL, Walker R, Harris A. Magnetic resonance spectroscopy of traumatic brain injury and subconcussive hits: A systematic review and meta-analysis. J Neurotrauma 2022; 39:1455-1476. [PMID: 35838132 DOI: 10.1089/neu.2022.0125] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) is a non-invasive technique used to study metabolites in the brain. MRS findings in traumatic brain injury (TBI) and subconcussive hit literature have been mixed. The most common observation is a decrease in N-acetyl-aspartate (NAA), traditionally considered a marker of neuronal integrity. Other metabolites, however, such as creatine (Cr), choline (Cho), glutamate+glutamine (Glx) and myo-inositol (mI) have shown inconsistent changes in these populations. The objective of this systematic review and meta-analysis was to synthesize MRS literature in head injury and explore factors (brain region, injury severity, time since injury, demographic, technical imaging factors, etc.) that may contribute to differential findings. One hundred and thirty-eight studies met inclusion criteria for the systematic review and of those, 62 NAA, 24 Cr, 49 Cho, 18 Glx and 21 mI studies met inclusion criteria for meta-analysis. A random effects model was used for meta-analyses with brain region as a subgroup for each of the five metabolites studied. Meta-regression was used to examine the influence of potential moderators including injury severity, time since injury, age, sex, tissue composition and methodological factors. In this analysis of 1428 unique head-injured subjects and 1132 controls, the corpus callosum was identified as a brain region highly susceptible to metabolite alteration. NAA was consistently decreased in TBI of all severity, but not in subconcussive hits. Cho and mI were found to be increased in moderate-to-severe TBI but not mild TBI. Glx and Cr were largely unaffected, however did show alterations in certain conditions.
Collapse
Affiliation(s)
- Julie Michele Joyce
- University of Calgary, 2129, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
| | - Parker L La
- University of Calgary, 2129, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
| | - Robyn Walker
- University of Calgary, 2129, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
| | - Ashley Harris
- University of Calgary, Radiology, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, 157742, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, 157744, Calgary, Alberta, Canada.,Integrated Concussion Research Program, Calgary, Alberta, Canada;
| |
Collapse
|
4
|
Kieffer EE, Brolinson PG, Maerlender AE, Smith EP, Rowson S. In-Season Concussion Symptom Reporting in Male and Female Collegiate Rugby Athletes. Neurotrauma Rep 2021; 2:503-511. [PMID: 34901945 PMCID: PMC8655811 DOI: 10.1089/neur.2021.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Symptom inventories are generally only collected after a suspected concussion, but regular in-season monitoring may allude to clinical symptoms associated with repetitive subconcussive impacts and potential undiagnosed concussions. Despite sex-specific differences in symptom presentation and outcome of concussion, no return-to-play protocol takes sex into account. The objective of this study was to monitor a cohort of contact-sport athletes and compare the frequency and severity of in-season concussion-like symptom reporting between sexes. Graded symptom checklists from 144 female and 104 male athlete-seasons were administered weekly to quantify the effect of subconcussive impacts on frequency and severity of in-season symptom reporting. In-season, mean symptom severity score (SSS) (p = 0.026, mean difference of 1.8), mean number of symptoms (p = 0.044, mean difference of 0.9), max SSS (p < 0.001, mean difference of 19.2), and max number of symptoms (p < 0.001, mean difference of 6.8) were higher in the females. The females' survey results showed differences between elevated and concussed SSS (p < 0.005, mean difference of 28.1) and number of symptoms reported (p = 0.001, mean difference of 6.6). The males did not have a difference in SSS (p = 0.97, mean difference of 1.12) nor in number of symptoms (p = 0.35, mean difference of 1.96) from elevated to concussed athletes. Rugby players report concussion-like symptoms in the absence of a diagnosed concussion in-season. Female athletes reported elevated symptom frequencies with greater severities than the males, but both sexes reported considerable levels throughout the season.
Collapse
Affiliation(s)
- Emily E Kieffer
- School of Biomedical Engineering and Sciences and Virginia Tech, Blacksburg, Virginia, USA
| | | | - Arthur E Maerlender
- Center for Brain, Biology and Behavior, University of Nebraska at Lincoln, Lincoln, Nebraska, USA
| | - Eric P Smith
- Department of Statistics, Virginia Tech, Blacksburg, Virginia, USA
| | - Steven Rowson
- School of Biomedical Engineering and Sciences and Virginia Tech, Blacksburg, Virginia, USA
| |
Collapse
|
5
|
Sung D, Smith JL, Yarabarla S, Prasad O, Owusu-Ansah M, Ekici S, Allen JW, Mines B, Fleischer CC. Changes in brain metabolites and resting-state connectivity in collegiate basketball players as a function of play time. J Neuroimaging 2021; 31:1146-1155. [PMID: 34288203 DOI: 10.1111/jon.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic resonance (MR) biomarkers are emerging for sports-related traumatic brain injury (TBI), but the effect of play time has not been characterized. Our goal was to characterize brain and inflammatory marker changes as a function of play time. METHODS Nine male players (21±2 years old) from a single collegiate basketball team were included. MR imaging (MRI), MR spectroscopy, and plasma were collected pre, mid, and postseason. Game time played was calculated for each subject. Changes in brain volume, diffusion tensor imaging (DTI), metabolites (normalized to total creatine, tCr), temperature, structural and functional connectivity, and inflammatory markers were quantified. RESULTS Myo-inositol/tCr in the left frontal white matter and brain temperature in the left frontal lobe varied significantly between time points. Glutamate (Glu/tCr) in the right frontal white matter and N-acetylaspartate in the posterior cingulate cortex (PCC) were negatively associated with minutes played. Midseason play time was associated with stronger blood-oxygen-level-dependent correlations between PCC and occipital areas, and weaker correlations between PCC and superior frontal connectivity. PCC Glu/tCr was positively associated with connectivity between the PCC and posterior supramarginal gyrus at preseason and with connectivity across time points among several right hemisphere regions. Volume, DTI, and inflammatory markers did not vary significantly. CONCLUSION Given that MR parameters vary with game play time in the absence of diagnosed injury, play time should be considered as a factor in sports-related TBI research.
Collapse
Affiliation(s)
- Dongsuk Sung
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Suma Yarabarla
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, USA
| | - Ojaswa Prasad
- Department of Medicine, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia, USA
| | - Maame Owusu-Ansah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Selin Ekici
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jason W Allen
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brandon Mines
- Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Candace C Fleischer
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
6
|
Schranz AL, Dekaban GA, Fischer L, Blackney K, Barreira C, Doherty TJ, Fraser DD, Brown A, Holmes J, Menon RS, Bartha R. Brain Metabolite Levels in Sedentary Women and Non-contact Athletes Differ From Contact Athletes. Front Hum Neurosci 2020; 14:593498. [PMID: 33324185 PMCID: PMC7726472 DOI: 10.3389/fnhum.2020.593498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/28/2020] [Indexed: 01/31/2023] Open
Abstract
White matter tracts are known to be susceptible to injury following concussion. The objective of this study was to determine whether contact play in sport could alter white matter metabolite levels in female varsity athletes independent of changes induced by long-term exercise. Metabolite levels were measured by single voxel proton magnetic resonance spectroscopy (MRS) in the prefrontal white matter at the beginning (In-Season) and end (Off-Season) of season in contact (N = 54, rugby players) and non-contact (N = 23, swimmers and rowers) varsity athletes. Sedentary women (N = 23) were scanned once, at a time equivalent to the Off-Season time point. Metabolite levels in non-contact athletes did not change over a season of play, or differ from age matched sedentary women except that non-contact athletes had a slightly lower myo-inositol level. The contact athletes had lower levels of myo-inositol and glutamate, and higher levels of glutamine compared to both sedentary women and non-contact athletes. Lower levels of myo-inositol in non-contact athletes compared to sedentary women indicates long-term exercise may alter glial cell profiles in these athletes. The metabolite differences observed between contact and non-contact athletes suggest that non-contact athletes should not be used as controls in studies of concussion in high-impact sports because repetitive impacts from physical contact can alter white matter metabolite level profiles. It is imperative to use athletes engaged in the same contact sport as controls to ensure a matched metabolite profile at baseline.
Collapse
Affiliation(s)
- Amy L Schranz
- Department of Medical Biophysics, Robarts Research Institute, Centre for Functional and Metabolic Mapping, Western University, London, ON, Canada
| | - Gregory A Dekaban
- Molecular Medicine Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Lisa Fischer
- Fowler Kennedy Sport Medicine Clinic, Department of Family Medicine, Western University, London, ON, Canada
| | - Kevin Blackney
- Molecular Medicine Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Christy Barreira
- Molecular Medicine Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada
| | - Timothy J Doherty
- Physical Medicine and Rehabilitation, Western University, London, ON, Canada
| | - Douglas D Fraser
- Paediatrics Critical Care Medicine, London Health Sciences Centre, London, ON, Canada
| | - Arthur Brown
- Molecular Medicine Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada.,Department of Anatomy and Cell Biology, Western University, London, ON, Canada
| | - Jeff Holmes
- School of Occupational Therapy, Western University, London, ON, Canada
| | - Ravi S Menon
- Department of Medical Biophysics, Robarts Research Institute, Centre for Functional and Metabolic Mapping, Western University, London, ON, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Robarts Research Institute, Centre for Functional and Metabolic Mapping, Western University, London, ON, Canada
| |
Collapse
|
7
|
Abstract
After a concussion, a series of complex, overlapping, and disruptive events occur within the brain, leading to symptoms and behavioral dysfunction. These events include ionic shifts, damaged neuronal architecture, higher concentrations of inflammatory chemicals, increased excitatory neurotransmitter release, and cerebral blood flow disruptions, leading to a neuronal crisis. This review summarizes the translational aspects of the pathophysiologic cascade of postconcussion events, focusing on the role of excitatory neurotransmitters and ionic fluxes, and their role in neuronal disruption. We review the relationship between physiologic disruption and behavioral alterations, and proposed treatments aimed to restore the balance of disrupted processes.
