Brain Injury

Study Finds Head Impacts in Contact Sports May Reduce Learning in College Athletes

ababb@aan.com — Wed, 16 May 2012 21:00:00 GMT

A new study suggests that head impacts experienced during contact sports such as football and hockey may worsen some college athletes' ability to acquire new information. The research is published in the May 16, 2012, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study involved college athletes at three Division I schools and compared 214 athletes in contact sports to 45 athletes in non-contact sports such as track, crew and Nordic skiing at the beginning and at the end of their seasons. The contact sport athletes wore special helmets that recorded the acceleration speed and other data at the time of any head impact. The contact sport athletes experienced an average of 469 head impacts during the season. Athletes were not included in the study if they were diagnosed with a concussion during the season. All of the athletes took tests of thinking and memory skills before and after the season. A total of 45 contact sport athletes and 55 non-contact sport athletes from one of the schools also took an additional set of tests of concentration, working memory and other skills. "The good news is that overall there were few differences in the test results between the athletes in contact sports and the athletes in non-contact sports," said study author Thomas W. McAllister, MD, of The Geisel School of Medicine at Dartmouth in Lebanon, N.H. "But we did find that a higher percentage of the contact sport athletes had lower scores than would have been predicted after the season on a measure of new learning than the non-contact sport athletes." A total of 22 percent of the contact sport athletes performed worse than expected on the test of new learning, compared to four percent of the non-contact sport athletes. McAllister noted that the study did not find differences in test results between the two groups of athletes at the beginning of the season, suggesting that the cumulative head impacts that contact athletes had incurred over many previous seasons did not result in reduced thinking and memory skills in the overall group. "These results are somewhat reassuring, given the recent heightened concern about the potential negative effects of these sports," he said. "Nevertheless, the findings do suggest that repetitive head impacts may have a negative effect on some athletes." McAllister said it's possible that some people may be genetically more sensitive to head impacts. The study was supported by the National Institutes of Health and the National Operating Committee on Standards for Athletic Equipment. To learn more about concussion, visit http://www.aan.com/patients. The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson's disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

NFL Players May Be at Higher Risk of Death from Alzheimer's and ALS

ababb@aan.com — Wed, 05 Sep 2012 16:32:15 GMT

New research shows that professional football players may be at a higher risk of death from diseases that damage the cells in the brain, such as Alzheimer's disease and ALS (also known as Lou Gehrig's disease), compared to the general U.S. population. The study is published in the September 5, 2012, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study included 3,439 players with an average age of 57 from the National Football League with at least five playing seasons from 1959-1988. Researchers reviewed death certificates for causes of death from Alzheimer's disease, Parkinson's disease and ALS. At the time of the analysis, only 10 percent of the participants had passed away. The research found that professional football players in this study were three times more likely to die as a result of diseases that damage brain cells compared to the general population. A player's risk of death from Alzheimer's disease or ALS was almost four times higher than the general population. Of the 334 who died, seven had Alzheimer's disease and seven had ALS. The risk of dying from Parkinson's disease was not significantly different than that of the general population. To determine if these risks differed by position played, researchers divided the players into two groups: those who played non-line ("speed") positions which included quarterbacks, running backs, halfbacks, fullbacks, wide receivers, tight ends, defensive backs, safeties and linebackers, and those who played line ("non-speed") positions, which included defensive and offensive linemen. Speed position players were more than three times more likely to die from a neurodegenerative cause than non-speed position players. A total of 62 percent of the players were in speed positions. "These results are consistent with recent studies that suggest an increased risk of neurodegenerative disease among football players," said study author Everett J. Lehman, MS, with the National Institute for Occupational Safety and Health in Cincinnati. "Although our study looked at causes of death from Alzheimer's disease and ALS as shown on death certificates, research now suggests that chronic traumatic encephalopathy (CTE) may have been the true primary or secondary factor in some of these deaths. A brain autopsy is necessary to diagnose CTE and distinguish it from Alzheimer's or ALS. While CTE is a separate diagnosis, the symptoms are often similar to those found in Alzheimer's, Parkinson's and ALS, and can occur as the result of multiple concussions." Lehman said the study was limited by the small number of deaths in the analysis. The study was supported by the National Institute for Occupational Safety and Health. To learn more about CTE, Alzheimer's disease, ALS and Parkinson's disease, visit http://www.aan.com/patients. The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson's disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

