Dr. Williams Discusses Concussion Guidelines with Orthopedics This Week

Dr. Williams Discusses Concussion Guidelines with Orthopedics This Week

Posted By Vernon B. Williams, MD || 7-Mar-2017

Tracey Romero • Wed, March 1st, 2017
A new concussion model of repeat, mild, bilateral traumatic brain injury (TBI) induced earlier onset of familial amyotrophic lateral sclerosis (ALS) symptoms in rats with the human SOD1 mutation (SOD1), providing a better understanding of the relationship between TBI and neurodegenerative diseases.
The model developed by Gretchen Thomsen, Ph.D., of the Regenerative Medicine Institute at Cedars-Sinai Medical Center in Los Angeles and colleagues, was published in the December 2016 issue of the Journal of Trauma and Acute Care Surgery.

Thomsen recently shared her research during a sports concussion panel at a Cedars-Sinai conference, “Regenerative and Neurological Trauma: From the Playing Field to the Battlefield,” held February 9 and 10, 2017 at Sofitel Los Angeles at Beverly Hills in Los Angeles, California. The conference featured two days of scientific sessions on military sports concussions/traumatic brain injury, spinal cord trauma, and regenerative approaches.

Traumatic Brain Injury and Neurodegenerative Diseases

Thomsen and her colleagues have been using animal models to look at amyotrophic lateral sclerosis (ALS) and long term effects of brain injury. She explained that while they see the phenomenon of chronic traumatic encephalopathy
(CTE) and ALS in athletes, the mechanisms by which this may happen and how it relates to type of impact hasn’t been clear.

To develop their most recent model, Thomsen and colleagues evaluated functional and pathological consequences of repeated traumatic brain injury (TBI) over time in wild type rats and rats harboring the human SOD1 (“SOD1”) mutation, a model of familial amyotrophic lateral sclerosis (ALS). The rats at 60 days of age were exposed to mild, bilateral TBI once per week for either two weeks or five weeks using a controlled cortical impact device. The two-week injured rats initially recovered motor function, but never recovered to baseline during the 12-week study. The five-week injured rats exhibited more significant deficits overall. The SOD1 TBI rate also showed early onset of the ALS phenotype.

Thomsen and colleagues concluded, “Unlike previous models of repeat brain injury, which demonstrates only transient deficits in motor function, our concussion model of repeat, mild, bilateral TBI induced long-lasting deficits in motor function, decreased cortical thickness, shrinkage of the corpus callosum, increased brain tauopathy, and earlier onset of ALS symptoms in SOD1 rats.
“This model may allow for a greater understanding of the complex relationship between TBI and neurodegenerative diseases and provides a potential method for testing novel therapeutic strategies.”

Thomsen told OTW, “We now have a good model of CTE. Before we thought mice could recover from mild impact, but now we know that when there is repeat impact, the brain can’t recover.”
She also said they are looking at biomarkers and imaging studies in these animal models to help understand repetitive brain injury in humans and to develop therapeutics for treatment. The hope is that by developing these animal models, they won’t have to wait until an athlete dies to understand the impact the concussion has on the brain. They also hope to create variations of the models to relate to different populations like soccer and football.

Collaboration Between Scientists, Clinicians and Athletes

Besides new research, collaboration between scientists, clinicians and athletes was also a focus of the conference. Two former professional athletes, Ex-NFL football player Ben Utecht, author of Counting the Days While My Mind Slips Away: A Love Letter to My Family; and ex-Major League Soccer player Alecko Eskandarian, now assistant coach for the New York Cosmos, also participated in the concussion panel with Thomsen, sharing their personal experiences with concussion-related brain damage.

“It was really important to have these retired athletes be a part of the conversation and have dialogue with the scientists and clinicians,” Thomsen said. She is a soccer player herself, having played division one at Villanova University and later in W-League. “I used to head the ball for an hour after practice and now I look back and ask will I let my child do this?” Because there are also so many nonprofessional athletes, she believes that they should be a part of the conversation

Eric Ley, M.D., director of the Surgical Intensive Care Unit and director of the Surgical Care Fellowship Program at Cedars-Sinai and Vernon B. Williams, M.D., a physician with Kerlan-Jobe who specializes in pain management and sports neurology also participated in the conference, which was co-sponsored by the Cedars-Sinai Board of Governors Regenerative Medicine Institute, the Cedars-Sinai Department of Surgery and the Kerlan-Jobe Orthopaedic Clinic, a Cedars-Sinai affiliate.
Williams’ presentation was on “Clinical evaluation of sports concussion: what we know…and wish we knew,” and one of the topics he discussed was the guidelines on sports concussions. He explained that most guidelines talk about the signs and symptoms of concussion and risk factors and tools for evaluation, adding that most experts agree with the guidelines whether they are evidence-based or from a consensus statement.

“This information is necessary if you are managing athletes, but there is so much more we really should know,” Williams said. “We are all interested in a collaboration between scientists and clinicians. Part of the goal of interaction is to help one another,” he said.

He explained that clinicians could share what questions they have about brain injury with scientists to help guide research, and scientists can in turn share with clinicians what they are finding out in the lab.

He added, “We wish we knew why some people will recover quickly, while others have lingering symptoms. When a patient comes in with a concussion, it is hard to tell where he or she will fall.”
He also wished there was a better understanding of genetic and environmental factors. For example, he explained that we have non-neurological contributors like depression that can’t be studied in a lab.

Categories: In the News

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