Collapse
Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, 13123 East 16th Avenue, B060, Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Julia Southard
- Sports Medicine Center, Children's Hospital Colorado, 13123 East 16th Avenue, B060, Aurora, CO 80045, USA; Department of Psychology and Neuroscience, Regis University, 3333 Regis Boulevard, Denver, CO 80221, USA
| |
Collapse
|
8
|
Alosco ML, Tripodis Y, Rowland B, Chua AS, Liao H, Martin B, Jarnagin J, Chaisson CE, Pasternak O, Karmacharya S, Koerte IK, Cantu RC, Kowall NW, McKee AC, Shenton ME, Greenwald R, McClean M, Stern RA, Lin A. A magnetic resonance spectroscopy investigation in symptomatic former NFL players. Brain Imaging Behav 2020; 14:1419-1429. [PMID: 30848432 PMCID: PMC6994233 DOI: 10.1007/s11682-019-00060-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The long-term neurologic consequences of exposure to repetitive head impacts (RHI) are not well understood. This study used magnetic resonance spectroscopy (MRS) to examine later-life neurochemistry and its association with RHI and clinical function in former National Football League (NFL) players. The sample included 77 symptomatic former NFL players and 23 asymptomatic individuals without a head trauma history. Participants completed cognitive, behavior, and mood measures. N-acetyl aspartate, glutamate/glutamine, choline, myo-inositol, creatine, and glutathione were measured in the posterior (PCG) and anterior (ACG) cingulate gyrus, and parietal white matter (PWM). A cumulative head impact index (CHII) estimated RHI. In former NFL players, a higher CHII correlated with lower PWM creatine (r = -0.23, p = 0.02). Multivariate mixed-effect models examined neurochemical differences between the former NFL players and asymptomatic individuals without a history of head trauma. PWM N-acetyl aspartate was lower among the former NFL players (mean diff. = 1.02, p = 0.03). Between-group analyses are preliminary as groups were recruited based on symptomatic status. The ACG was the only region associated with clinical function, including positive correlations between glutamate (r = 0.32, p = 0.004), glutathione (r = 0.29, p = 0.02), and myo-inositol (r = 0.26, p = 0.01) with behavioral/mood symptoms. Other positive correlations between ACG neurochemistry and clinical function emerged (i.e., behavioral/mood symptoms, cognition), but the positive directionality was unexpected. All analyses controlled for age, body mass index, and education (for analyses examining clinical function). In this sample of symptomatic former NFL players, there was a direct effect between RHI and reduced cellular energy metabolism (i.e., lower creatine). MRS neurochemicals associated with neuroinflammation also correlated with behavioral/mood symptoms.
Collapse
Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Benjamin Rowland
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Street HIM-820, Boston, MA, 02115, USA
| | - Alicia S Chua
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Huijun Liao
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Street HIM-820, Boston, MA, 02115, USA
| | - Brett Martin
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
- Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Johnny Jarnagin
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Christine E Chaisson
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarina Karmacharya
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Inga K Koerte
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Robert C Cantu
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine, Boston, MA, USA
- Concussion Legacy Foundation, Boston, MA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology, and Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- Neurology Service, VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology, and Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Martha E Shenton
- Departments of Psychiatry and Radiology, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA
| | - Richard Greenwald
- Simbex, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Center, Departments of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Alexander Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Street HIM-820, Boston, MA, 02115, USA.
| |
Collapse
|
9
|
Koerte IK, Schultz V, Sydnor VJ, Howell DR, Guenette JP, Dennis E, Kochsiek J, Kaufmann D, Sollmann N, Mondello S, Shenton ME, Lin AP. Sex-Related Differences in the Effects of Sports-Related Concussion: A Review. J Neuroimaging 2020; 30:387-409. [PMID: 32533752 PMCID: PMC8221087 DOI: 10.1111/jon.12726] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/30/2020] [Indexed: 01/11/2023] Open
Abstract
Sports-related concussion is a serious health challenge, and females are at higher risk of sustaining a sports-related concussion compared to males. Although there are many studies that investigate outcomes following concussion, females remain an understudied population, despite representing a large proportion of the organized sports community. In this review, we provide a summary of studies that investigate sex-related differences in outcome following sports-related concussion. Moreover, we provide an introduction to the methods used to study sex-related differences after sports-related concussion, including common clinical and cognitive measures, neuroimaging techniques, as well as biomarkers. A literature search inclusive of articles published to March 2020 was performed using PubMed. The studies were reviewed and discussed with regard to the methods used. Findings from these studies remain mixed with regard to the effect of sex on clinical symptoms, concussion-related alterations in brain structure and function, and recovery trajectories. Nonetheless, there is initial evidence to suggest that sex-related differences following concussion are important to consider in efforts to develop objective biomarkers for the diagnosis and prognosis of concussion. Additional studies on this topic are, however, clearly needed to improve our understanding of sex-related differences following concussion, as well as to understand their neurobiological underpinnings. Such studies will help pave the way toward more personalized clinical management and treatment of sports-related concussion.
Collapse
Affiliation(s)
- Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Vivian Schultz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Valerie J Sydnor
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Jeffrey P Guenette
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily Dennis
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Neurology, University of Utah, Salt Lake City, UT
| | - Janna Kochsiek
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - David Kaufmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Nico Sollmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,VA Boston Healthcare System, Boston, MA
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
10
|
Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Neurometabolites and sport-related concussion: From acute injury to one year after medical clearance. Neuroimage Clin 2020; 27:102258. [PMID: 32388345 PMCID: PMC7215245 DOI: 10.1016/j.nicl.2020.102258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/25/2020] [Accepted: 04/09/2020] [Indexed: 01/21/2023]
Abstract
Sport-related concussion is associated with acute disturbances in neurometabolic function, with effects that may last weeks to months after injury. However, is presently unknown whether these disturbances resolve at medical clearance to return to play (RTP) or continue to evolve over longer time intervals. Moreover, little is known about how these neurometabolic changes correlate with other measures of brain physiology. In this study, these gaps were addressed by evaluating ninety-nine (99) university-level athletes, including 33 with sport-related concussion and 66 without recent injury, using multi-parameter magnetic resonance imaging (MRI), which included single-voxel spectroscopy (SVS), diffusion tensor imaging (DTI) and resting-state functional MRI (fMRI). The concussed athletes were scanned at the acute phase of injury (27/33 imaged), medical clearance to RTP (25/33 imaged), one month post-RTP (25/33 imaged) and one year post-RTP (13/33 imaged). We measured longitudinal changes in N-acetyl aspartate (NAA) and myo-inositol (Ins), over the course of concussion recovery. Concussed athletes showed no significant abnormalities or longitudinal change in NAA values, whereas Ins was significantly elevated at RTP and one month later. Interestingly, Ins response was attenuated by a prior history of concussion. Subsequent analyses identified significant associations between Ins values, DTI measures of white matter microstructure and fMRI measures of functional connectivity. These associations varied over the course of concussion recovery, suggesting that elevated Ins values at RTP and beyond reflect distinct changes in brain physiology, compared to acute injury. These findings provide novel information about neurometabolic recovery after a sport-related concussion, with evidence of disturbances that persist beyond medical clearance to RTP.
Collapse
Affiliation(s)
- Nathan W Churchill
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, Canada; Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada.
| | - Michael G Hutchison
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, ON, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tom A Schweizer
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, Canada; Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada; Faculty of Medicine (Neurosurgery) University of Toronto, Toronto, ON, Canada; The Institute of Biomaterials & Biomedical Engineering (IBBME) at the University of Toronto, Toronto, ON, Canada
| |
Collapse
|
11
|
Tsushima WT, Ahn HJ, Siu AM, Yoshinaga K, Choi SY, Murata NM. Effects of repetitive subconcussive head trauma on the neuropsychological test performance of high school athletes: A comparison of high, moderate, and low contact sports. APPLIED NEUROPSYCHOLOGY. CHILD 2019; 8:223-230. [PMID: 29393677 DOI: 10.1080/21622965.2018.1427095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to examine the neuropsychological test results of non-concussed high school athletes playing at three different levels of contact sports. Based on the concussion risk data of 12 different sports, a High Contact group (n=2819; wrestling/martial arts, cheerleading, track and field, football), a Moderate Contact group (n=2323; softball, basketball, soccer), and a Low Contact group (n=1580; baseball, volleyball, water polo, tennis, cross-country) were formed and compared in terms of their scores on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The results revealed that the High Contact group obtained small but statistically poorer performances in ImPACT Visual Memory, Visual Motor Speed, Impulse Control, and Total Symptom scores compared to the Moderate and Low Contact groups. The High Contact group also had poorer Reaction Time scores compared to the Low Contact group. No differences between the Moderate and Low Contact groups were noted. The findings, along with prior similar results, tentatively raise concerns that participant in high contact sports, exposed to repetitive subconcussive head trauma, may be at greater risk for lowered neuropsychological functioning and increased symptoms, compared to other high school athletes. In view of the preliminary nature of this investigation, more research into the effects of frequent head impacts in high school sports is strongly recommended.
