American football has come under increased scrutiny following findings that the contact sport has been causing serious brain trauma in players. Now, a team of researchers at Israel’s Ben Gurion University of the Negev's (BGU) Brain Imaging Research Center has developed a method that can detect damage to the brain much earlier than previously thought.
"This is an important study, it gives us the opportunity for the first time to be able to look at a functional change in the brain and individuals who've had concussions or sub-concussive head injuries," Dr. Lee Goldstein, Associate Professor at Boston University School of Medicine, told The Media Line.
"We know that these injuries are occurring... but at the moment we don't have an easy or meaningful way to diagnose these injuries in individuals, and this is a technique that may allow us to do that.”
After nearly a decade of research, Dr. Alon Friedman and his team of researchers at BGU developed a contrast-enhanced MRI that is able to identify significant damage to the blood vessels of the brain much earlier than was previously possible.
"We developed the study following basic research in animals which showed that the blood-brain barrier can break down after trauma or strokes, which can lead to complications," Friedman told The Media Line. "Following these studies we decided it was crucial to develop ways to measure leakage in blood vessels.”
The blood-brain barrier is a permeable membrane separating circulating blood from extracellular fluid. This membrane protects the brain and prevents certain substances from entering it. If there is a breach in the barrier, external factors can cause inflammation that worsens psychiatric and neurological effects of any present brain injury.
The new method of MRI detects and localizes pathologies in the brain's blood vessels caused by even mild brain injuries. The Dynamic Contrast-Enhanced MRI generates more detailed brain maps that are able to show brain regions with vascular abnormalities.
"We tested it in football players from a local team and used athletes in non-contact sports as a control group," Friedman said. "The big difference is that 40 percent of the football players showed significant pathology (in the blood vessels and blood barrier) before any other pathology can be seen," he said.
The damage only showed up in the MRI Friedman and his team developed. The same players who showed brain damage in the contrast-enhanced MRI showed completely normal brain scans in previous MRI exams.
Friedman said they focused the study on American football players because they have been known to suffer complications from injuries to the head, including depression, dementia, Alzheimer's disease and Parkinson's disease. The previous studies they ran on animals showed that a breakdown in the blood barrier could lead to similar pathologies, but until now the diagnostic capability to identify mild injuries soon after the trauma didn't exist.
"There are two separate things we need to know about – the acute injuring which is what happens in and around the time of the single episode, and what happens chronically, over a period of many hits and what happens thereafter," Goldstein said. "At the moment, we have no good way of sorting out either one, nor do we have a good way of being able to relate one to the other. This technique really offers for the first time a way to do both, to look at the acute injury and at what happens over a season," he said, adding this technique could also provide a way to tell who is at risk for brain injury.
Although the study focused on football players, brain injuries are also common among soldiers which contributes to many neurological and psychological symptoms associated with post-traumatic stress disorder (PTSD).
Dr. Hadar Shalev, a psychiatrist in charge of the trauma clinic at Soroka Medical Center, told The Media Line that even though the vast majority of traumatic brain injuries (TBIs) are considered mild or moderate, the disabilities that accompany them can be quite serious.
Around 10 percent of patients with a traumatic brain injury will continue to suffer from post-concussion syndrome, which can cause dizziness and headaches that can persist for weeks after suffering a brain injury. Problems with concentration, memory and problem solving have also been associated with brain injuries; distressed moods, irritability, difficulty sleeping and low frustration thresholds are common as well,
"It's important to understand that most of the time we don't see the pathologies early enough. We have no objective measure of when they should go back to play, if at all," Friedman said. "When the damage appears in the exams it’s too late. What we are trying to create is a test that can detect very early on the brain pathologies, at a stage where we hope it can still be reversed," he added.
Since TBIs change the brains of patients, the psychiatric effects must be treated differently as well. Shalev told The Media Line that because many of these patients have brain damage, the effects are difficult to deal with, something the new detection method might be able to help with.
"Because it is due to brain damage in many cases, (symptoms like depression) are hard to deal with, the techniques we use to treat psychoses in non-TBI patients aren't applicable," Shalev told The Media Line.
He said that some patients may not recognize the symptoms and often self-medicate in order to deal with issues like severe anxiety or depression. That in turn, leads to a growing incidence of substance abuse among TBI patients.
“If I can identify the process in the brain of the patient, maybe I will be able to provide different treatments to reduce stress around the brain," Shalev said.
The initial study at BGU was relatively small, so it's essential to enlarge the studies and apply it to other fields in order to confirm the method works and is relevant. Additional studies which they hope to conduct in the US and Canada would specify the conditions in which the method works and areas where there is still room for improvement.
This new detection method is also applicable to other types of diseases, unrelated to brain injuries sustained in contact sports. A certain percentage of patients with Alzheimer's disease and dementia also suffer from the same brain pathologies the new MRI detects, which can lead to earlier detection and treatment of these degenerative diseases.
Article written by Samantha Badgen.
Reprinted with permission from The Media Line .