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Lee JK, Wu J, Bullen J, Banks S, Bernick C, Modic MT, Ruggieri P, Bennett L, Jones SE. Association of Cavum Septum Pellucidum and Cavum Vergae With Cognition, Mood, and Brain Volumes in Professional Fighters. JAMA Neurol 2020; 77:35-42. [PMID: 31498371 DOI: 10.1001/jamaneurol.2019.2861] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Many studies have investigated the imaging findings showing sequelae of repetitive head trauma, with mixed results. Objective To determine whether fighters (boxers and mixed martial arts fighters) with cavum septum pellucidum (CSP) and cavum vergae (CV) have reduced volumes in various brain structures or worse clinical outcomes on cognitive and mood testing. Design, Setting, and Participants This cohort study assessed participants from the Professional Fighters Brain Health Study. Data were collected from April 14, 2011, to January 17, 2018, and were analyzed from September 1, 2018, to May 23, 2019. This study involved a referred sample of 476 active and retired professional fighters. Eligible participants were at least 18 years of age and had at least a fourth-grade reading level. Healthy age-matched controls with no history of trauma were also enrolled. Exposures Presence of CSP, CV, and their total (additive) length (CSPV length). Main Outcomes and Measures Information regarding depression, impulsivity, and sleepiness among study participants was obtained using the Patient Health Questionnaire depression scale, Barrett Impulsiveness Scale, and the Epworth Sleepiness Scale. Cognition was assessed using raw scores from CNS Vital Signs. Volumes of various brain structures were measured via magnetic resonance imaging. Results A total of 476 fighters (440 men, 36 women; mean [SD] age, 30.0 [8.2] years [range, 18-72 years]) and 63 control participants (57 men, 6 women; mean [SD] age, 30.8 [9.6] years [range, 18-58 years]) were enrolled in the study. Compared with fighters without CV, fighters with CV had significantly lower mean psychomotor speed (estimated difference, -11.3; 95% CI, -17.4 to -5.2; P = .004) and lower mean volumes in the supratentorium (estimated difference, -31 191 mm3; 95% CI, -61 903 to -479 mm3; P = .05) and other structures. Longer CSPV length was associated with lower processing speed (slope, -0.39; 95% CI, -0.49 to -0.28; P < .001), psychomotor speed (slope, -0.43; 95% CI, -0.53 to -0.32; P < .001), and lower brain volumes in the supratentorium (slope, -1072 mm3 for every 1-mm increase in CSPV length; 95% CI, -1655 to -489 mm3; P < .001) and other structures. Conclusions and Relevance This study suggests that the presence of CSP and CV is associated with lower regional brain volumes and cognitive performance in a cohort exposed to repetitive head trauma.
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Affiliation(s)
| | - Jenny Wu
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Sarah Banks
- Department of Psychology, University of California San Diego Health-La Jolla, San Diego
| | - Charles Bernick
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
| | - Michael T Modic
- Department of Radiology, Vanderbilt University, Medical Center North, South Nashville, Tennessee
| | - Paul Ruggieri
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lauren Bennett
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
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Bigler ED. Structural neuroimaging in sport-related concussion. Int J Psychophysiol 2018; 132:105-123. [DOI: 10.1016/j.ijpsycho.2017.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 09/03/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
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Kellar D, Newman S, Pestilli F, Cheng H, Port NL. Comparing fMRI activation during smooth pursuit eye movements among contact sport athletes, non-contact sport athletes, and non-athletes. NEUROIMAGE-CLINICAL 2018. [PMID: 29541575 PMCID: PMC5849867 DOI: 10.1016/j.nicl.2018.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives Though sub-concussive impacts are common during contact sports, there is little consensus whether repeat blows affect brain function. Using a "lifetime exposure" rather than acute exposure approach, we examined oculomotor performance and brain activation among collegiate football players and two control groups. Our analysis examined whether there are group differences in eye movement behavioral performance and in brain activation during smooth pursuit. Methods Data from 21 off-season Division I football "starters" were compared with a) 19 collegiate cross-country runners, and b) 11 non-athlete college students who were SES matched to the football player group (total N = 51). Visual smooth pursuit was performed while undergoing fMRI imaging via a 3 Tesla scanner. Smooth pursuit eye movements to three stimulus difficulty levels were measured with regard to RMS error, gain, and lag. Results No meaningful differences were found for any of the standard analyses used to assess smooth pursuit eye movements. For fMRI, greater activation was seen in the oculomotor region of the cerebellar vermis and areas of the FEF for football players as compared to either control group, who did not differ on any measure. Conclusion Greater cerebellar activity among football players while performing an oculomotor task could indicate that they are working harder to compensate for some subtle, long-term subconcussive deficits. Alternatively, top athletes in a sport requiring high visual motor skill could have more of their cerebellum and FEF devoted to oculomotor task performance regardless of subconcussive history. Overall, these results provide little firm support for an effect of accumulated subconcussion exposure on brain function.