Collapse
Affiliation(s)
- William T Tsushima
- a Psychiatry and Psychology Department , Straub Medical Center , Honolulu , Hawaii , USA
| | - Hyeong Jun Ahn
- b Office of Biostatistics & Quantitative Health Sciences, John A. Burns School of Medicine , University of Hawaii , Honolulu , Hawaii , USA
| | - Andrea M Siu
- c Hawaii Pacific Health, Research Institute , Honolulu , Hawaii , USA
| | - Kara Yoshinaga
- d Department of Psychology , University of Hawaii at Manoa , Honolulu , Hawaii , USA
| | - So Yung Choi
- e Department of Complementary and Integrative Medicine, John A. Burns School of Medicine , University of Hawaii , Honolulu , Hawaii , USA
| | - Nathan M Murata
- f Department of Kinesiology and Rehabilitation Science , University of Hawaii at Manoa , Honolulu , Hawaii , USA
| |
Collapse
|
12
|
Hunter LE, Branch CA, Lipton ML. The neurobiological effects of repetitive head impacts in collision sports. Neurobiol Dis 2019; 123:122-126. [PMID: 29936233 PMCID: PMC6453577 DOI: 10.1016/j.nbd.2018.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/30/2018] [Accepted: 06/20/2018] [Indexed: 12/20/2022] Open
Abstract
It is now recognized that repetitive head impacts (RHI) in sport have the potential for long-term neurological impairments. In order to identify targets for intervention and/or pharmacological treatment, it is necessary to characterize the neurobiological mechanisms associated with RHI. This review aims to summarize animal and human studies that specifically address Blood Brain Barrier (BBB) dysfunction, abnormal neuro-metabolic and neuro-inflammatory processes as well as Tau aggregation associated with RHI in collision sports. Additionally, we examine the influence of physical activity and genetics on outcomes of RHI, discuss methodological considerations, and provide suggestions for future directions of this burgeoning area of research.
Collapse
Affiliation(s)
- Liane E Hunter
- The Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
| | - Craig A Branch
- The Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Departments of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Departments of Physiology and Biophysics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Michael L Lipton
- The Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Departments of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Departments of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
13
|
Mainwaring L, Ferdinand Pennock KM, Mylabathula S, Alavie BZ. Subconcussive head impacts in sport: A systematic review of the evidence. Int J Psychophysiol 2018; 132:39-54. [DOI: 10.1016/j.ijpsycho.2018.01.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 12/18/2022]
|
14
|
Panchal H, Sollmann N, Pasternak O, Alosco ML, Kinzel P, Kaufmann D, Hartl E, Forwell LA, Johnson AM, Skopelja EN, Shenton ME, Koerte IK, Echlin PS, Lin AP. Neuro-Metabolite Changes in a Single Season of University Ice Hockey Using Magnetic Resonance Spectroscopy. Front Neurol 2018; 9:616. [PMID: 30177905 PMCID: PMC6109794 DOI: 10.3389/fneur.2018.00616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/09/2018] [Indexed: 01/13/2023] Open
Abstract
Background: Previous research has shown evidence for transient neuronal loss after repetitive head impacts (RHI) as demonstrated by a decrease in N-acetylaspartate (NAA). However, few studies have investigated other neuro-metabolites that may be altered in the presence of RHI; furthermore, the relationship of neuro-metabolite changes to neurocognitive outcome and potential sex differences remain largely unknown. Objective: The aim of this study was to identify alterations in brain metabolites and their potential association with neurocognitive performance over time as well as to characterize sex-specific differences in response to RHI. Methods: 33 collegiate ice hockey players (17 males and 16 females) underwent 3T magnetic resonance spectroscopy (MRS) and neurocognitive evaluation before and after the Canadian Interuniversity Sports (CIS) ice hockey season 2011–2012. The MRS voxel was placed in the corpus callosum. Pre- and postseason neurocognitive performances were assessed using the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Absolute neuro-metabolite concentrations were then compared between pre- and postseason MRS were (level of statistical significance after correction for multiple comparisons: p < 0.007) and correlated to ImPACT scores for both sexes. Results: A significant decrease in NAA was observed from preseason to postseason (p = 0.001). Furthermore, a trend toward a decrease in total choline (Cho) was observed (p = 0.044). Although no overall effect was observed for glutamate (Glu) over the season, a difference was observed with females showing a decrease in Glu and males showing an increase in Glu, though this was not statistically significant (p = 0.039). In both males and females, a negative correlation was observed between changes in Glu and changes in verbal memory (p = 0.008). Conclusion: The results of this study demonstrate changes in absolute concentrations of neuro-metabolites following exposure to RHI. Results suggest that changes in Glu are correlated with changes in verbal memory. Future studies need to investigate further the association between brain metabolites and clinical outcome as well as sex-specific differences in the brain's response to RHI.
Collapse
Affiliation(s)
- Hemali Panchal
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nico Sollmann
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael L Alosco
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States.,Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Philipp Kinzel
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - David Kaufmann
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Elisabeth Hartl
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lorie A Forwell
- 3M Centre, The University of Western Ontario, London, ON, Canada
| | - Andrew M Johnson
- School of Health Studies, The University of Western Ontario, London, ON, Canada
| | - Elaine N Skopelja
- Ruth Lilly Medical Library, Indiana University, Indianapolis, IN, United States
| | - Martha E Shenton
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,VA Boston Healthcare System, Brockton, MA, United States
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Paul S Echlin
- Elliott Sports Medicine Clinic, Burlington, ON, Canada
| | - Alexander P Lin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
15
|
Chang XD, Yang P, Mu XY, Ma WL, Zhou M. Evaluation of Knees in Asymptomatic Amateur Ice Hockey Players Using 3.0-T Magnetic Resonance Imaging: A Case-Control Study. Chin Med J (Engl) 2018; 131:1038-1044. [PMID: 29692374 PMCID: PMC5937311 DOI: 10.4103/0366-6999.230723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Research on the changes to knee structures in asymptomatic amateur ice hockey players (AAIHPs) has been limited. We aimed to assess the performance of the knees in AAIHPs using 3.0-T magnetic resonance imaging (MRI). Methods: A total of 71 asymptomatic knees (32 AAIHPs and 39 age- and sex-matched controls) were imaged using a 3.0-T MRI scanner at the Affiliated Zhongshan Hospital of Dalian University in April 2017. Two experienced musculoskeletal radiologists were blinded to assess all MRI findings, including bursae around the knee, bone marrow edema (BME), meniscal signal changes, and articular cartilage and ligament damage. Any disagreements were resolved by a third professor of musculoskeletal radiology. Categorical variables were compared using the Chi-square test and continuous variables using the Student's t-test or Mann-Whitney U-test. Results: The most common finding was fluid-filled bursae surrounding the knee. In the AAIHP group, which totaled 32 knees and 416 bursae, 155 (37%) fluid-filled bursae were present. In the control group, there were a total of 39 knees and 507 bursae, and 91 (18%) fluid-filled bursae were present. There was a significant difference in the number of fluid-filled bursae between the two groups (P < 0.05). However, in AAIHPs, the prevalence of meniscal signal changes (16 knees, 50%) was higher than in the control group (2 knees, 5%; P < 0.001). Importantly, 15 of the 19 were grade II signals. Other changes were only found in AAIHPs. Articular cartilage lesions were detected in 47% of their knees, predominantly at the patellofemoral joint, and BME was found in 34% of their knees. Conclusion: The MRI findings of knees in AAIHPs mainly manifested as self-protection reaction, and proper ice hockey exercise could be advocated.
Collapse
Affiliation(s)
- Xiao-Dan Chang
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, China
| | - Pei Yang
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, China
| | - Xin-Yan Mu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, China
| | - Wei-Li Ma
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, China
| | - Mo Zhou
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, China
| |
Collapse
|
16
|
Schranz AL, Manning KY, Dekaban GA, Fischer L, Jevremovic T, Blackney K, Barreira C, Doherty TJ, Fraser DD, Brown A, Holmes J, Menon RS, Bartha R. Reduced brain glutamine in female varsity rugby athletes after concussion and in non-concussed athletes after a season of play. Hum Brain Mapp 2018; 39:1489-1499. [PMID: 29271016 PMCID: PMC6866259 DOI: 10.1002/hbm.23919] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/07/2017] [Accepted: 12/04/2017] [Indexed: 11/07/2022] Open
Abstract
The purpose of this study was to use non-invasive proton magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) to monitor changes in prefrontal white matter metabolite levels and tissue microstructure in female rugby players with and without concussion (ages 18-23, n = 64). Evaluations including clinical tests and 3 T MRI were performed at the beginning of a season (in-season) and followed up at the end of the season (off-season). Concussed athletes were additionally evaluated 24-72 hr (n = 14), three months (n = 11), and six months (n = 8) post-concussion. Reduced glutamine at 24-72 hr and three months post-concussion, and reduced glutamine/creatine at three months post-concussion were observed. In non-concussed athletes (n = 46) both glutamine and glutamine/creatine were lower in the off-season compared to in-season. Within the MRS voxel, an increase in fractional anisotropy (FA) and decrease in radial diffusivity (RD) were also observed in the non-concussed athletes, and correlated with changes in glutamine and glutamine/creatine. Decreases in glutamine and glutamine/creatine suggest reduced oxidative metabolism. Changes in FA and RD may indicate neuroinflammation or re-myelination. The observed changes did not correlate with clinical test scores suggesting these imaging metrics may be more sensitive to brain injury and could aid in assessing recovery of brain injury from concussion.
