Identifying Research Needs in Brain Injuries
Ann McKee, MD, professor of Neurology and Pathology at Boston University School of Medicine, called for more research on brain trauma at the 2017 Regenerative Medicine Institute Symposium.
Leading scientists and clinicians from around the country gathered recently at Cedars-Sinai for the 2017 Regenerative Medicine Institute Symposium to present their latest research and identify the most pressing areas for further study about traumatic brain injury and sports concussions.
The two-day symposium, "Regeneration and Neurological Trauma: From the Playing Field to the Battle Field," was co-sponsored by the Cedars-Sinai Board of Governors Regenerative Medicine Institute, the Department of Surgery and the Kerlan-Jobe Institute, a Cedars-Sinai affiliate.
The meeting highlighted several new studies that advanced understanding of how head trauma can temporarily, and sometimes permanently, alter brain physiology. While nodding to the promising new research, speakers called for additional work to expand the field's still-limited knowledge about the brain.
"It's the most complex organ in our body, and we know the least about it," retired U.S. Army Col. Dallas Hack, MD, former director of the Combat Casualty Care Research Program at Fort Detrick, Maryland, told the audience at Harvey Morse Auditorium on Friday, Feb. 10.
In the symposium's keynote speech, Peter Rhee, MD, senior vice president and chief of trauma at Grady Health System in Atlanta, urged physicians to treat gunshot wounds to the brain more aggressively. Only about 10 percent of these patients typically survive, he said.
Rhee, who treated former U.S. Rep. Gabrielle Giffords after she was shot in the head in 2011, advocated a regimen that includes transfusion of blood products and treatment to control brain swelling. At the University of Arizona Medical Center in Tucson, this regimen raised the survival rate to 46 percent for brain-injured gunshot victims, Rhee said.
"If you manage these people with a different philosophy, you'll have a better outcome," he said.
Contact Sports, CTE and Concussions
In another lecture, Ann McKee, MD, professor of Neurology and Pathology at Boston University School of Medicine, widely viewed as one the nation's top experts on chronic traumatic encephalopathy (CTE), discussed the progressive degenerative disease and its links to contact sports such as football, hockey and boxing. The disease, which can cause memory loss, explosive behavior, depression and dementia, has garnered vast media attention largely because of its potential impact on athletes in the National Football League.
CTE currently has no treatment or cure. The disease, which is characterized by deposits in the brain of an abnormal protein called tau, can only be diagnosed post-mortem.
"Let's figure out a way to prevent this disease, a way to treat this disease," said McKee. "We want to give hope, inspiration and optimism to players who are worried they have it. Right now, we can't."
While concern over concussions, especially for parents weighing whether to let their children play tackle football, has come to dominate the national conversation, the available evidence suggests the more pronounced danger may lay elsewhere. Rather than a single injury to the brain, it is repeated mild trauma over a period of years that appears to have the clearest relationship to future brain impairment, said McKee and other scientists at the symposium. About 16 percent of people with CTE never experienced a diagnosed concussion, she added.
Research about CTE is just beginning, said McKee, who offered a list of the most urgent questions, including:
- How common is CTE?
- Can anyone get CTE or is there a genetic susceptibility?
- Are young brains more susceptible to CTE?
- Once it starts, how does it spread even though there is no more trauma?
- Does CTE provoke other neurodegenerative diseases?
Working to provide insight into CTE is Gretchen Thomsen, PhD, a research scientist at Cedars-Sinai. Thomsen discussed her recent findings that showed the lasting impact of repeated concussions. The study, which was done in collaboration with Eric Ley, MD, director of Cedar-Sinai's Surgical Intensive Care Unit in the Department of Surgery, may help lead to models to test potential therapies.
Ben Utecht, a former NFL player, (right) and Alecko Eskandarian, a former MLS player, talk about their experiences with concussions during an evening panel.
In the Clinic and On the Football Field
From a clinical perspective, Vernon Williams, MD, with the Kerlan-Jobe Institute, said it's been challenging to educate athletes about what happens inside the brain during a concussion. It takes at least a couple of days for cerebral blood flow to return to normal, he explains to athletes. Force of will cannot reverse the physical symptoms of a concussion, he added.
"This is not something you can just shake off because you're tough," said Williams. "The culture of sports is so strong, and so is the power of denial. People will either underreport, minimize or not report symptoms at all even though they know it might be in their best interests."
Few understand the difficulty of an athlete voluntarily stepping off the playing field more than Ben Utecht, a former NFL player who spoke at a symposium panel on Thursday, Feb. 9. Utecht, who suffered numerous concussions during his career and later wrote Counting the Days While My Mind Slips Away: A Love Letter to My Family, explained the game is a powerful source of identity for players that often transcends fame and money.
"You can take away the millions of dollars and many players would still want to play," said Utecht, who once testified at a congressional hearing about the long-term effects of concussions.
Still, extensive media attention about concussions and CTE has produced an unexpected consequence that Williams observed is playing out with increasing frequency in his clinic. Amid the swirl of highly publicized tragedies linked to CTE, some young athletes who have suffered a concussion are catastrophizing their relatively minor symptoms.
"I've had patients fill in the new-patient history form, and in the chief complaint section it doesn't say headaches or dizziness," said Williams. "It says CTE."