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Affiliation(s)
- Derek Kellar
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Sharlene Newman
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Franco Pestilli
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Hu Cheng
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Nicholas L Port
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States.
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Lin A, Charney M, Shenton ME, Koerte IK. Chronic traumatic encephalopathy: neuroimaging biomarkers. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:309-322. [PMID: 30482359 DOI: 10.1016/b978-0-444-63954-7.00029-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impact exposure, such as that resulting from sports-related concussive and subconcussive brain trauma. Currently, the only way to diagnose CTE is by using neuropathologic markers obtained postmortem. To diagnose CTE earlier, so that possible treatment interventions may be employed, there is a need to develop noninvasive in vivo biomarkers of CTE. Neuroimaging provides promising biomarkers for the diagnosis of CTE and may also help elucidate pathophysiologic changes that occur with chronic sports-related brain injury. To describe the use of neuroimaging as presumed biomarkers of CTE, this chapter focuses on only those studies that report the chronic stages of sports-related brain injury, as opposed to previous chapters that described neuroimaging in the context of acute and subacute injury. Studies using positron emission tomography and magnetic resonance imaging and spectroscopy will be discussed for contact/collision sports such as American football, boxing, mixed martial arts, rugby, and soccer, in which repetitive head impacts are common.
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Affiliation(s)
- Alexander Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Molly Charney
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Martha E Shenton
- Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; VA Boston Healthcare System, Boston, MA, United States
| | - Inga Katharina Koerte
- Psychiatric 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.
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Moss RA, Priluck J, Bonilla X, Evans C, Macedo PS. Neuropsychological assessment in two cases of adult mild traumatic brain injury with a history of childhood head trauma. APPLIED NEUROPSYCHOLOGY. ADULT 2017; 24:385-393. [PMID: 27144284 DOI: 10.1080/23279095.2016.1159562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The existence of residual cognitive deficits following mild traumatic brain injury (MTBI) has been a topic of controversy. The current paper describes neuropsychological assessment in two cases of adulthood mild traumatic brain injury. Both patients showed objective results demonstrating cognitive impairment. The first patient experienced a head trauma around the age of 4 and the other patient had a head injury around the age of 7. Discussion focuses on the need for the systematic consideration of a history of childhood head injury as a moderating factor that may account for why a subgroup of patients show cognitive deficits following MTBI.