Collapse
Affiliation(s)
- Amy L. Schranz
- Centre for Functional and Metabolic MappingRobarts Research Institute, The University of Western Ontario, 1151 Richmond Street NorthLondonOntarioN6A 5B7Canada
- Department of Medical BiophysicsThe University of Western Ontario, Schulich School of Medicine and Dentistry, 1151 Richmond Street North, Medical Sciences BuildingLondonOntarioN6A 5C1Canada
| | - Kathryn Y. Manning
- Centre for Functional and Metabolic MappingRobarts Research Institute, The University of Western Ontario, 1151 Richmond Street NorthLondonOntarioN6A 5B7Canada
- Department of Medical BiophysicsThe University of Western Ontario, Schulich School of Medicine and Dentistry, 1151 Richmond Street North, Medical Sciences BuildingLondonOntarioN6A 5C1Canada
| | - Gregory A. Dekaban
- Molecular Medicine Research Laboratories, Robarts Research Institute, The University of Western Ontario, 1151 Richmond Street NorthLondonOntarioN6A 5B7Canada
- Department of Microbiology and ImmunologyThe University of Western Ontario, Schulich School of Medicine and Dentistry, 1151 Richmond Street North, Dental Sciences BuildingLondonOntarioN6A 3K7Canada
| | - Lisa Fischer
- Department of Family Medicine and Fowler Kennedy Sport Medicine ClinicThe University of Western Ontario, 3M Centre, 1151 Richmond Street NorthLondonOntarioN6A 3K7Canada
| | - Tatiana Jevremovic
- Department of Family Medicine and Fowler Kennedy Sport Medicine ClinicThe University of Western Ontario, 3M Centre, 1151 Richmond Street NorthLondonOntarioN6A 3K7Canada
| | - Kevin Blackney
- Molecular Medicine Research Laboratories, Robarts Research Institute, The University of Western Ontario, 1151 Richmond Street NorthLondonOntarioN6A 5B7Canada
- Department of Microbiology and ImmunologyThe University of Western Ontario, Schulich School of Medicine and Dentistry, 1151 Richmond Street North, Dental Sciences BuildingLondonOntarioN6A 3K7Canada
| | - Christy Barreira
- Molecular Medicine Research Laboratories, Robarts Research Institute, The University of Western Ontario, 1151 Richmond Street NorthLondonOntarioN6A 5B7Canada
| | - Timothy J. Doherty
- Department of Physical Medicine and RehabilitationThe University of Western Ontario, Schulich School of Medicine and Dentistry, Parkwood Institute, 550 Wellington Road, Hobbins BuildingLondonOntarioN6C 0A7Canada
| | - Douglas D. Fraser
- Paediatrics Critical Care Medicine, London Health Sciences Centre, Children's Hospital, 800 Commissioners Road EastLondonOntarioN6A 5W9Canada
| | - Arthur Brown
- Molecular Medicine Research Laboratories, Robarts Research Institute, The University of Western Ontario, 1151 Richmond Street NorthLondonOntarioN6A 5B7Canada
- Department of Anatomy and Cell BiologyThe University of Western Ontario, 1151 Richmond Street North, Medical Sciences BuildingLondonOntarioN6A 3K7Canada
| | - Jeff Holmes
- School of Occupational TherapyThe University of Western Ontario, 1201 Western Road, Elborn CollegeLondonOntarioN6A 1H1Canada
| | - Ravi S. Menon
- Centre for Functional and Metabolic MappingRobarts Research Institute, The University of Western Ontario, 1151 Richmond Street NorthLondonOntarioN6A 5B7Canada
- Department of Medical BiophysicsThe University of Western Ontario, Schulich School of Medicine and Dentistry, 1151 Richmond Street North, Medical Sciences BuildingLondonOntarioN6A 5C1Canada
| | - Robert Bartha
- Centre for Functional and Metabolic MappingRobarts Research Institute, The University of Western Ontario, 1151 Richmond Street NorthLondonOntarioN6A 5B7Canada
- Department of Medical BiophysicsThe University of Western Ontario, Schulich School of Medicine and Dentistry, 1151 Richmond Street North, Medical Sciences BuildingLondonOntarioN6A 5C1Canada
| |
Collapse
|
17
|
Magnetic resonance spectroscopy abnormalities in traumatic brain injury: A meta-analysis. J Neuroradiol 2018; 45:123-129. [DOI: 10.1016/j.neurad.2017.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/28/2017] [Accepted: 09/05/2017] [Indexed: 11/22/2022]
|
18
|
Lefebvre G, Chamard E, Proulx S, Tremblay S, Halko M, Soman S, de Guise E, Pascual-Leone A, Théoret H. Increased Myo-Inositol in Primary Motor Cortex of Contact Sports Athletes without a History of Concussion. J Neurotrauma 2018; 35:953-962. [PMID: 29279021 DOI: 10.1089/neu.2017.5254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The objective of the study was to determine whether repetitive hits to the head at a subclinical level are associated with structural and functional brain abnormalities and whether these effects are influenced by high levels of fitness associated with intense physical activity. Seventy-two college students were recruited: 24 nonathletic, 24 athletes practicing a varsity contact sport, and 24 athletes practicing a varsity noncontact sport. They were recruited for a neuropsychological evaluation and a magnetic resonance imaging session that included magnetic resonance spectroscopy of primary motor cortex (M1) and prefrontal cortex and susceptibility-weighted imaging. There was no evidence for reduced cognitive performance or presence of micro bleeds in contact sports athletes. Abnormalities in contact sports athletes were found for myo-inositol concentration (mIns) in M1, where levels were significantly higher compared with noncontact sports athletes (p = 0.016) and nonathletes (p = 0.029). In prefrontal cortex, glutamate + glutamine (Glx) was significantly reduced in contact sports athletes compared with noncontact sports athletes (p = 0.016), and a similar reduction was observed for gamma-aminobutyric acid (GABA) levels (p = 0.005). Varsity contact sports are associated with area-specific alterations in mIns concentration in the primary motor cortex. In the prefrontal cortex, high levels of fitness could modulate the effects of head impact exposure on prefrontal metabolite concentration. Indeed, although athletes in contact and noncontact sports show different neurometabolic profiles, they do not differ from sedentary controls.
Collapse
Affiliation(s)
- Geneviève Lefebvre
- Department of Psychology, University of Montreal, Montreal, Québec, Canada
| | - Emilie Chamard
- Department of Psychology, University of Montreal, Montreal, Québec, Canada
| | | | - Sara Tremblay
- Department of Psychology, University of Montreal, Montreal, Québec, Canada
| | - Mark Halko
- Division of Cognitive Neurology and Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Salil Soman
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Elaine de Guise
- Department of Psychology, University of Montreal, Montreal, Québec, Canada
| | - Alvaro Pascual-Leone
- Division of Cognitive Neurology and Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Institut de Neurorrehabilitacion Guttmann, Universitat Autonoma, Barcelona, Spain
| | - Hugo Théoret
- Department of Psychology, University of Montreal, Montreal, Québec, Canada
- Research Center, CHU Sainte-Justine, Montreal, Québec, Canada
| |
Collapse
|
19
|
Sollmann N, Echlin PS, Schultz V, Viher PV, Lyall AE, Tripodis Y, Kaufmann D, Hartl E, Kinzel P, Forwell LA, Johnson AM, Skopelja EN, Lepage C, Bouix S, Pasternak O, Lin AP, Shenton ME, Koerte IK. Sex differences in white matter alterations following repetitive subconcussive head impacts in collegiate ice hockey players. NEUROIMAGE-CLINICAL 2017; 17:642-649. [PMID: 29204342 PMCID: PMC5709295 DOI: 10.1016/j.nicl.2017.11.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/08/2017] [Accepted: 11/18/2017] [Indexed: 12/31/2022]
Abstract
Objective Repetitive subconcussive head impacts (RSHI) may lead to structural, functional, and metabolic alterations of the brain. While differences between males and females have already been suggested following a concussion, whether there are sex differences following exposure to RSHI remains unknown. The aim of this study was to identify and to characterize sex differences following exposure to RSHI. Methods Twenty-five collegiate ice hockey players (14 males and 11 females, 20.6 ± 2.0 years), all part of the Hockey Concussion Education Project (HCEP), underwent diffusion-weighted magnetic resonance imaging (dMRI) before and after the Canadian Interuniversity Sports (CIS) ice hockey season 2011-2012 and did not experience a concussion during the season. Whole-brain tract-based spatial statistics (TBSS) were used to compare pre- and postseason imaging in both sexes for fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Pre- and postseason neurocognitive performance were assessed by the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Results Significant differences between the sexes were primarily located within the superior longitudinal fasciculus (SLF), the internal capsule (IC), and the corona radiata (CR) of the right hemisphere (RH). In significant voxel clusters (p < 0.05), decreases in FA (absolute difference pre- vs. postseason: 0.0268) and increases in MD (0.0002), AD (0.00008), and RD (0.00005) were observed in females whereas males showed no significant changes. There was no significant correlation between the change in diffusion scalar measures over the course of the season and neurocognitive performance as evidenced from postseason ImPACT scores. Conclusions The results of this study suggest sex differences in structural alterations following exposure to RSHI. Future studies need to investigate further the underlying mechanisms and association with exposure and clinical outcomes.
