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Doucet M, Brisebois H, McKerral M. Heart Rate Variability in Concussed College Athletes: Follow-Up Study and Biological Sex Differences. Brain Sci 2023; 13:1669. [PMID: 38137117 PMCID: PMC10741497 DOI: 10.3390/brainsci13121669] [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: 11/01/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Finding reliable biomarkers to assess concussions could play a pivotal role in diagnosis, monitoring, and predicting associated risks. The present study aimed to explore the use of heart rate variability (HRV) in the follow-up of concussions among college athletes and to investigate the relationships between biological sex, symptomatology, and HRV values at baseline and after a concussion. Correlations between measures were also analyzed. A total of 169 (55 females) athletes aged 16 to 22 years old completed baseline testing, and 30 (8 females) concussion cases were followed. Baseline assessment (T1) included psychosocial and psychological questionnaires, symptoms report, and four minutes of HRV recording. In the event of a concussion, athletes underwent re-testing within 72 h (T2) and before returning to play (T3). Baseline findings revealed that girls had higher %VLF while sitting than boys, and a small negligible correlation was identified between %HF and total symptoms score as well as %HF and affective sx. Post-concussion analyses demonstrated a significant effect of time × position × biological sex for %HF, where girls exhibited higher %HF at T3. These findings suggest disruptions in HRV following a concussion and underscore biological sex as an important factor in the analysis of HRV variation in concussion recovery trajectory.
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Affiliation(s)
- Mariane Doucet
- Departement of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada;
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC H3S 2J4, Canada
| | - Hélène Brisebois
- Departement of Psychology, Collège Montmorency, Laval, QC H7N 5H9, Canada
| | - Michelle McKerral
- Departement of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada;
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC H3S 2J4, Canada
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Yumul JN, Catroppa C, McKinlay A, Anderson V. Post-Concussive Symptoms in Preschool Children up to Three Months Post-Injury. Dev Neurorehabil 2023; 26:338-347. [PMID: 37548355 DOI: 10.1080/17518423.2023.2242945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/20/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS Post-concussive symptoms (PCS) are central to the assessment and management of mild traumatic brain injury (mTBI); however, this remains poorly understood in children aged ≤5 years. The study aimed to explore individual PCS, pattern of parents' PCS report over time, proportion of symptomatic children, and variables associated with parents' report of PCS in their preschool child after a mTBI. METHODS Children aged 2-5 years with either a mTBI (n=13) or limb injury (n=6) were recruited from the emergency department (ED). Parent ratings of child PCS were assessed at ED presentation, at one month, and at three months post-injury. Injury (e.g. injury group, pain), child (e.g. pre-existing behavior, symptoms), and parent (e.g. parental stress, education) characteristics were considered when investigating variables that may be relevant to parent report of PCS. RESULTS The number of total, physical, and sleep PCS were significantly higher after mTBI, with a significant decrease in physical and sleep PCS over time. The proportion of symptomatic children was comparable between injury groups at each time point. Acute pain and pre-injury symptoms were significantly associated with parents' acute PCS report in the mTBI group. Further research is needed on variables that may be relevant to parents' PCS report at follow-up. CONCLUSION Preliminary findings suggest a general trauma response after a mTBI or limb injury, but acute physical and sleep PCS may help differentiate the injury groups. Injury and premorbid child variables may be relevant to parents' report of acute PCS in their child. Additional research is needed to investigate PCS in preschoolers and variables that may predict parents' PCS report.
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Affiliation(s)
- Joy Noelle Yumul
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
| | - Audrey McKinlay
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- University of Canterbury, Christchurch, New Zealand
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
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Campbell A, Hartling L, Plourde V, Scott SD. Parental Knowledge, Self-confidence, and Usability Evaluation of a Web-Based Infographic for Pediatric Concussion: Multimethod Study. JMIR Pediatr Parent 2022; 5:e36317. [PMID: 35536631 PMCID: PMC9131137 DOI: 10.2196/36317] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Concussions, which are known as mild traumatic brain injuries, are complex injuries caused by direct or indirect blows to the head and are increasingly being recognized as a significant public health concern for children and their families. Previous research has identified few studies examining the efficacy of educational interventions on parental concussion knowledge. The aim of this research was to actively work together with children who have experienced a concussion and their parents to develop, refine, and evaluate the usability of a web-based infographic for pediatric concussion. OBJECTIVE The objective of this study was to report on the usability of the infographic, parental knowledge, and self-confidence in pediatric concussion knowledge before and after exposure to the infographic. METHODS A multiphase, multimethod research design using patient engagement techniques was used to develop a web-based infographic. For this phase of the research (usability, knowledge, and confidence evaluation), parents who could communicate in English were recruited via social media platforms and invited to complete web-based questionnaires. Electronic preintervention and postintervention questionnaires were administered to parents to assess changes to concussion knowledge and confidence after viewing the infographic. A usability questionnaire with 11 items was also completed. RESULTS A web-based, infographic was developed. The infographic is intended for parents and children and incorporates information that parents and children identified as both wants and needs about concussion alongside the best available research evidence on pediatric concussion. A total of 31 surveys were completed by parents. The mean scores for each item on the usability surveys ranged from 8.03 (SD 1.70) to 9.26 (SD 1.09) on a 10-point Likert scale, indicating that the usability components of the infographic were largely positive. There was no statistically significant difference between preintervention and postintervention knowledge scores (Z=-0.593; P=.55; both preintervention and postintervention knowledge scores had a median of 9 out of 10). In contrast, there was a statistically significant difference between preintervention (mean 3.9/5, SD 0.56) and postintervention (mean 4.4/5, SD 0.44) confidence in knowledge scores (t30=-5.083; P<.001). CONCLUSIONS Our results demonstrate that parents positively rated a web-based, infographic for pediatric concussion. In addition, although there was no statistically significant difference overall in parents' knowledge scores before and after viewing the infographic, their confidence in their knowledge did significantly increase. These results suggest that using a web-based infographic as a knowledge translation intervention may be useful in increasing parents' confidence in managing their child's concussion.