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Affiliation(s)
- Robert A Moss
- a North Mississippi Medical Center , Tupelo , MS , USA
| | - Jacob Priluck
- b American School of Professional Psychology, Argosy University , Washington , DC , USA
| | - Xavier Bonilla
- b American School of Professional Psychology, Argosy University , Washington , DC , USA
- c Mid Atlantic Internship Consortium, Argosy University , Washington , DC , USA
| | - Charles Evans
- c Mid Atlantic Internship Consortium, Argosy University , Washington , DC , USA
- d Washington Medical Group , Washington , DC , USA
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Hart MG, Housden CR, Suckling J, Tait R, Young A, Müller U, Newcombe VFJ, Jalloh I, Pearson B, Cross J, Trivedi RA, Pickard JD, Sahakian BJ, Hutchinson PJ. Advanced magnetic resonance imaging and neuropsychological assessment for detecting brain injury in a prospective cohort of university amateur boxers. NEUROIMAGE-CLINICAL 2017; 15:194-199. [PMID: 28529875 PMCID: PMC5429235 DOI: 10.1016/j.nicl.2017.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 04/22/2017] [Accepted: 04/25/2017] [Indexed: 10/25/2022]
Abstract
BACKGROUND/AIM The safety of amateur and professional boxing is a contentious issue. We hypothesised that advanced magnetic resonance imaging and neuropsychological testing could provide evidence of acute and early brain injury in amateur boxers. METHODS We recruited 30 participants from a university amateur boxing club in a prospective cohort study. Magnetic resonance imaging (MRI) and neuropsychological testing was performed at three time points: prior to starting training; within 48 h following a first major competition to detect acute brain injury; and one year follow-up. A single MRI acquisition was made from control participants. Imaging analysis included cortical thickness measurements with Advanced Normalization Tools (ANTS) and FreeSurfer, voxel based morphometry (VBM), and Tract Based Spatial Statistics (TBSS). A computerized battery of neuropsychological tests was performed assessing attention, learning, memory and impulsivity. RESULTS During the study period, one boxer developed seizures controlled with medication while another developed a chronic subdural hematoma requiring neurosurgical drainage. A total of 10 boxers contributed data at to the longitudinal assessment protocol. Reasons for withdrawal were: logistics (10), stopping boxing (7), withdrawal of consent (2), and development of a chronic subdural hematoma (1). No significant changes were detected using VBM, TBSS, cortical thickness measured with FreeSurfer or ANTS, either cross-sectionally at baseline, or longitudinally. Neuropsychological assessment of boxers found attention/concentration improved over time while planning and problem solving ability latency decreased after a bout but recovered after one year. CONCLUSION While this neuroimaging and neuropsychological assessment protocol could not detect any evidence of brain injury, one boxer developed seizures and another developed a chronic sub-dural haematoma.
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Affiliation(s)
- M G Hart
- Academic Division of Neurosurgery, Department of Clinical Neurosciences, Department of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
| | - C R Housden
- Department of Psychiatry, University of Cambridge and the MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, Cambridge CB2 2QQ, United Kingdom
| | - J Suckling
- Department of Psychiatry, University of Cambridge and the MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, Cambridge CB2 2QQ, United Kingdom
| | - R Tait
- Department of Psychiatry, University of Cambridge and the MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, Cambridge CB2 2QQ, United Kingdom
| | - A Young
- Academic Division of Neurosurgery, Department of Clinical Neurosciences, Department of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - U Müller
- Department of Psychiatry, University of Cambridge and the MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, Cambridge CB2 2QQ, United Kingdom; Adult ADHD Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge Road, Fulbourn, Cambridge CB21 5HH, United Kingdom
| | - V F J Newcombe
- Wolfson Brain Imaging Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; University Division of Anaesthesia, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - I Jalloh
- Academic Division of Neurosurgery, Department of Clinical Neurosciences, Department of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - B Pearson
- Academic Division of Neurosurgery, Department of Clinical Neurosciences, Department of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - J Cross
- Department of Radiology, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - R A Trivedi
- Academic Division of Neurosurgery, Department of Clinical Neurosciences, Department of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - J D Pickard
- Academic Division of Neurosurgery, Department of Clinical Neurosciences, Department of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Wolfson Brain Imaging Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - B J Sahakian
- Department of Psychiatry, University of Cambridge and the MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, Cambridge CB2 2QQ, United Kingdom
| | - P J Hutchinson
- Academic Division of Neurosurgery, Department of Clinical Neurosciences, Department of Neurosurgery, Box 167, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Wolfson Brain Imaging Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
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Asken BM, DeKosky ST, Clugston JR, Jaffee MS, Bauer RM. Diffusion tensor imaging (DTI) findings in adult civilian, military, and sport-related mild traumatic brain injury (mTBI): a systematic critical review. Brain Imaging Behav 2017; 12:585-612. [DOI: 10.1007/s11682-017-9708-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Bouchon A, Noblet V, Heitz F, Lamy J, Blanc F, Armspach JP. Which is the most appropriate strategy for conducting multivariate voxel-based group studies on diffusion tensors? Neuroimage 2016; 142:99-112. [PMID: 27241484 DOI: 10.1016/j.neuroimage.2016.05.040] [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: 10/26/2015] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022] Open
Abstract
There is a real need in the neuroscience community for efficient tools to compare Diffusion Tensor Magnetic Resonance Imaging across cohorts of subjects. Most studies focus on the comparison of scalar images such as fractional anisotropy or mean diffusivity. Although different statistical frameworks have been proposed to compare the whole diffusion tensor information, they are still seldom used in neuroimaging studies. In this paper, we investigate on both simulated and real data whether there is a real added value of considering the whole tensor information for conducting voxel-based group studies. Then, we compare two statistical tests dedicated to tensor, namely the Cramér test and a tensor-based extension of the General Linear Model (GLM), the latter presenting the advantage to account for covariates. We also evaluate the impact of different metrics (Euclidean, Log-Euclidean and affine-invariant Riemannian metrics) for estimating the GLM parameters. Finally, we address the problem of interpreting the change detection maps obtained by tensor-based methods by proposing a way to characterize each of the detected clusters according to several scalar indices. Our study suggests that if there is no prior assumption about the nature of the expected changes, it is really preferable to use tensor-based rather than scalar-based statistical analysis. The Cramér test can advantageously be used when no confounding variable hampers the group comparison, otherwise the GLM should be considered. Finally, the different metrics show similar performance in the real scenario, with a significant computational overhead for the Riemannian framework.