We Need Your Story! Now Accepting Entries for 2013 Neuro Film Festival

ababb@aan.com — Mon, 10 Sep 2012 19:11:59 GMT

The American Brain Foundation, the foundation for the American Academy of Neurology, is now accepting video entries to its 2013 Neuro Film Festival. Now in its fourth year, the Neuro Film Festival is a contest to raise awareness about why more money is needed for research to find cures for brain diseases such as Alzheimer's disease, stroke, autism and Parkinson's disease. Winners could receive up to $1,000 and a trip to San Diego to see their film shown to a live audience at the Neuro Film Festival event. The deadline to enter is January 31, 2013, at http://www.NeuroFilmFestival.com. "Please consider submitting your video about someone with a brain disorder to help us make the case as to why more research is needed to help the 50 million Americans affected by brain disease," said John Mazziotta, MD, PhD, Chair of the American Brain Foundation's Board of Trustees and Professor and Chair of UCLA's Department of Neurology and Brain Mapping Center in Los Angeles. A video showing how to submit to the Neuro Film Festival is available at www.NeuroFilmFestival.com along with complete contest rules. Video entries should be no more than 5:00 minutes in length and include the phrase "Let's put our brains together to cure brain disease. Visit CureBrainDisease.org." Since 2010, nearly 300 videos have been submitted to the Neuro Film Festival along with thousands of votes cast from the public for their favorite entries. The American Brain Foundation supports vital research and education to discover causes, improved treatments, and cures for brain and other nervous system diseases. Learn more at http://www.CureBrainDisease.org or find the Foundation on Facebook and YouTube. The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson's disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

Head Injury + Pesticide Exposure = Triple the Risk of Parkinson's Disease

ababb@aan.com — Mon, 12 Nov 2012 22:00:00 GMT

A new study shows that people who have had a head injury and have lived or worked near areas where the pesticide paraquat was used may be three times more likely to develop Parkinson's disease. The study is published in the November 13, 2012, print issue of Neurology®, the medical journal of the American Academy of Neurology. Paraquat is a herbicide commonly used on crops to control weeds. It can be deadly to humans and animals. "While each of these two factors is associated with an increased risk of Parkinson's on their own, the combination is associated with greater risk than just adding the two factors together," said study author Beate Ritz, MD, PhD, of UCLA's Fielding School of Public Health. "This study suggests that the physiological process that is triggered by a head injury may increase brain cells' vulnerability to attacks from pesticides that can be toxic to the brain or the other way around, for example, chronic low dose exposure to pesticides may increase the risk of Parkinson's after a head injury." The study involved 357 people with Parkinson's disease and 754 people without the disease, all of whom lived in an agricultural area in central California. The participants reported any head injuries they had ever received with a loss of consciousness for more than five minutes. The researchers determined participants' exposure to the weed killer based on a 500-meter area around their home and work addresses, using a geographic information system (GIS) that combined data on paraquat use collected by the state of California's Pesticide Use Reporting system with land use maps. People with Parkinson's disease were twice as likely to have had a head injury with loss of consciousness for more than five minutes as people who did not have the disease. Of the 357 people with Parkinson's disease, 42, or 12 percent, reported ever having had such a head injury, compared to 50 of the 754 people without the disease, or 7 percent. People with Parkinson's disease were 36 percent more likely to have exposure to paraquat than those who did not have the disease. Of those with Parkinson's, 169 had exposure to the weed killer, or 47 percent, compared to 291 of those without the disease, or 39 percent. The study was supported by the National Institute of Environmental Health Science, National Institute of Neurological Disorders and Stroke, National Institutes of Health and American Parkinson Disease Association. To learn more about Parkinson's disease, visit http://www.aan.com/patients. The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson's disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