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Affiliation(s)
- Alyson Campbell
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vickie Plourde
- École de Psychologie, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, NB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Yumul JN, Crowe L, Catroppa C, Anderson V, McKinlay A. Post-concussive Signs and Symptoms in Preschool Children: A Systematic Review. Neuropsychol Rev 2021; 32:631-650. [PMID: 34390464 DOI: 10.1007/s11065-021-09518-z] [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: 09/04/2020] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Mild traumatic brain injury (mTBI) is common in children aged < 5 years, however, less is known about their experience of post-concussive signs and symptoms. This systematic review aims to identify post-concussive signs and symptoms experienced by preschool children up to 12 months post-injury, and to review the methods used to report this data. Relevant findings, including rates, progression, and possible predictors of post-concussive signs and symptoms were also identified. Databases (Ovid MEDLINE, EMBASE, PsycInfo, PubMed, Scopus) and reference lists were searched for relevant articles, which were screened based on specified criteria. Eleven articles met the inclusion criteria, being original studies published in English and presenting data on post-concussive signs and symptoms specific to preschool children with mTBI. Most reviewed studies investigated acute presentations of mTBI, and identified that preschool children demonstrate post-concussive symptoms (PCS) similar to other age groups. Post-traumatic amnesia duration of approximately one day was reported in preschool children following mTBI, as were changes in mood and behavior during the recovery period. Parents were the main informants, with data obtained through either interview or questionnaire. Review findings highlight the lack of empirical data regarding the presentation and progression of PCS in preschoolers following mTBI and evidence on how to best manage this group during recovery.
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Affiliation(s)
- Joy Noelle Yumul
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia. .,Murdoch Children's Research Institute, Melbourne, Australia.
| | - Louise Crowe
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Cathy Catroppa
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Audrey McKinlay
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Psychology, University of Canterbury, Christchurch, New Zealand
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Ly A, Zemek R, Wright B, Zwicker J, Schneider K, Mikrogianakis A, Conradi A, Johnson D, Clark B, Barlow K, Burey J, Kolstad A, Yeates KO. "What is the actual goal of the pathway?": examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework. BMC Health Serv Res 2021; 21:119. [PMID: 33546684 PMCID: PMC7863464 DOI: 10.1186/s12913-021-06110-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/21/2021] [Indexed: 01/17/2023] Open
Abstract
Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.