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Affiliation(s)
- Alix Bouchon
- ICube, University of Strasbourg, CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), France.
| | - Vincent Noblet
- ICube, University of Strasbourg, CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), France
| | - Fabrice Heitz
- ICube, University of Strasbourg, CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), France
| | - Julien Lamy
- ICube, University of Strasbourg, CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), France
| | - Frédéric Blanc
- ICube, University of Strasbourg, CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), France; Geriatry service, Memory Resources and Research Center (CMRR), University Hospital of Strasbourg, France
| | - Jean-Paul Armspach
- ICube, University of Strasbourg, CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), France
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Herweh C, Hess K, Meyding-Lamadé U, Bartsch AJ, Stippich C, Jost J, Friedmann-Bette B, Heiland S, Bendszus M, Hähnel S. Reduced white matter integrity in amateur boxers. Neuroradiology 2016; 58:911-20. [PMID: 27230917 DOI: 10.1007/s00234-016-1705-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/13/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Professional boxing can lead to chronic traumatic encephalopathy, a variant of traumatic brain injury (TBI). Its occurrence in amateur boxers is a matter of debate since amateur boxing is considered to be less harmful due to more strict regulations. However, several studies using different methodological approaches have revealed subtle signs of TBI even in amateurs. Diffusion tensor imaging (DTI) is sensitive to microscopic white matter changes and has been proven useful in TBI when routine MR imaging often is unrevealing. METHODS DTI, with tract-based spatial statistics (TBSS) together with neuropsychological examination of executive functions and memory, was used to investigate a collective of 31 male amateur boxers and 31 age-matched controls as well as a subgroup of 19 individuals, respectively, who were additionally matched for intellectual performance (IQ). RESULTS All participants had normal findings in neurological examination and conventional MR. Amateur boxers did not show deficits in neuropsychological tests when their IQ was taken into account. Fractional anisotropy was significantly reduced, while diffusivity measures were increased along central white matter tracts in the boxers group. These changes were in part associated with the number of fights. CONCLUSIONS TBSS revealed widespread white matter disturbance partially related to the individual fighting history in amateur boxers. These findings closely resemble those in patients with accidental TBI and indicate similar histological changes in amateur boxers.
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Affiliation(s)
- Christian Herweh
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Klaus Hess
- Department of Neurology, University of Heidelberg Medical School, Heidelberg, Germany
| | | | - Andreas J Bartsch
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christoph Stippich
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Joachim Jost
- National Training Center for Boxing, Heidelberg, Germany
| | - Birgit Friedmann-Bette
- Department of Sports Medicine, University of Heidelberg Medical School, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Stefan Hähnel
- Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Seifert T, Bernick C, Jordan B, Alessi A, Davidson J, Cantu R, Giza C, Goodman M, Benjamin J. Determining brain fitness to fight: Has the time come? PHYSICIAN SPORTSMED 2015; 43:395-402. [PMID: 26295482 DOI: 10.1080/00913847.2015.1081551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Professional boxing is associated with a risk of chronic neurological injury, with up to 20-50% of former boxers exhibiting symptoms of chronic brain injury. Chronic traumatic brain injury encompasses a spectrum of disorders that are associated with long-term consequences of brain injury and remains the most difficult safety challenge in modern-day boxing. Despite these concerns, traditional guidelines used for return to sport participation after concussion are inconsistently applied in boxing. Furthermore, few athletic commissions require either formal consultation with a neurological specialist (i.e. neurologist, neurosurgeon, or neuropsychologist) or formal neuropsychological testing prior to return to fight. In order to protect the health of boxers and maintain the long-term viability of a sport associated with exposure to repetitive head trauma, we propose a set of specific requirements for brain safety that all state athletic commissions would implement.