NFL Players May Be at Higher Risk for Depression as They Age

ababb@aan.com — Wed, 16 Jan 2013 22:00:00 GMT

National Football League (NFL) players may be at increased risk of depression as they age due to brain damage resulting from concussions, according to two studies released today that will be presented at the American Academy of Neurology's 65th Annual Meeting in San Diego, March 16 to 23, 2013. "The Centers for Disease Control and Prevention estimates that about 1.6 to 3.8 million sports concussions occur each year. While it is known that sports concussions can cause immediate disturbances in mood and thinking, few studies have investigated the long-term effects that may emerge later in life, especially those related to depression," said study author Nyaz Didehbani, PhD, of the Center for BrainHealth at The University of Texas at Dallas. "Our study shows that athletes who have sustained concussions in early adulthood may be at a higher risk for developing depression as they age compared to the general population. It is important when a concussive experience occurs that medical professionals appropriately include depression screening in their follow-up assessment. Depression is a treatable condition if the proper and necessary steps are taken." In the first study, researchers evaluated 34 retired NFL athletes with a history of concussion and 29 people of the same age from the general population with no concussion history. Participants were tested for depression. Concussions were retrospectively graded based on American Academy of Neurology guidelines. The researchers examined thinking skills, mood and the physical symptoms of depression. The study found that those athletes who exhibited greater symptoms on the Beck Depression Inventory scored significantly higher than the minimal range for depressive symptoms. The Beck Depression Inventory measures symptoms related to thinking, mood and the physical signs of depression. The retired athletes included in the study reported an average of four concussions, reinforcing the correlation between depression scores and the number of lifetime concussions. The second study included 26 retired NFL athletes. Of those, five had depression and 21 did not have depression. Diffusion tensor MRI brain scans were used to measure damage to white matter in the brain. White matter contains tissue and nerve fibers that help carry signals from one part of the brain to another. Damage to white matter occurs in traumatic brain injury and also has been seen in some people with depression. By looking at the amount of white matter damage in one area of the brain, researchers could predict which former players had depression with 100 percent sensitivity and 95 percent specificity. Sensitivity is the percentage of actual positives that are correctly identified as positive, and specificity is the percentage of negatives that are correctly identified. The severity of the depressive symptoms was also associated with the degree of white matter damage in a wide range of brain regions. "Aside from providing important insights into the nature of depression as it relates to brain damage in retired NFL athletes who have been exposed to concussive and repetitive head injuries, this study also may help us to understand the similar behavioral symptoms seen in other sports-related head injuries and in combat-related blast injuries seen in armed service members," said study author Kyle Womack, MD, of the University of Texas Southwestern Medical Center in Dallas. Both studies were primarily supported by the the BrainHealth Institute for Athletes at the Center for BrainHealth, a research center at the University of Texas at Dallas. The second study also was supported by the National Institutes of Health. Learn more about concussion at http://www.aan.com/concussion. The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson's disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

AAN Issues Statement Applauding National Payment Reform Report

ababb@aan.com — Tue, 05 Mar 2013 18:15:01 GMT

The American Academy of Neurology (AAN), the world's largest association of neurologists, is applauding today's "Report of the National Commission on Physician Payment Reform" for highlighting the importance of fair reimbursement for evaluation and management (E/M) services, also known as face-to-face care or cognitive care, for medical specialties such as neurology. Evaluation and management services are used by neurologists to care for the estimated 50 million people in the United States affected by a brain disease. US doctors must use E/M, a series of medical procedural codes, to be reimbursed by programs such as Medicare, Medicaid and private health insurers for patient visits. The report is also gaining praise from the AAN for acknowledging that the recent emphasis on E/M services provided only by primary care physicians misses the mark and excludes consideration of cognitive specialists such as neurologists. "The commission reached out for broad input, and we are pleased the recommendations reflect many of the concerns the AAN shared several months ago about E/M services and the role of care coordination. We hope Congress and CMS act on these recommendations and reward the high-quality care that neurologists provide to their patients," said Bruce Sigsbee, MD, FAAN, President of the American Academy of Neurology. Sigsbee notes that neurologists are seeking fair reimbursement for face-to-face care of neurology patients in hopes of reducing wait times to see a neurologist and preventing a nationwide shortage of neurologists to care for people with brain diseases. "The increasing number of people neurologists treat with complex, chronic brain conditions such as Alzheimer's disease, Parkinson's disease, stroke, autism and epilepsy requires that new payment systems reward ongoing care management and coordination that will result in high-quality, efficient care," said Sigsbee. To learn more about brain disease, visit http://www.aan.com/patients. The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson's disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