Collapse
Key Words
- AD, axial diffusivity
- CIS, Canadian Interuniversity Sports
- CR, corona radiata
- Diffusion tensor imaging
- EC, external capsule
- FA, fractional anisotropy
- HCEP, Hockey Concussion Education Project
- IC, internal capsule
- Ice hockey
- ImPACT, Immediate Post-Concussion Assessment and Cognitive Test
- LH, left hemisphere
- MD, mean diffusivity
- MRI, magnetic resonance imaging
- NCAA, National Collegiate Athletic Association
- RD, radial diffusivity
- RH, right hemisphere
- RSHI, repetitive subconcussive head impacts
- Repetitive subconcussive head impacts
- SD, standard deviation
- SLF, superior longitudinal fasciculus
- Sex difference
- TBI, traumatic brain injury
- TBSS, tract-based spatial statistics
- Traumatic brain injury
- WM, white matter
- White matter
- dMRI, diffusion magnetic resonance imaging
- rs, Spearman's rank correlation coefficient
Collapse
Affiliation(s)
- Nico Sollmann
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Paul S Echlin
- Elliott Sports Medicine Clinic, Burlington, ON, Canada.
| | - Vivian Schultz
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Petra V Viher
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland.
| | - Amanda E Lyall
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.
| | - David Kaufmann
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany.
| | - Elisabeth Hartl
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Epilepsy Center, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Philipp Kinzel
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Lorie A Forwell
- 3M Centre, The University of Western Ontario, London, ON, Canada.
| | - Andrew M Johnson
- School of Health Studies, The University of Western Ontario, London, ON, Canada.
| | - Elaine N Skopelja
- Ruth Lilly Medical Library, Indiana University, Indianapolis, IN, USA.
| | - Christian Lepage
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; School of Psychology, University of Ottawa, Ottawa, ON, Canada.
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Brockton Division, Brockton, MA, USA.
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
20
|
Simmons MM, Swedler DI, Kerr ZY. Injury Surveillance of Head, Neck, and Facial Injuries in Collegiate Ice Hockey Players, 2009-2010 Through 2013-2014 Academic Years. J Athl Train 2017; 52:776-784. [PMID: 28662349 DOI: 10.4085/1062-6050-52.4.03] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Ice hockey is a high-speed, full-contact sport with a high risk of head/face/neck (HFN) injuries. However, men's and women's ice hockey differ; checking is allowed only among men. OBJECTIVES To describe the epidemiology of HFN injuries in collegiate men's and women's ice hockey during the 2009-2010 through 2013-2014 academic years. DESIGN Descriptive epidemiology study. SETTING Ice hockey data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program during the 2009-2010 through 2013-2014 academic years. PATIENTS OR OTHER PARTICIPANTS Fifty-seven men's and 26 women's collegiate ice hockey programs from all NCAA divisions provided 106 and 51 team-seasons of data, respectively. MAIN OUTCOME MEASURE(S) Injury rates per 1000 athlete-exposures and rate ratios with 95% confidence intervals (CIs). RESULTS The NCAA Injury Surveillance Program reported 496 and 131 HFN injuries in men's and women's ice hockey, respectively. The HFN injury rate was higher in men than in women (1.75 versus 1.16/1000 athlete-exposures; incidence rate ratio = 1.51; 95% CI = 1.25, 1.84). The proportion of HFN injuries from checking was higher in men than in women for competitions (38.5% versus 13.6%; injury proportion ratio = 2.82; 95% CI = 1.64, 4.85) and practices (21.9% versus 2.3%; injury proportion ratio = 9.41; 95% CI = 1.31, 67.69). The most common HFN injury diagnosis was concussion; most concussions occurred in men's competitions from player contact while checking (25.9%). Player contact during general play comprised the largest proportion of concussions in men's practices (25.9%), women's competitions (25.0%), and women's practices (24.0%). While 166 lacerations were reported in men, none were reported in women. In men, most lacerations occurred from player contact during checking in competitions (41.8%) and player contact during general play in practices (15.0%). CONCLUSIONS A larger proportion of HFN injuries in ice hockey occurred during checking in men versus women. Concussion was the most common HFN injury and was most often due to player contact. Lacerations were reported only among men and were mostly due to checking. Injury-prevention programs should aim to reduce checking-related injuries.
Collapse
Affiliation(s)
- Molly MacMhathan Simmons
- VA Center for Health Organization and Implementation Research, Bedford, MA, and Boston University School of Public Health, MA
| | - David I Swedler
- Pacific Institute for Research and Evaluation, Calverton, MD
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| |
Collapse
|
21
|
Kamins J, Bigler E, Covassin T, Henry L, Kemp S, Leddy JJ, Mayer A, McCrea M, Prins M, Schneider KJ, Valovich McLeod TC, Zemek R, Giza CC. What is the physiological time to recovery after concussion? A systematic review. Br J Sports Med 2017; 51:935-940. [DOI: 10.1136/bjsports-2016-097464] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 12/14/2022]
|
22
|
McCrea M, Meier T, Huber D, Ptito A, Bigler E, Debert CT, Manley G, Menon D, Chen JK, Wall R, Schneider KJ, McAllister T. Role of advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion: a systematic review. Br J Sports Med 2017; 51:919-929. [DOI: 10.1136/bjsports-2016-097447] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 01/17/2023]
|
23
|
Barlow KM, Marcil LD, Dewey D, Carlson HL, MacMaster FP, Brooks BL, Lebel RM. Cerebral Perfusion Changes in Post-Concussion Syndrome: A Prospective Controlled Cohort Study. J Neurotrauma 2017; 34:996-1004. [PMID: 27554429 PMCID: PMC5333570 DOI: 10.1089/neu.2016.4634] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The biology of post-concussive symptoms is unclear. Symptoms are often increased during activities, and have been linked to decreased cerebrovascular reactivity and perfusion. The aim of this study was to examine cerebral blood flow (CBF) in children with different clinical recovery patterns following mild traumatic brain injury (mTBI). This was a prospective controlled cohort study of children with mTBI (ages 8 to 18 years) who were symptomatic with post-concussive symptoms at one month post-injury (symptomatic, n = 27) and children who had recovered quickly (asymptomatic, n = 24). Pseudo continuous arterial spin labeling magnetic resonance imaging (MRI) was used to quantify CBF. The mTBI groups were imaged at 40 days post-injury. Global and regional CBF were compared with healthy controls of similar age and sex but without a history of mTBI (n = 21). Seventy-two participants (mean age: 14.1 years) underwent neuroimaging. Significant differences in CBF were found: global CBF was higher in the symptomatic group and lower in the asymptomatic group compared with controls, (F(2,69) 9.734; p < 0.001). Post-injury symptom score could be predicted by pre-injury symptoms and CBF in presence of mTBI (adjusted R2 = 0.424; p < 0.001). Altered patterns of cerebral perfusion are seen following mTBI and are associated with the recovery trajectory. Symptomatic children have higher CBF. Children who "recovered" quickly, have decreased CBF suggesting that clinical recovery precedes the cerebral recovery. Further longitudinal studies are required to determine if these perfusion patterns continue to change over time.