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Affiliation(s)
- Tad Seifert
- a 1 Department of Neurology, Norton Healthcare , Louisville, KY, USA.,b 2 Department of Neurology, University of Kentucky , KY, USA.,c 3 Kentucky State Boxing Commission , KY, USA
| | - Charles Bernick
- d 4 Lou Ruvo Center for Brain Health, Cleveland Clinic , Las Vegas, NV, USA
| | - Barry Jordan
- e 5 Department of Neurology, Burke Rehabilitation Hospital , White Plains, NY, USA.,f 6 New York State Athletic Commission , NY, USA
| | - Anthony Alessi
- g 7 Department of Neurology, Backus Hospital , Norwich, CT, USA.,h 8 Department of Neurology, University of Connecticut , CT, USA
| | - Jeff Davidson
- i 9 Department of Emergency Medicine, Valley Hospital , Las Vegas, NV, USA.,j 10 Ultimate Fighting Championship , Las Vegas, NV, USA
| | - Robert Cantu
- k 11 Department of Neurosurgery, Emerson Hospital , MA, USA.,l 12 Sports Legacy Institute , Boston, MA, USA
| | - Christopher Giza
- m 13 Department of Pediatric Neurology, University of California at Los Angeles , CA, USA.,n 14 California State Athletic Commission , CA, USA
| | - Margaret Goodman
- o 15 Headache Center of Southern Nevada , Las Vegas, NV, USA.,p 16 Voluntary Anti-Doping Association , Las Vegas, NV, USA
| | - Johnny Benjamin
- q 17 Department of Orthopedic Surgery, Pro Spine Center , Vero Beach, FL , USA
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Gandy S, Ikonomovic MD, Mitsis E, Elder G, Ahlers ST, Barth J, Stone JR, DeKosky ST. Chronic traumatic encephalopathy: clinical-biomarker correlations and current concepts in pathogenesis. Mol Neurodegener 2014; 9:37. [PMID: 25231386 PMCID: PMC4249716 DOI: 10.1186/1750-1326-9-37] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/13/2014] [Indexed: 12/14/2022] Open
Abstract
Background Chronic traumatic encephalopathy (CTE) is a recently revived term used to describe a neurodegenerative process that occurs as a long term complication of repetitive mild traumatic brain injury (TBI). Corsellis provided one of the classic descriptions of CTE in boxers under the name “dementia pugilistica” (DP). Much recent attention has been drawn to the apparent association of CTE with contact sports (football, soccer, hockey) and with frequent battlefield exposure to blast waves generated by improvised explosive devices (IEDs). Recently, a promising serum biomarker has been identified by measurement of serum levels of the neuronal microtubule associated protein tau. New positron emission tomography (PET) ligands (e.g., [18 F] T807) that identify brain tauopathy have been successfully deployed for the in vitro and in vivo detection of presumptive tauopathy in the brains of subjects with clinically probable CTE. Methods Major academic and lay publications on DP/CTE were reviewed beginning with the 1928 paper describing the initial use of the term CTE by Martland. Results The major current concepts in the neurological, psychiatric, neuropsychological, neuroimaging, and body fluid biomarker science of DP/CTE have been summarized. Newer achievements, such as serum tau and [18 F] T807 tauopathy imaging, are also introduced and their significance has been explained. Conclusion Recent advances in the science of DP/CTE hold promise for elucidating a long sought accurate determination of the true prevalence of CTE. This information holds potentially important public health implications for estimating the risk of contact sports in inflicting permanent and/or progressive brain damage on children, adolescents, and adults.
