Tuesday, 4 February 2014

New Noggin Knowledge

Hockey took a major step forward today as it was reported in the Journal of Neurosurgery that a team of doctors in and around Toronto had discovered physical injuries in players who suffered a concussion. While the symptoms are apparent in those that are concussed, the actual damage done to one's brain was not. With the release of the report today, though, it appears we're closer to understanding what damage is caused when a player is concussed. That's a major step in the right direction for the treatment and safety of all players who have suffered a concussion and for those may suffer a concussion in the future.

The team of doctors assembled "45 male and female athletes who played on two undisclosed Canadian university hockey teams during the 2011-2012 season" for this study. They then had their brains scanned via MRI using advanced imaging techniques to map the brains of these athletes. This would be the baseline for each athlete as they would have their brains scanned at the end of the season to see if there was any change in the structure of the brain. Those who suffered concussion during the season also had MRIs within 72 hours of the injury, with follow-up scans at two weeks and at two months to monitor the brain's structure during the injury.

The findings have been incredible. According to the report, "[t]he findings suggest concussions alter the microstructure of the white matter — the "wiring" that transmits signals from one brain region to another — at least in the short term, but possibly in the long term as well." In other words, there is actual structural damage in the brain when one is concussed, and that damage could have long-term effects on the athlete affected.

"It means we're finding organic, objective evidence of this trauma," Dr. Paul Echlin, a sports medicine physician in Burlington, Ontario who led the studies, told the CBC. "We know that trauma occurs. We know that in soft tissue you're going to have these findings of inflammation and neuroplasticity, which means changes in the structure, but we'd never seen it before."

Now that the team knows there is a change in the structure of the brain as it is injured, the next step is to figure out what happens after the injury.

"What we think we see is some kind of immune response that is activated right after the concussion," Ofer Pasternak, co-author of the study and a researcher at Brigham and Women's Hospital, said Monday from Boston. "We cannot say yet whether it is long-term damage."

That's a profound statement because doctors now know what to look for if there is a baseline comparison that can be made. If the damage is significant, we no longer have to rely upon "symptom-free" when considering allowing players back onto the ice. For their safety, an actual medical review of the player's brain can be done to determine the severity of the injury, and the return date can be set if the player's brain structure begins to regenerate with respect to the baseline scan's appearance.

Of course, there's always a push to make the logical jump that these structural changes in the brain show evidence of there being long-term damage. That's not the case, however, and linking the cause and effect after these preliminary studies may prove to be more dangerous.

"We don't know what the long-term effects are. I think we're still at a stage where it's too early to tell," said Martha Shenton, director of the psychiatry neuroimaging laboratory at Brigham and Women's Hospital and co-principal author with Echlin on the studies. "I think one has to be careful here and not say, 'Hey, we're showing permanent damage.' We aren't saying that. We're saying there's evidence of changes here and we don't know whether they're going to be long term or whether they're going to resolve and what they're associated with. But it's at least a little kind of warning... that if someone has a concussion, don't send them back in right away, give them the proper rest period they need before they get a secondary impact, which can actually be fatal."

How many hockey players' careers have been cut short by multiple concussions? We've seen far too many stars hang up the skates early because concussions have robbed them of some of their most productive years of their lives. Players like Eric Lindros, Keith Primeau, and Pat Lafontaine saw their careers cut short due to concussions with some of those concussions happening in rapid succession of the previous concussion suffered. If there is long-term success - and it appears there is from the multiple stories told about these players - this study might be able to provide insight as to what is happening on the inside. If the white matter isn't sending or receiving signals that are functionally-important in keeping mood swings, headaches, and other symptoms at bay, doctors will now have a possible explanation and place to start when trying to treat these injuries.

The best part of this study? It's not just limited to hockey. All sports should be reviewing these findings and acting accordingly to see if they can prevent future long-term injuries resulting from concussions. While the research is admittedly still in the preliminary state, there is a lot of good information that can be taken from the studies to help other sports in their research as well.

"About 15 to 30 per cent of people will have long-term symptoms," Pasternak stated. "And our study gives us the first steps towards understanding what goes wrong in those people."

And that's an encouraging first step for everyone involved in concussion injuries and CTE-related studies. To all the doctors and athletes participating in the science of this study, HBIC is extremely encouraged by your work! Keep up the great work, Canada!

Until next time, keep your sticks on the ice!

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