Collapse
Affiliation(s)
- Karen M. Barlow
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | | | - Deborah Dewey
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Helen L. Carlson
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Frank P. MacMaster
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Brian L. Brooks
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - R. Marc Lebel
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Biomedical Engineering, University of Calgary, Calgary, Alberta, Canada
- GE Healthcare, Calgary, Alberta, Canada
| |
Collapse
|
24
|
Wilke S, List J, Mekle R, Lindenberg R, Bukowski M, Ott S, Schubert F, Ittermann B, Flöel A. No Effect of Anodal Transcranial Direct Current Stimulation on Gamma-Aminobutyric Acid Levels in Patients with Recurrent Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:281-290. [DOI: 10.1089/neu.2016.4399] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Skadi Wilke
- Department of Neurology, Charité–University Hospital, Berlin, Germany
| | - Jonathan List
- Department of Neurology, Charité–University Hospital, Berlin, Germany
| | - Ralf Mekle
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig und Berlin, Berlin, Germany
| | - Robert Lindenberg
- Department of Neurology, Charité–University Hospital, Berlin, Germany
| | - Martin Bukowski
- Department of Neurology, Charité–University Hospital, Berlin, Germany
| | - Stefanie Ott
- Department of Neurology, Charité–University Hospital, Berlin, Germany
| | - Florian Schubert
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig und Berlin, Berlin, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig und Berlin, Berlin, Germany
| | - Agnes Flöel
- Department of Neurology, Charité–University Hospital, Berlin, Germany
- Center for Stroke Research Berlin, Charité–University Hospital, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité–University Hospital, Berlin, Germany
| |
Collapse
|
25
|
Advanced neuroimaging applied to veterans and service personnel with traumatic brain injury: state of the art and potential benefits. Brain Imaging Behav 2016; 9:367-402. [PMID: 26350144 DOI: 10.1007/s11682-015-9444-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Traumatic brain injury (TBI) remains one of the most prevalent forms of morbidity among Veterans and Service Members, particularly for those engaged in the conflicts in Iraq and Afghanistan. Neuroimaging has been considered a potentially useful diagnostic and prognostic tool across the spectrum of TBI generally, but may have particular importance in military populations where the diagnosis of mild TBI is particularly challenging, given the frequent lack of documentation on the nature of the injuries and mixed etiologies, and highly comorbid with other disorders such as post-traumatic stress disorder, depression, and substance misuse. Imaging has also been employed in attempts to understand better the potential late effects of trauma and to evaluate the effects of promising therapeutic interventions. This review surveys the use of structural and functional neuroimaging techniques utilized in military studies published to date, including the utilization of quantitative fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), volumetric analysis, diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), positron emission tomography (PET), magnetoencephalography (MEG), task-based and resting state functional MRI (fMRI), arterial spin labeling (ASL), and magnetic resonance spectroscopy (MRS). The importance of quality assurance testing in current and future research is also highlighted. Current challenges and limitations of each technique are outlined, and future directions are discussed.
Collapse
|
26
|
Williams VB, Danan IJ. A Historical Perspective on Sports Concussion: Where We Have Been and Where We Are Going. Curr Pain Headache Rep 2016; 20:43. [DOI: 10.1007/s11916-016-0569-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
27
|
Fernandes FAO, de Sousa RJA. Head injury predictors in sports trauma--a state-of-the-art review. Proc Inst Mech Eng H 2016; 229:592-608. [PMID: 26238791 DOI: 10.1177/0954411915592906] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Head injuries occur in a great variety of sports. Many of these have been associated with neurological injuries, affecting the central nervous system. Some examples are motorsports, cycling, skiing, horse riding, mountaineering and most contact sports such as football, ice and field hockey, soccer, lacrosse, etc. The outcome of head impacts in these sports can be very severe. The worst-case scenarios of permanent disability or even death are possibilities. Over recent decades, many In recent decades, a great number of head injury criteria and respective thresholds have been proposed. However, the available information is much dispersed and a consensus has still not been achieved regarding the best injury criteria or even their thresholds. This review paper gives a thorough overview of the work carried out by the scientific community in the field of impact biomechanics about head injuries sustained during sports activity. The main goal is to review the head injury criteria, as well as their thresholds. Several are reviewed, from the predictors based on kinematics to the ones based on human tissue thresholds. In this work, we start to briefly introduce the head injuries and their mechanisms commonly seen as a result of head trauma in sports. Then, we present and summarize the head injury criteria and their respective thresholds.
Collapse
Affiliation(s)
- Fábio A O Fernandes
- Centre for Mechanical Technology and Automation, Department of Mechanical Engineering, University of Aveiro, Portugal
| | - Ricardo J Alves de Sousa
- Centre for Mechanical Technology and Automation, Department of Mechanical Engineering, University of Aveiro, Portugal
| |
Collapse
|
28
|
Tsushima WT, Geling O, Arnold M, Oshiro R. Are There Subconcussive Neuropsychological Effects in Youth Sports? An Exploratory Study of High- and Low-Contact Sports. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 5:149-55. [PMID: 26979930 DOI: 10.1080/21622965.2015.1052813] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This exploratory study was designed to examine the neuropsychological effects of sports-related head trauma-specifically, repetitive subconcussive impacts or head blows that do not result in a diagnosable concussion. The researchers compared the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test scores of 2 groups of nonconcussed youth athletes (n = 282), grouped according to the frequency of concussions in their respective sports, with the assumption that more subconcussive impacts occur in sports in which there are more reported concussions. The results indicated that high-contact-sport (football) athletes had significantly poorer performance in processing speed and reaction time compared with athletes in low-contact sports (wrestling, soccer, baseball, judo, and basketball). This study into the effects of repetitive subconcussive head trauma tentatively raises concern that participation in high-contact sports, even without evidence of a diagnosable concussion, could result in lowered neuropsychological functioning among high school athletes. Limitations of this exploratory research effort are discussed.
Collapse
|
29
|
Abstract
Postconcussion syndrome is a symptom complex with a wide range of somatic, cognitive, sleep, and affective features, and is the most common consequence of traumatic brain injury. Between 14% and 29% of children with mild traumatic brain injury will continue to have postconcussion symptoms at 3 months, but the pathophysiological mechanisms driving this is poorly understood. The relative contribution of injury factors to postconcussion syndrome decreases over time and, instead, premorbid factors become important predictors of symptom persistence by 3 to 6 months postinjury. The differential diagnoses include headache disorder, cervical injury, anxiety, depression, somatization, vestibular dysfunction, and visual dysfunction. The long-term outcome for most children is good, although there is significant morbidity in the short term. Management strategies target problematic symptoms such as headaches, sleep and mood disturbances, and cognitive complaints.
Collapse
Affiliation(s)
- Karen M Barlow
- Department of Pediatrics and Clinical Neurosciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
30
|
Ventura RE, Balcer LJ, Galetta SL, Rucker JC. Ocular motor assessment in concussion: Current status and future directions. J Neurol Sci 2015; 361:79-86. [PMID: 26810521 DOI: 10.1016/j.jns.2015.12.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/25/2015] [Accepted: 12/07/2015] [Indexed: 11/27/2022]
Abstract
Mild head injury such as concussions and subconcussive repetitive impact may lead to subtle changes in brain function and it is imperative to find sensitive and reliable tests to detect such changes. Tests involving the visual system, in particular eye movements, can incorporate higher cortical functioning and involve diffuse pathways in the brain, including many areas susceptible to head impact. With concussions, the clinical neuro-ophthalmic exam is important for detecting abnormalities in vergence, saccades, pursuit, and visual fixation. On the sidelines, the King-Devick test has been used as a visual performance measure that incorporates eye movements and increases the sensitivity in detecting possible concussions in conjunction with standard sideline tests of cognition, symptom checklists, and balance. Much promise lies in the eye movement laboratory to quantitate changes in saccades and pursuit with concussions using video-oculography. A combination of eye movement tasks coupled with neuroimaging techniques and other objective biomarkers may lead to a better understanding of the anatomical and physiological consequences of concussion and to better understand the natural history of this condition.
Collapse
Affiliation(s)
- Rachel E Ventura
- New York University School of Medicine, Department of Neurology, United States.
| | - Laura J Balcer
- New York University School of Medicine, Department of Neurology, United States; New York University School of Medicine, Department of Population Health, United States; New York University School of Medicine, Department of Ophthalmology, United States
| | - Steven L Galetta
- New York University School of Medicine, Department of Neurology, United States; New York University School of Medicine, Department of Ophthalmology, United States
| | - Janet C Rucker
- New York University School of Medicine, Department of Neurology, United States
| |
Collapse
|
31
|
Kroshus E, Kubzansky LD, Goldman RE, Austin SB. Norms, athletic identity, and concussion symptom under-reporting among male collegiate ice hockey players: a prospective cohort study. Ann Behav Med 2015; 49:95-103. [PMID: 25236670 DOI: 10.1007/s12160-014-9636-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many athletes fail to report concussion symptoms to coaches or medical personnel, putting them at risk for potentially catastrophic neurologic consequences if additional brain trauma is sustained prior to full recovery. PURPOSE The purpose of this study was to determine whether concussion reporting norms prior to the start of the athletic season predicted reporting symptoms of a possible concussion during the season, and whether this association was moderated by athletic identity. METHODS Members of six National Collegiate Athletic Association Division 1 men's ice hockey teams (n = 116) completed written surveys before and after the 2012-2013 collegiate ice hockey season. RESULTS Participants who at pre-season perceived that "most athletes" were likely to report symptoms of a concussion were themselves more likely to report symptoms during the season. Athletic identity weakly moderated this association. CONCLUSIONS Perceived reporting norms may be an important target of interventions aimed at reducing symptom under-reporting among athletes.