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Affiliation(s)
- Anh Ly
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Roger Zemek
- Department of Pediatrics, University of Ottawa, 75 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta, 3-513 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 2R7, Canada
| | - Jennifer Zwicker
- University of Calgary, School of Public Policy, 906 8th Avenue SW, Calgary, Alberta, T2P 1H9, Canada
| | - Kathryn Schneider
- University of Calgary, Faculty of Kinesiology, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Angelo Mikrogianakis
- Department of Pediatrics, McMaster University, 1280 Main Street, Hamilton, Ontario, L8S 4K1, Canada
| | - Alf Conradi
- Department of Pediatrics, University of Alberta, 4-539 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 2R7, Canada
| | - David Johnson
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, Calgary, T3B 6A8, Canada
| | - Brenda Clark
- Department of Pediatrics, University of Alberta, 10230 111 Avenue, Edmonton, Alberta, T5G 0B7, Canada
| | - Karen Barlow
- University of Queensland, Child Health Research Centre, Brisbane, QLD, 4072, Australia
| | - Joseph Burey
- Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4, Canada
| | - Ash Kolstad
- University of Calgary, Faculty of Kinesiology, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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Sensitivity and Specificity of a Multimodal Approach for Concussion Assessment in Youth Athletes. J Sport Rehabil 2021; 30:850-859. [PMID: 33547256 DOI: 10.1123/jsr.2020-0279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/21/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Current international consensus endorses a multimodal approach to concussion assessment. However, the psychometric evaluation of clinical measures used to identify postconcussion performance deficits once an athlete is asymptomatic remains limited, particularly in the pediatric population. OBJECTIVE To describe and compare the sensitivity and specificity of a multimodal assessment battery (balance, cognition, and upper and lower body strength) versus individual clinical measures at discriminating between concussed youth athletes and noninjured controls when asymptomatic. DESIGN Prospective cohort study. SETTING Hospital laboratory setting. PARTICIPANTS A total of 32 youth athletes with a concussion and 32 matched (age and sex) noninjured control participants aged 10-18 years. INTERVENTION(S) Participants were administered preinjury (baseline) assessments of cognition (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT]), balance (BioSway), and upper and lower body strength (grip strength and standing long jump). Assessments were readministered when concussed participants reported symptom resolution (asymptomatic time point). Noninjured control participants were reassessed using the same time interval as their concussion matched pair. Sensitivity and specificity were calculated using standardized regression-based methods and receiver operating characteristic curves. MAIN OUTCOME MEASURES Outcome measures included baseline and postinjury ImPACT, BioSway, grip strength, and standing long jump scores. RESULTS When asymptomatic, declines in performance on each individual clinical measure were seen in 3% to 22% of the concussion group (sensitivity = 3%-22%) compared with 3% to 13% of the noninjured control group (specificity = 87%-97%) (90% confidence interval). The multimodal battery of all combined clinical measures yielded a sensitivity of 41% and a specificity of 77% (90% confidence interval). Based on discriminative analyses, the multimodal approach was statistically superior compared with an individual measures approach for balance and upper and lower body strength, but not for cognition. CONCLUSIONS Results provide a foundation for understanding which domains of assessment (cognition, balance, and strength) may be sensitive and specific to deficits once symptoms resolve in youth athletes. More work is needed prior to clinical implementation of a preinjury (baseline) to postinjury multimodal approach to assessment following concussion in youth athletes.
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Macartney G, Simoncic V, Goulet K, Aglipay M. Concussion Symptom Prevalence, Severity and Trajectory: Implications for Nursing Practice. J Pediatr Nurs 2018; 40:58-62. [PMID: 29776480 DOI: 10.1016/j.pedn.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the symptom severity and trajectory in concussed children who were followed during a one year period at a concussion clinic. DESIGN AND METHODS A retrospective chart review was completed to describe the symptom trajectory up to three months during the recovery. RESULTS One hundred and thirty-six patients were included (74 female, 62 male) with a median age of 15.4years (range 13-17). The most common mechanisms of injury included: falls (19.9%), hockey injuries (15.4%), soccer (14.0%) and football injuries (6.6%). Most concussion symptoms decreased in severity or improved over time. Four symptoms including fatigue/low energy, drowsiness, concentration difficulties and irritability had the highest symptoms scores at both 28 and 84days post-injury in patients with persistent symptoms. Emotionality and nervousness/anxiousness and nausea/vomiting scores were seen to increase over time in patients with persistent symptoms. IMPLICATIONS Clinical use of standardized assessment tools can help caregivers track and monitor concussion symptoms over time. Appropriate management strategies need to be devised for symptoms that are prevalent or increasing over time.
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Affiliation(s)
- Gail Macartney
- Children's Hospital of Eastern Ontario (CHEO), Canada; CHEO Research Institute, Canada.
| | | | - Kristian Goulet
- Children's Hospital of Eastern Ontario (CHEO), Canada; CHEO Research Institute, Canada
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Daverio M, Babl FE, Barker R, Gregori D, Da Dalt L, Bressan S. Helmet use in preventing acute concussive symptoms in recreational vehicle related head trauma. Brain Inj 2018; 32:335-341. [PMID: 29355399 DOI: 10.1080/02699052.2018.1426107] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Helmets use has proved effective in reducing head trauma (HT) severity in children riding non-motorised recreational vehicles. Scant data are available on their role in reducing concussive symptoms in children with HT while riding non-motorised recreational vehicles such as bicycles, push scooters and skateboards (BSS). We aimed to investigate whether helmet use is associated with a reduction in acute concussive symptoms in children with BSS-related-HT. METHODS Prospective study of children <18 years who presented with a BSS related-HT between April 2011 and January 2014 at a tertiary Paediatric Emergency Department (ED). RESULTS We included 190 patients. Median age 9.4 years (IQR 4.8-13.8). 66% were riding a bicycle, 23% a push scooter, and 11% a skateboard. 62% were wearing a helmet and 62% had at least one concussive symptom. Multivariate logistic regression analysis adjusting for age, gender, and type of vehicle showed that patients without a helmet presented more likely with headache (adjusted odds-ratio (aOR) 2.54, 95% CI 1.27-5.06), vomiting (aOR 2.16, 95% CI 1.00-4.66), abnormal behaviour (aOR 2.34, 95% CI 1.08-5.06), or the presence of at least one concussive symptom (aOR 2.39, 95% CI 1.20-4.80). CONCLUSIONS In children presenting to the ED following a wheeled BSS-related HT helmet use was associated with less acute concussive symptoms. ABBREVIATIONS aOR, adjusted odds ratio; APHIRST, Australasian Paediatric Head Injury Rules Study; BSS, bicycles, push scooters and skateboards; CI, confidence interval; CT, computed tomography; ED, emergency department; HT, head trauma; IQR, interquartile range; OR, odds ratio; RCH, Royal Children's Hospital; RV, recreational vehicle.
