Million-dollar grants given to long-term TBI studies (10/10/19 newsletter)

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We are pleased to have Carleton College students and alumni interning with Concussion Alliance. Intern contributors this week:

Editor: Galen Moller
Contributors: Galen Moller, Warren Situ, Julian Szieff, and Katie Taylor.


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Education

Case Western Reserve University teams up with the CDC to improve return-to-school programs

There are many challenges that students must face when returning to school after a traumatic brain injury. While some programs exist to support students after their injury, many states do not offer them, and those that do have not collected much data on program outcomes or effectiveness. To address this issue, the Centers for Disease Control (CDC) have given Case Western Reserve University a four-year, $2.2 million grant to study the qualities of a good return-to-school program, The Daily reports.

They will compare data from 308 students with TBI in Ohio who are not participating in a formal program, with data from 450 Pennsylvania students participating in BrainSTEPS, a return-to-school program recognized by the CDC as a national model for educational support and resources following an acquired brain injury. The research could improve return-to-school programs by elucidating how these programs help students. The CDC also hopes to use the research to provide national guidance to states that lack formal programs.

Sports

Former UC Berkeley cheerleader files a lawsuit calling for better safety measures for cheerleaders

Melissa Martin, a former cheerleader at the University of California at Berkeley, has filed a lawsuit against the school, her coaches, and USA Cheer, for negligent treatment after suffering a concussion. East Bay Times reports that Martin was kicked in the head during practice in October of 2017, and despite suffering from concussion-like symptoms, she was still expected to participate in sporting events with the team.

After a leave of absence in September 2018, Martin has now returned to school to complete her last semester. But after her initial injury and the re-injuries that occurred in the months that followed, Martin was left with lasting symptoms, including nausea and confusion, and has been diagnosed with post-concussion syndrome. She says she is already behind in classwork due to difficulties concentrating. She hopes that this lawsuit will push the school to enact more effective post-concussion treatment plans for all athletes, including cheerleaders.

Cannabis

Blackmarket THC vapes contain a fungicide that turns to cyanide when burned

We covered the illnesses and deaths due to vaping THC in last week’s newsletter; this week, NBC News published the results of a lab analysis of marijuana vapes. NBC hired the cannabis testing company CannaSafe, which did a lab analysis of 18 THC cartridges. The three cartridges that were purchased in legal marijuana stores in California did not have pesticides, heavy metal, Vitamin E, or other solvents.

However, all 15 of the THC vape cartridges purchase from illegal vendors on the street contained myclobutanil, “a fungicide that can transform into hydrogen cyanide when burned.” In addition, 13 of the 15 illegal cartridges contained Vitamin E, one of the substances suspected to cause the sometimes fatal lung disease. According to The New York Times, as of October 8, there have been 24 vaping-related deaths and 1,080 illnesses.

Diagnostics

Eye-tracking could be an objective test for TBI

A report published in the journal Concussion details the efforts of a group of researchers from RightEye, an eye-tracking test, to see if their software could work as an objective screening tool for TBI. Melissa Hunfalvay et al. explain that rapid eye movements between two fixed points, known as saccades, activate different areas of the brain, and past studies indicate that damage to these areas can make saccades more challenging. The researchers wanted to see if they could differentiate between people with TBI and people without TBI based solely on measurements from saccade tasks.

They recruited 144 participants who had sustained a TBI within 30 days before testing, and matched them by age and gender to a non-TBI control group. Participants completed 10 seconds of saccades in the horizontal plane and 10 seconds of saccades in the vertical plane. Regardless of injury severity, patients with TBI completed the tasks with significantly less speed and accuracy than the control group. These results suggest that saccades could be used to determine objectively if someone has a TBI.

The authors note that their sample size was relatively small, and acknowledge that there is a conflict of interest since three of the researchers work for an eye-tracking company. Still, they feel their results are promising and merit further investigation.

Therapies

The gut-brain connection: probiotics as a potential therapy for TBI

An article published in Frontiers in Neurology explores the possibility of using pre/probiotics and microbiota transplants as a therapy for the effects of TBIs. Authors Matthew W. Rice et al. discuss the “Microbiota-Gut-Brain-Axis” in detail, as well as research with animals that shows a relationship between gut problems and brain recovery. For example, research with mice has found that the probiotic Clostridium butyricum, which causes the gut to produce butyric acid, could reduce brain edema, neurodegeneration, and impairment of the blood-brain barrier. Additionally, "probiotics have been shown to reduce the rate of infection and time spent in intensive care of hospitalized patients suffering from brain trauma."