Collapse
Affiliation(s)
- Emily Kroshus
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA,
| | | | | | | |
Collapse
|
32
|
Rowson B, Rowson S, Duma SM. Hockey STAR: A Methodology for Assessing the Biomechanical Performance of Hockey Helmets. Ann Biomed Eng 2015; 43:2429-43. [PMID: 25822907 PMCID: PMC4569651 DOI: 10.1007/s10439-015-1278-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
Optimizing the protective capabilities of helmets is one of several methods of reducing brain injury risk in sports. This paper presents the experimental and analytical development of a hockey helmet evaluation methodology. The Summation of Tests for the Analysis of Risk (STAR) formula combines head impact exposure with brain injury probability over the broad range of 227 head impacts that a hockey player is likely to experience during one season. These impact exposure data are mapped to laboratory testing parameters using a series of 12 impact conditions comprised of three energy levels and four head impact locations, which include centric and non-centric directions of force. Injury risk is determined using a multivariate injury risk function that incorporates both linear and rotational head acceleration measurements. All testing parameters are presented along with exemplar helmet test data. The Hockey STAR methodology provides a scientific framework for manufacturers to optimize hockey helmet design for injury risk reduction, as well as providing consumers with a meaningful metric to assess the relative performance of hockey helmets.
Collapse
Affiliation(s)
- Bethany Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA.
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| | - Stefan M Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| |
Collapse
|
33
|
Koerte IK, Lin AP, Muehlmann M, Merugumala S, Liao H, Starr T, Kaufmann D, Mayinger M, Steffinger D, Fisch B, Karch S, Heinen F, Ertl-Wagner B, Reiser M, Stern RA, Zafonte R, Shenton ME. Altered Neurochemistry in Former Professional Soccer Players without a History of Concussion. J Neurotrauma 2015; 32:1287-93. [PMID: 25843317 DOI: 10.1089/neu.2014.3715] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Soccer is played by more than 250 million people worldwide. Repeatedly heading the ball may place soccer players at high risk for repetitive subconcussive head impacts (RSHI). This study evaluates the long-term effects of RSHI on neurochemistry in athletes without a history of clinically diagnosed concussion, but with a high exposure to RSHI. Eleven former professional soccer players (mean age 52.0±6.8 years) and a comparison cohort of 14 age- and gender-matched, former non-contact sport athletes (mean age 46.9±7.9 years) underwent 3T magnetic resonance spectroscopy (MRS) and neurocognitive evaluation. In the soccer players a significant increase was observed in both choline (Cho), a membrane marker, and myo-inositol (ml), a marker of glial activation, compared with control athletes. Additionally, ml and glutathione (GSH) were significantly correlated with lifetime estimate of RSHI within the soccer group. There was no significant difference in neurocognitive tests between groups. Results of this study suggest an association between RSHI in soccer players and MRS markers of neuroinflammation, suggesting that even subconcussive head impacts affect the neurochemistry of the brain and may precede neurocognitive changes. Future studies will need to determine the role of neuroinflammation in RSHI and the effect on neurocognitive function.
Collapse
Affiliation(s)
- Inga K Koerte
- 1 Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts.,2 Institute for Clinical Radiology, Ludwig-Maximilian-University , Munich, Germany .,3 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Alexander P Lin
- 1 Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts.,4 Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts
| | - Marc Muehlmann
- 1 Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts.,2 Institute for Clinical Radiology, Ludwig-Maximilian-University , Munich, Germany .,3 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Sai Merugumala
- 4 Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts
| | - Huijun Liao
- 4 Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts
| | - Tyler Starr
- 4 Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts
| | - David Kaufmann
- 2 Institute for Clinical Radiology, Ludwig-Maximilian-University , Munich, Germany .,5 Department of Radiology, Charité Berlin , Berlin, Germany
| | - Michael Mayinger
- 1 Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts.,2 Institute for Clinical Radiology, Ludwig-Maximilian-University , Munich, Germany
| | - Denise Steffinger
- 2 Institute for Clinical Radiology, Ludwig-Maximilian-University , Munich, Germany
| | - Barbara Fisch
- 2 Institute for Clinical Radiology, Ludwig-Maximilian-University , Munich, Germany
| | - Susanne Karch
- 6 Department of Psychiatry, Ludwig-Maximilian-University , Munich, Germany
| | - Florian Heinen
- 7 Department of Pediatric Neurology, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-University , Munich, Germany
| | - Birgit Ertl-Wagner
- 2 Institute for Clinical Radiology, Ludwig-Maximilian-University , Munich, Germany
| | - Maximilian Reiser
- 2 Institute for Clinical Radiology, Ludwig-Maximilian-University , Munich, Germany
| | - Robert A Stern
- 8 Departments of Neurology, Neurosurgery, and Anatomy and Neurobiology, Boston University Alzheimer's Disease Center, Boston University School of Medicine , Boston, Massachusetts
| | - Ross Zafonte
- 9 Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts
| | - Martha E Shenton
- 1 Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts.,4 Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts.,10 Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School , Boston, Massachusetts.,11 VA Boston Healthcare System , Boston, Massachusetts
| |
Collapse
|
34
|
Koerte IK, Lin AP, Willems A, Muehlmann M, Hufschmidt J, Coleman MJ, Green I, Liao H, Tate DF, Wilde EA, Pasternak O, Bouix S, Rathi Y, Bigler ED, Stern RA, Shenton ME. A review of neuroimaging findings in repetitive brain trauma. Brain Pathol 2015; 25:318-49. [PMID: 25904047 PMCID: PMC5699448 DOI: 10.1111/bpa.12249] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/05/2015] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease confirmed at postmortem. Those at highest risk are professional athletes who participate in contact sports and military personnel who are exposed to repetitive blast events. All neuropathologically confirmed CTE cases, to date, have had a history of repetitive head impacts. This suggests that repetitive head impacts may be necessary for the initiation of the pathogenetic cascade that, in some cases, leads to CTE. Importantly, while all CTE appears to result from repetitive brain trauma, not all repetitive brain trauma results in CTE. Magnetic resonance imaging has great potential for understanding better the underlying mechanisms of repetitive brain trauma. In this review, we provide an overview of advanced imaging techniques currently used to investigate brain anomalies. We also provide an overview of neuroimaging findings in those exposed to repetitive head impacts in the acute/subacute and chronic phase of injury and in more neurodegenerative phases of injury, as well as in military personnel exposed to repetitive head impacts. Finally, we discuss future directions for research that will likely lead to a better understanding of the underlying mechanisms separating those who recover from repetitive brain trauma vs. those who go on to develop CTE.
Collapse
Affiliation(s)
- Inga K. Koerte
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Child and Adolescent PsychiatryPsychosomatic and PsychotherapyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Alexander P. Lin
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Center for Clinical SpectroscopyDepartment of RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Anna Willems
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Child and Adolescent PsychiatryPsychosomatic and PsychotherapyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Marc Muehlmann
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Child and Adolescent PsychiatryPsychosomatic and PsychotherapyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Jakob Hufschmidt
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Pediatric NeurologyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Michael J. Coleman
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Isobel Green
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Huijun Liao
- Center for Clinical SpectroscopyDepartment of RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - David F. Tate
- General Dynamic Information Technologies ContractorDefense and Veterans Brain Injury CentersSan Antonio Military Medical CenterSan AntonioTX
| | - Elisabeth A. Wilde
- Departments of Physical Medicine and RehabilitationNeurology and RadiologyBaylor College of MedicineSan AntonioTX
- Michael E. DeBakey VA Medical CenterSan AntonioTX
| | - Ofer Pasternak
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Sylvain Bouix
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Yogesh Rathi
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Erin D. Bigler
- Neuroscience Center and Department of PsychologyBrigham Young UniversityProvoUT
| | - Robert A. Stern
- Departments of Neurology, Neurosurgery, and Anatomy and Neurobiology, Boston University Alzheimer's Disease CenterBoston University School of MedicineBostonMA
| | - Martha E. Shenton
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- VA Boston Healthcare SystemBostonMA
| |
Collapse
|
35
|
Rowson B, Rowson S, Duma SM. Hockey STAR: A Methodology for Assessing the Biomechanical Performance of Hockey Helmets. Ann Biomed Eng 2015. [PMID: 25822907 DOI: 10.1007/s10439-015-1278-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Optimizing the protective capabilities of helmets is one of several methods of reducing brain injury risk in sports. This paper presents the experimental and analytical development of a hockey helmet evaluation methodology. The Summation of Tests for the Analysis of Risk (STAR) formula combines head impact exposure with brain injury probability over the broad range of 227 head impacts that a hockey player is likely to experience during one season. These impact exposure data are mapped to laboratory testing parameters using a series of 12 impact conditions comprised of three energy levels and four head impact locations, which include centric and non-centric directions of force. Injury risk is determined using a multivariate injury risk function that incorporates both linear and rotational head acceleration measurements. All testing parameters are presented along with exemplar helmet test data. The Hockey STAR methodology provides a scientific framework for manufacturers to optimize hockey helmet design for injury risk reduction, as well as providing consumers with a meaningful metric to assess the relative performance of hockey helmets.
Collapse
Affiliation(s)
- Bethany Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA.