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Affiliation(s)
- Marco Daverio
- a Murdoch Children's Research Institute , Melbourne , Victoria , Australia.,b Department of Woman's and Child's Health, Department of Paediatrics , University of Padova , Padova , Italy
| | - Franz E Babl
- a Murdoch Children's Research Institute , Melbourne , Victoria , Australia.,c Emergency Department , Royal Children's Hospital , Melbourne , Victoria , Australia.,d Department of Paediatrics, Faculty of Medicine , Dentistry and Health Sciences, University of Melbourne , Melbourne , VIC , Australia
| | - Ruth Barker
- e Queensland Injury Surveillance Unit , Mater Medical Research Institute , South Brisbane Queensland , Australia
| | - Dario Gregori
- f Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences , University of Padova , Padova , Italy
| | - Liviana Da Dalt
- b Department of Woman's and Child's Health, Department of Paediatrics , University of Padova , Padova , Italy
| | - Silvia Bressan
- a Murdoch Children's Research Institute , Melbourne , Victoria , Australia.,b Department of Woman's and Child's Health, Department of Paediatrics , University of Padova , Padova , Italy
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Namjoshi DR, Cheng WH, Carr M, Martens KM, Zareyan S, Wilkinson A, McInnes KA, Cripton PA, Wellington CL. Chronic Exposure to Androgenic-Anabolic Steroids Exacerbates Axonal Injury and Microgliosis in the CHIMERA Mouse Model of Repetitive Concussion. PLoS One 2016; 11:e0146540. [PMID: 26784694 PMCID: PMC4718534 DOI: 10.1371/journal.pone.0146540] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/17/2015] [Indexed: 12/14/2022] Open
Abstract
Concussion is a serious health concern. Concussion in athletes is of particular interest with respect to the relationship of concussion exposure to risk of chronic traumatic encephalopathy (CTE), a neurodegenerative condition associated with altered cognitive and psychiatric functions and profound tauopathy. However, much remains to be learned about factors other than cumulative exposure that could influence concussion pathogenesis. Approximately 20% of CTE cases report a history of substance use including androgenic-anabolic steroids (AAS). How acute, chronic, or historical AAS use may affect the vulnerability of the brain to concussion is unknown. We therefore tested whether antecedent AAS exposure in young, male C57Bl/6 mice affects acute behavioral and neuropathological responses to mild traumatic brain injury (TBI) induced with the CHIMERA (Closed Head Impact Model of Engineered Rotational Acceleration) platform. Male C57Bl/6 mice received either vehicle or a cocktail of three AAS (testosterone, nandrolone and 17α-methyltestosterone) from 8-16 weeks of age. At the end of the 7th week of treatment, mice underwent two closed-head TBI or sham procedures spaced 24 h apart using CHIMERA. Post-repetitive TBI (rTBI) behavior was assessed for 7 d followed by tissue collection. AAS treatment induced the expected physiological changes including increased body weight, testicular atrophy, aggression and downregulation of brain 5-HT1B receptor expression. rTBI induced behavioral deficits, widespread axonal injury and white matter microgliosis. While AAS treatment did not worsen post-rTBI behavioral changes, AAS-treated mice exhibited significantly exacerbated axonal injury and microgliosis, indicating that AAS exposure can alter neuronal and innate immune responses to concussive TBI.
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Affiliation(s)
- Dhananjay R. Namjoshi
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Wai Hang Cheng
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Michael Carr
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kris M. Martens
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Shahab Zareyan
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Anna Wilkinson
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kurt A. McInnes
- Department of Biomechanical Engineering, University of British Columbia, Vancouver, Canada
| | - Peter A. Cripton
- Department of Biomechanical Engineering, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Cheryl L. Wellington
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
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