The authors believe that probiotics could be a promising treatment, but more research is needed. They suggest that future studies could focus on defining appropriate doses, length of treatment, when to administer probiotics, and how age and gender might affect treatment.

Veterans

$50 million grant to study the relationship between concussions and long-term neurological diseases

According to the Military Times, “Nearly 384,000 U.S. service members experienced a traumatic brain injury between 2000 and June 2018, 83 percent of which were classified as ‘mild.’” Virginia Commonwealth University is launching an extensive long-term study of combat concussions, using a $50 million grant from the Departments of Defense and Veterans Affairs. They will examine the military and health records of over two million veterans, as well as 3,000 former service members who suffered multiple concussions in combat. The University researchers will follow these veterans and service members for life. By performing such an extensive analysis of health outcomes from combat concussions, they hope to better understand the relationship between brain injuries and neurodegenerative diseases such as Alzheimers, dementia, Parkinson’s disease, as well as suicide risk.

Mental Health

Continued behavior changes in preschool-aged children with mild TBIs

The Journal of Pediatric Psychology recently published a study by Charlotte Gagner et al. that documents how mTBI in early childhood can, over time, lead to changes in externalizing behaviors (actions towards others) and internalizing behaviors (attitudes towards the self). The researchers recorded these behaviors by administering The Child Behavior Checklist to preschool-aged children with a history of mTBI. They did this at 6, 18, and 30 months post-injury, and then compared the results with children who had no history of mTBI, including children who sustained an orthopedic injury.

They found that, for at least eighteen months post-injury, preschool-aged children who sustain mTBIs show significantly more behavioral problems than preschool-aged children who do not sustain mTBIs or who sustain orthopedic injuries. These symptoms can last up to thirty months and are complicated by external factors that make patients more vulnerable to stressors, such as a concussion. They also note that the majority of pediatric concussion patients experience behavioral changes that do not need to be monitored clinically, but there is a subset of patients who require clinical supervision.

Statistics

Prior health conditions may correlate to increased risk of concussion in older adults

Although many people agree that the risk of mTBI rises with age, a new study found that older patients with preexisting health conditions are more likely to sustain mTBI and more likely to experience complicating effects. Controlling for age, education, and sex, individuals with seemingly unrelated health conditions have a higher rate of mTBIs caused by falls with loss of consciousness. These health conditions include but are not limited to, cerebrovascular disease, depression, disability, and other medical conditions.

Additionally, patients with these conditions who also sustain an mTBI may experience concussion symptoms that are superimposed on the symptoms of their pre-existing conditions. Although fall-prevention is already an essential part of geriatric care, these findings emphasize the importance of fall-prevention, especially in adults with complex health factors. The study, by Kristen Dams‐O'Connor et al., was published in The Journal of the American Geriatrics Society.

Women's Health

A 9-day “window of vulnerability” to suffering a concussion during the low-hormone part of the menstrual cycle

A preliminary study by Michael F. La Fountaine et al., published in Frontiers in Neurology, suggests that females may be more vulnerable to concussion during the nine days of their menstrual cycle when estrogen and progesterone are declining or at their lowest. In a study of 20 female athletes, 67% of the athletes suffered a concussion during this low-hormone stage. The authors hypothesize that estrogen and progesterone may have a neuroprotective effect, and high levels of them could reduce the likelihood of sustaining a concussion and reduce concussion symptoms. They suggest that more research is needed. Additionally, they warn against presuming that hormone supplementation would promote healing, “unless, of course, the presence of a clinically-significant hormone deficiency has been identified after screening by an endocrinologist.”


Culture

New podcast explores sound and nature for mTBI

In the debut podcast of Australian journalist and audio producer Sarah Allely, background noise is brought to the fore. After getting an mTBI from a bike accident in 2015, Allely found herself unable to read or write, and especially sensitive to the deluge of man-made noise she’d unconsciously filtered out before her injury. The hustle and bustle of her former life gave her crippling headaches and a feeling of brain fog, so she replaced it with bush walks and gardening, and this helped her heal. In six sound-rich episodes, Brain on Nature seeks to recreate her experience from injury to recovery and to understand the science behind why changing her environment had such a profound impact.


Executive Editor (and Contributor)


Concussion Alliance co-founder Malayka Gormally

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