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| | - Stefan M Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| |
Collapse
|
36
|
Tremblay S, Beaulé V, Proulx S, Tremblay S, Marjańska M, Doyon J, Lassonde M, Théoret H. Multimodal assessment of primary motor cortex integrity following sport concussion in asymptomatic athletes. Clin Neurophysiol 2014; 125:1371-9. [PMID: 24462505 PMCID: PMC4381958 DOI: 10.1016/j.clinph.2013.11.040] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/22/2013] [Accepted: 11/13/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Recent studies have shown, in asymptomatic concussed athletes, metabolic disruption in the primary motor cortex (M1) and abnormal intracortical inhibition lasting for more than six months. The present study aims to assess if these neurochemical and neurophysiological alterations are persistent and linked to M1 cortical thickness. METHODS Sixteen active football players who sustained their last concussion, on average, three years prior to testing and 14 active football players who never sustained a concussion were recruited for a single session of proton magnetic resonance spectroscopy ((1)H-MRS) and transcranial magnetic stimulation (TMS). Measures of M1 and whole brain cortical thickness were acquired, and (1)H-MRS data were acquired from left M1 using a MEGA-PRESS sequence. Cortical silent period (CSP) and long-interval intracortical inhibition (LICI) were measured with TMS applied over left M1. RESULTS No significant group differences were observed for metabolic concentrations, TMS measures, and cortical thickness. However, whereas GABA and glutamate levels were positively correlated in control athletes, this relationship was absent in concussed athletes. CONCLUSION These data suggest the general absence of neurophysiologic, neurometabolic and neuroanatomical disruptions in M1 three years following the last concussive event. However, correlational analyses suggest the presence of a slight metabolic imbalance between GABA and glutamate concentrations in the primary motor cortex of concussed athletes. SIGNIFICANCE The present study highlights the importance of multimodal assesments of the impacts of sport concussions.
Collapse
Affiliation(s)
- Sara Tremblay
- Centre de recherche en neuropsychologie et cognition, Université de Montréal, Canada; Centre de recherche du Centre Hospitalier Universitaire de l'Hôpital Sainte-Justine, Canada
| | - Vincent Beaulé
- Centre de recherche en neuropsychologie et cognition, Université de Montréal, Canada; Centre de recherche du Centre Hospitalier Universitaire de l'Hôpital Sainte-Justine, Canada
| | - Sébastien Proulx
- Unité de Neuroimagerie Fonctionnelle, Centre de recherche de l'institut universitaire de gériatrie de Montréal, Canada; Montreal Neurological Institute, McGill University, Canada
| | - Sébastien Tremblay
- Unité de Neuroimagerie Fonctionnelle, Centre de recherche de l'institut universitaire de gériatrie de Montréal, Canada
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, United States
| | - Julien Doyon
- Unité de Neuroimagerie Fonctionnelle, Centre de recherche de l'institut universitaire de gériatrie de Montréal, Canada
| | - Maryse Lassonde
- Centre de recherche en neuropsychologie et cognition, Université de Montréal, Canada; Centre de recherche du Centre Hospitalier Universitaire de l'Hôpital Sainte-Justine, Canada
| | - Hugo Théoret
- Centre de recherche en neuropsychologie et cognition, Université de Montréal, Canada; Centre de recherche du Centre Hospitalier Universitaire de l'Hôpital Sainte-Justine, Canada.
| |
Collapse
|
37
|
Ng TS, Lin AP, Koerte IK, Pasternak O, Liao H, Merugumala S, Bouix S, Shenton ME. Neuroimaging in repetitive brain trauma. ALZHEIMERS RESEARCH & THERAPY 2014; 6:10. [PMID: 25031630 PMCID: PMC3978843 DOI: 10.1186/alzrt239] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sports-related concussions are one of the major causes of mild traumatic brain injury. Although most patients recover completely within days to weeks, those who experience repetitive brain trauma (RBT) may be at risk for developing a condition known as chronic traumatic encephalopathy (CTE). While this condition is most commonly observed in athletes who experience repetitive concussive and/or subconcussive blows to the head, such as boxers, football players, or hockey players, CTE may also affect soldiers on active duty. Currently, the only means by which to diagnose CTE is by the presence of phosphorylated tau aggregations post-mortem. Non-invasive neuroimaging, however, may allow early diagnosis as well as improve our understanding of the underlying pathophysiology of RBT. The purpose of this article is to review advanced neuroimaging methods used to investigate RBT, including diffusion tensor imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, susceptibility weighted imaging, and positron emission tomography. While there is a considerable literature using these methods in brain injury in general, the focus of this review is on RBT and those subject populations currently known to be susceptible to RBT, namely athletes and soldiers. Further, while direct detection of CTE in vivo has not yet been achieved, all of the methods described in this review provide insight into RBT and will likely lead to a better characterization (diagnosis), in vivo, of CTE than measures of self-report.
Collapse
Affiliation(s)
- Thomas Sc Ng
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Circle, Boston, MA 02115, USA ; Keck School of Medicine of the University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Circle, Boston, MA 02115, USA ; Psychiatric Neuroimaging Laboratory, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA
| | - Inga K Koerte
- Psychiatric Neuroimaging Laboratory, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA ; Institute for Clinical Radiology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377 Munich, Germany
| | - Ofer Pasternak
- Psychiatric Neuroimaging Laboratory, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA
| | - Huijun Liao
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Circle, Boston, MA 02115, USA
| | - Sai Merugumala
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan Circle, Boston, MA 02115, USA
| | - Sylvain Bouix
- Psychiatric Neuroimaging Laboratory, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA
| | - Martha E Shenton
- Psychiatric Neuroimaging Laboratory, Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA 02215, USA ; Research and Development, VA Boston Healthcare System, 850 Belmont Street, Brockton, MA 02130, USA
| |
Collapse
|
38
|
Chamard E, Henry L, Boulanger Y, Lassonde M, Théoret H. A follow-up study of neurometabolic alterations in female concussed athletes. J Neurotrauma 2013; 31:339-45. [PMID: 24053210 DOI: 10.1089/neu.2013.3083] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Athletes who sustain a concussion demonstrate a variety of symptoms and neuropsychological alterations that could be brought on by neurometabolic abnormalities. However, no study has yet investigated these aspects in female athletes using magnetic resonance spectroscopy. The present study investigated the neurometabolic and -psychological effects of a concussion in the acute (7-10 days postinjury) and chronic (6 months postinjury) phases after injury. Eleven female concussed athletes and 10 female control athletes were scanned at both time points in a 3T magnetic resonance imaging scanner. Neuropsychological and symptomatic evaluations were completed at each time point. Neuropsychological alterations and a higher severity of symptoms were found in the acute phase in concussed athletes, relative to controls, but showed recovery in the chronic phase. Concussed athletes showed neurometabolic impairment in prefrontal and motor cortices characterized by a pathological increase of glutamine/glutamate and creatine (Cr) only in the chronic phase. Also, a significant decrease in N-acetyl-aspartate/Cr ratio was observed in control athletes at the second time point. Concussed female athletes showed acute cognitive alterations and higher severity of symptoms that do not appear to be underlied by neurometabolic abnormalities, which are only present in the chronic postinjury phase.
Collapse
Affiliation(s)
- Emilie Chamard
- 1 Department of Psychology, University of Montreal , Montreal, Quebec, Canada
| | | | | | | | | |
Collapse
|
39
|
Wilcox BJ, Beckwith JG, Greenwald RM, Chu JJ, McAllister TW, Flashman LA, Maerlender AC, Duhaime AC, Crisco JJ. Head impact exposure in male and female collegiate ice hockey players. J Biomech 2013; 47:109-14. [PMID: 24210478 DOI: 10.1016/j.jbiomech.2013.10.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/30/2013] [Accepted: 10/05/2013] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to quantify head impact exposure (frequency, location and magnitude of head impacts) for individual male and female collegiate ice hockey players and to investigate differences in exposure by sex, player position, session type, and team. Ninety-nine (41 male, 58 female) players were enrolled and 37,411 impacts were recorded over three seasons. Frequency of impacts varied significantly by sex (males: 287 per season, females: 170, p<0.001) and helmet impact location (p<0.001), but not by player position (p=0.088). Head impact frequency also varied by session type; both male and female players sustained more impacts in games than in practices (p<0.001), however the magnitude of impacts did not differ between session types. There was no difference in 95th percentile peak linear acceleration between sexes (males: 41.6 g, females: 40.8 g), but 95th percentile peak rotational acceleration and HITsp (a composite severity measure) were greater for males than females (4424, 3409 rad/s(2), and 25.6, 22.3, respectively). Impacts to the back of the helmet resulted in the greatest 95th percentile peak linear accelerations for males (45.2 g) and females (50.4 g), while impacts to the side and back of the head were associated with the greatest 95th percentile peak rotational accelerations (males: 4719, 4256 rad/sec(2), females: 3567, 3784 rad/sec(2) respectively). It has been proposed that reducing an individual's head impact exposure is a practical approach for reducing the risk of brain injuries. Strategies to decrease an individual athlete's exposure need to be sport and gender specific, with considerations for team and session type.
Collapse
Affiliation(s)
- Bethany J Wilcox
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903 USA.
| | | | - Richard M Greenwald
- Simbex, Lebanon, NH, USA; Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | | | | | - Laura A Flashman
- Department of Psychiatry, Dartmouth Medical School, Lebanon, NH, USA
| | - Arthur C Maerlender
- Pediatric Neuropsychological Services, Dartmouth Medical School, Lebanon, NH, USA
| | - Ann-Christine Duhaime
- Pediatric Neurosurgery, Children's Hospital at Dartmouth, Dartmouth Hitchcock Medical Center, Hanover, NH, USA
| | - Joseph J Crisco
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903 USA
| |
Collapse
|