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Affiliation(s)
- Sam Gandy
- Departments of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029, USA.
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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.
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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
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13
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Sasaki T, Pasternak O, Mayinger M, Muehlmann M, Savadjiev P, Bouix S, Kubicki M, Fredman E, Dahlben B, Helmer KG, Johnson AM, Holmes JD, Forwell LA, Skopelja EN, Shenton ME, Echlin PS, Koerte IK. Hockey Concussion Education Project, Part 3. White matter microstructure in ice hockey players with a history of concussion: a diffusion tensor imaging study. J Neurosurg 2014; 120:882-90. [PMID: 24471841 DOI: 10.3171/2013.12.jns132092] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECT The aim of this study was to examine the brain's white matter microstructure by using MR diffusion tensor imaging (DTI) in ice hockey players with a history of clinically symptomatic concussion compared with players without a history of concussion. METHODS Sixteen players with a history of concussion (concussed group; mean age 21.7 ± 1.5 years; 6 female) and 18 players without a history of concussion (nonconcussed group; mean age 21.3 ± 1.8 years, 10 female) underwent 3-T DTI at the end of the 2011-2012 Canadian Interuniversity Sports ice hockey season. Tract-based spatial statistics (TBSS) was used to test for group differences in fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and the measure "trace," or mean diffusivity. Cognitive evaluation was performed using the Immediate Postconcussion Assessment and Cognitive Test (ImPACT) and the Sport Concussion Assessment Tool-2 (SCAT2). RESULTS TBSS revealed a significant increase in FA and AD, and a significant decrease in RD and trace in several brain regions in the concussed group, compared with the nonconcussed group (p < 0.05). The regions with increased FA and decreased RD and trace included the right posterior limb of the internal capsule, the right corona radiata, and the right temporal lobe. Increased AD was observed in a small area in the left corona radiata. The DTI measures correlated with neither the ImPACT nor the SCAT2 scores. CONCLUSIONS The results of the current study indicate that a history of concussion may result in alterations of the brain's white matter microstructure in ice hockey players. Increased FA based on decreased RD may reflect neuroinflammatory or neuroplastic processes of the brain responding to brain trauma. Future studies are needed that include a longitudinal analysis of the brain's structure and function following a concussion to elucidate further the complex time course of DTI changes and their clinical meaning.
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Affiliation(s)
- Takeshi Sasaki
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
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14
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Hayes JP, Morey RA, Tupler LA. A case of frontal neuropsychological and neuroimaging signs following multiple primary-blast exposure. Neurocase 2012; 18:258-69. [PMID: 21879996 PMCID: PMC3718065 DOI: 10.1080/13554794.2011.588181] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Blast-related traumatic brain injury (TBI) from the Afghanistan and Iraq wars represents a significant medical concern for troops and veterans. To better understand the consequences of primary-blast injury in humans, we present a case of a Marine exposed to multiple primary blasts during his 14-year military career. The neuropsychological profile of this formerly high-functioning veteran suggested primarily executive dysfunction. Diffusion-tensor imaging revealed white-matter pathology in long fiber tracks compared with a composite fractional-anisotropy template derived from a veteran reference control group without TBI. This study supports the existence of primary blast-induced neurotrauma in humans and introduces a neuroimaging technique with potential to discriminate multiple-blast TBI.
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Affiliation(s)
- Jasmeet Pannu Hayes
- National Center for PTSD-116B-2, VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA 02130, USA.
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15
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Turner RC, Lucke-Wold BP, Robson MJ, Omalu BI, Petraglia AL, Bailes JE. Repetitive traumatic brain injury and development of chronic traumatic encephalopathy: a potential role for biomarkers in diagnosis, prognosis, and treatment? Front Neurol 2012; 3:186. [PMID: 23335911 PMCID: PMC3547169 DOI: 10.3389/fneur.2012.00186] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 12/21/2012] [Indexed: 02/05/2023] Open
Abstract
The diagnosis of chronic traumatic encephalopathy (CTE) upon autopsy in a growing number of athletes and soldiers alike has resulted in increased awareness, by both the scientific/medical and lay communities, of the potential for lasting effects of repetitive traumatic brain injury. While the scientific community has come to better understand the clinical presentation and underlying pathophysiology of CTE, the diagnosis of CTE remains autopsy-based, which prevents adequate monitoring and tracking of the disease. The lack of established biomarkers or imaging modalities for diagnostic and prognostic purposes also prevents the development and implementation of therapeutic protocols. In this work the clinical history and pathologic findings associated with CTE are reviewed, as well as imaging modalities that have demonstrated some promise for future use in the diagnosis and/or tracking of CTE or repetitive brain injury. Biomarkers under investigation are also discussed with particular attention to the timing of release and potential utility in situations of repetitive traumatic brain injury. Further investigation into imaging modalities and biomarker elucidation for the diagnosis of CTE is clearly both needed and warranted.
