NFL & NFLPA to research cannabinoid therapy (5/30/19 newsletter)

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Education


The CATT (Concussion Awareness Training Tool) online learning module for coaches was recently updated to incorporate information from the 2017 Consensus Statement on Concussion in Sport. The course is free of charge and available in English and French. The CATT is a Canadian online resource, with courses about concussions for medical professionals, coaches, parents/caregivers, school professionals, and players.

Sports


A study presented at the 2019 American Academy of Neurology (AAN) meeting established a correlation between concussions and increased lower extremity musculoskeletal injuries in females, and that "females are at a higher risk of post-concussion subsequent musculoskeletal injury" than males, according to an article in Medscape. The study of over 300 collegiate athletes from 17 institutions showed significant associations between concussions in females and knee sprains or lateral ankle sprains post-concussion. Lead author Thomas Buckley, EdD hypothesizes that this is caused by deficits in postural control or incomplete concussion recovery. Results suggest that future investigations should differentiate between male and female athletes and investigate gender differences in concussion response.

Cannabis


Nirushi Kuhathasan et al. reviewed clinical trials for THC and CBD’s effect on sleep quality and found self-reported increases in sleep quality and decreases in sleep disturbances and sleep onset times. The review notes several issues with the studies including lack of placebo controls, unreliable self-reporting questionnaires, and a lack of studies which examine specific sleep disorders. This is promising news for THC/CBD’s potential to improve sleep, which is crucial for health and recovery but also points towards a need for higher quality research on this subject. The study was published in the journal Experimental and Clinical Pharmacology.


The National Football League (NFL) and National Football League Player’s Association (NFLPA) announced the formation of a joint committee of medical experts which will create policies for prescription pain medication use and will research cannabinoid therapy. The league and association seek to provide players, coaches, and families with resources for pain management as well as behavioral health and suicide prevention.

Self-care


A study by T. Valovich McLeod et al. found that sleep was a crucial factor in the recovery time of concussed athletes younger than 19 years of age. Those with good sleep quality often had symptoms subside in around two weeks, whereas those with poor sleep quality often experienced symptoms beyond a month. Compared to those who slept for adequate amounts of time, the athletes with poor sleep quality reported their symptoms to be twice as severe at the initial clinic visit and three times as severe at the follow-up appointment three months later. (Study published in The Journal of Head Trauma Rehabilitation.)


One of the most commonly reported and debilitating symptoms of brain injury is chronic fatigue. A study by the UK nonprofit Headway has found that 70% of survey respondents felt that people did not understand the nature of their fatigue and were unfairly judging them for it. Check out the video in the article for a visual explanation of what it's like to live with chronic fatigue.

Diagnostics


A Canadian study by Alex P. di Battista et al. found that sport-related concussion is associated with inflammatory biomarkers that differ from those observed in athletes with a musculoskeletal injury. These findings, published in the Journal of Neuroinflammation, suggest that this particular biomarker could be measured systematically after sport-related concussion.


Professor Lyn Griffiths from the Queensland University of Technology is starting a study to examine if certain genes give people a higher chance of developing post-concussion headaches. Using whole-exome DNA sequencing allows for the study to scan a large number of genes to determine the presence and location of gene variants that would make an individual more susceptible to post-concussion headaches. The study is in its recruiting phase and is recruiting both people with concussions and those who play sports with a high risk for concussions.

Therapies


A recent New York Times article highlighted the potential of electrical stimulation therapy for treating several diseases and conditions of the brain, including Parkinson’s and epilepsy. In one study referenced in the article, led by Dr. Nicholas Schiff and Dr. Joseph Giacino, a patient who sustained a TBI eighteen years prior was treated with steady currents to the thalamus. Her symptoms, including brain fogginess, poor concentration, and fatigue were significantly relieved, and as such, her quality of life improved. This success was presented at the 2019 Annual BRAIN Initiative Investigators Meeting.


A team of researchers from Tufts University School of Medicine was able to prevent the development of epileptic activity in mice after traumatic brain injury by using a drug that mimics the neuroprotective and anticonvulsant effects of a ketogenic diet. The ketogenic diet has been proven to control seizures in people with epilepsy; this study, led by Chris Dulla and published in JCI Insight, extends previous research by suggesting that manipulating brain metabolism could be an effective way to prevent the development of epilepsy after TBI and restore normal synaptic communication in the brain.

Veterans


Researchers at the VA San Diego found through magnetic resonance imaging that veterans with combat-related PTSD and mild traumatic brain injury (mTBI) have significantly larger amygdalas than those of veterans only affected by combat-related mTBI. While these results only imply correlation, co-author Dr. Douglas Chang proposes that a volume increase in the amygdala, the part of the brain that regulates emotions such as fear and pleasure, could be linked to hyperactivity and abnormal growth of neural networks. Chang hopes that with more investigation, screening the amygdala for structural differences could aid in PTSD diagnosis and monitoring treatment efficacy. The study by Joel Pieper, MD, et al. was published in The Journal Head Trauma Rehabilitation.


A study by Laura D. Crocker et al. in The Journal of Psychiatric Research finds that characteristics of mTBI do not influence attendance or outcomes of veterans who undergo Cognitive Processing Therapy (CPT) for PTSD. Additionally, “veterans experienced a clinically significant reduction in PTSD symptoms [through CPT], regardless of injury characteristics.” This study is in response to some providers who are hesitant to provide Cognitive Processing Therapy for PTSD patients with mTBI, as it finds that, “history of mTBI should not preclude individuals from receiving Cognitive Processing Therapy regardless of injury characteristics.”

Statistics


Lead by professor Michael Escobar, a team of researchers at the University of Toronto ran an analysis on 240,000 Ontario residents who suffered brain injuries in an attempt to find predictive indicators. In general, the researchers found that the most likely groups to receive a TBI were youth and the elderly. However, authors Tatyana Mollayeva et al. believe the most unique finding is the “high percentage of men and women of working age who sought care after environmental exposures to gases and fumes, electrical currents, sharp objects, machinery, and the cold in the five years preceding their TBI event.” The study, published in Scientific Reports, notes that “future research may propose ways to regulate work environments for such exposures as a means to reduce injury rates.”


As mentioned in last week’s newsletter regarding Kim Gorgen’s TEDTalk, those in the criminal justice system have a disproportionate incidence of TBI compared to the general population. A longitudinal study done by Joseph A. Schwartz, Ph.D., published by Justice Quarterly, found that there is an association between TBI, violent criminal behavior, and criminal persistence. Interestingly, the correlation between TBI and non-violent criminal offenses is less apparent. Schwartz provides the disclaimer that it cannot be definitively said that these relationships are causal.


This week's contributors


Eloise Cowan, Malayka GormallyConor Gormally, Micalie Hunt, Hannah Kennicott, Umar Rasul, and Julian Szieff