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Affiliation(s)
- Ryan C. Turner
- Department of Neurosurgery, School of Medicine, West Virginia UniversityMorgantown, WV, USA
- Center for Neuroscience, School of Medicine, West Virginia UniversityMorgantown, WV, USA
- *Correspondence: Ryan C. Turner, Department of Neurosurgery, School of Medicine, West Virginia University, One Medical Center Drive, Suite 4300, Health Sciences Center, PO Box 9183, Morgantown, WV 26506-9183, USA. e-mail:
| | - Brandon P. Lucke-Wold
- Department of Neurosurgery, School of Medicine, West Virginia UniversityMorgantown, WV, USA
- Center for Neuroscience, School of Medicine, West Virginia UniversityMorgantown, WV, USA
| | - Matthew J. Robson
- Department of Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia UniversityMorgantown, WV, USA
| | - Bennet I. Omalu
- Department of Pathology, University of CaliforniaDavis, CA, USA
| | - Anthony L. Petraglia
- Department of Neurosurgery, University of Rochester Medical CenterRochester, NY, USA
| | - Julian E. Bailes
- Department of Neurosurgery, NorthShore University Health SystemEvanston, IL, USA
- Section of Neurosurgery, Department of Surgery, University of Chicago Medical CenterChicago, IL, USA
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16
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17
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Turken AU, Herron TJ, Kang X, O'Connor LE, Sorenson DJ, Baldo JV, Woods DL. Multimodal surface-based morphometry reveals diffuse cortical atrophy in traumatic brain injury. BMC Med Imaging 2009; 9:20. [PMID: 20043859 PMCID: PMC2811103 DOI: 10.1186/1471-2342-9-20] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 12/31/2009] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with traumatic brain injury (TBI) often present with significant cognitive deficits without corresponding evidence of cortical damage on neuroradiological examinations. One explanation for this puzzling observation is that the diffuse cortical abnormalities that characterize TBI are difficult to detect with standard imaging procedures. Here we investigated a patient with severe TBI-related cognitive impairments whose scan was interpreted as normal by a board-certified radiologist in order to determine if quantitative neuroimaging could detect cortical abnormalities not evident with standard neuroimaging procedures. METHODS Cortical abnormalities were quantified using multimodal surfaced-based morphometry (MSBM) that statistically combined information from high-resolution structural MRI and diffusion tensor imaging (DTI). Normal values of cortical anatomy and cortical and pericortical DTI properties were quantified in a population of 43 healthy control subjects. Corresponding measures from the patient were obtained in two independent imaging sessions. These data were quantified using both the average values for each lobe and the measurements from each point on the cortical surface. The results were statistically analyzed as z-scores from the mean with a p < 0.05 criterion, corrected for multiple comparisons. False positive rates were verified by comparing the data from each control subject with the data from the remaining control population using identical statistical procedures. RESULTS The TBI patient showed significant regional abnormalities in cortical thickness, gray matter diffusivity and pericortical white matter integrity that replicated across imaging sessions. Consistent with the patient's impaired performance on neuropsychological tests of executive function, cortical abnormalities were most pronounced in the frontal lobes. CONCLUSIONS MSBM is a promising tool for detecting subtle cortical abnormalities with high sensitivity and selectivity. MSBM may be particularly useful in evaluating cortical structure in TBI and other neurological conditions that produce diffuse abnormalities in both cortical structure and tissue properties.
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Affiliation(s)
- And U Turken
- Veterans Affairs Northern California Health Care System, Martinez, CA, USA.
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