Study: Brain Imaging After Mild Head Injury/Concussion Can Show Lesions

ababb@aan.com — Fri, 15 Mar 2013 15:18:16 GMT

Brain imaging soon after mild traumatic brain injury (mTBI) or mild concussion can detect tiny lesions that may eventually provide a target for treating people with mTBI, according to a study released today and that will be presented at the American Academy of Neurology's 65th Annual Meeting in San Diego, March 16 to 23, 2013. Studies of brain tissue once a person has died have shown that different types of lesions are associated with more severe TBI. "Our study suggests that imaging may be used to detect and distinguish between these lesions in a living person with mTBI and this finding has important implications for treatment," said Gunjan Parikh, MD, with the National Institute of Neurological Disorders and Stroke and the University of Maryland R Adams Cowley Shock Trauma Center in Baltimore, MD. Parikh is also a member of the American Academy of Neurology. The study involved 256 people with an average age of 50 who were admitted to the emergency department at Suburban Hospital in Bethesda and Washington Hospital Center in the District of Columbia after mild head injuries. They underwent magnetic resonance imaging (MRI) brain scans. Of those, 104 had imaging evidence of hemorrhage in the brain (67 percent reported loss of consciousness, and 65 percent reported amnesia, or temporary forgetfulness). People with hemorrhages underwent more detailed brain scans with advanced MRI within an average of 17 hours after the injury. Advanced imaging showed that-of those 104 people with imaging evidence of hemorrhage-20 percent had microbleed lesions and 33 percent had tube-shaped linear lesions. Microbleeds were distributed throughout the brain whereas linear lesions, which were found mainly in one area, were more likely to be associated with injury to adjacent brain tissue. The investigators hypothesized that the linear lesions seen on MRI may represent a type of vascular injury that is seen in brain tissue studies of people with more severe TBI. "If that theory is confirmed, it may provide an opportunity to develop treatment strategies for people who have suffered a mild TBI," said Parikh. The study was supported by the National Institutes of Health, the National Institute of Neurological Disorders and Stroke and the Center for Neuroscience and Regenerative Medicine at the Uniformed Services University of the Health Sciences, a collaborative effort among NIH, the Department of Defense and Walter Reed National Military Medical Center to develop innovative approaches to brain injury diagnosis and recovery. Learn more about concussion at http://www.aan.com/patients. The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson's disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

AAN Issues Updated Sports Concussion Guideline: Athletes with Suspected Concussion Should Be Removed from Play

ababb@aan.com — Mon, 18 Mar 2013 19:00:00 GMT

With more than one million athletes now experiencing a concussion each year in the United States, the American Academy of Neurology (AAN) has released an evidence-based guideline for evaluating and managing athletes with concussion. This new guideline replaces the 1997 AAN guideline on the same topic. The new guideline is published in the March 18, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology, was developed through an objective evidence-based review of the literature by a multidisciplinary committee of experts and has been endorsed by a broad range of athletic, medical and patient groups. "Among the most important recommendations the Academy is making is that any athlete suspected of experiencing a concussion immediately be removed from play," said co-lead guideline author Christopher C. Giza, MD, with the David Geffen School of Medicine and Mattel Children's Hospital at UCLA and a member of the AAN. "We've moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually. There is no set timeline for safe return to play." The updated guideline recommends athletes with suspected concussion be immediately taken out of the game and not returned until assessed by a licensed health care professional trained in concussion, return to play slowly and only after all acute symptoms are gone. Athletes of high school age and younger with a concussion should be managed more conservatively in regard to return to play, as evidence shows that they take longer to recover than college athletes. The guideline was developed reviewing all available evidence published through June 2012. These practice recommendations are based on an evaluation of the best available research. In recognition that scientific study and clinical care for sports concussions involves multiple specialties, a broad range of expertise was incorporated in the author panel. To develop this document, the authors spent thousands of work hours locating and analyzing scientific studies. The authors excluded studies that did not provide enough evidence to make recommendations, such as reports on individual patients or expert opinion. At least two authors independently analyzed and graded each study. According to the guideline: Among the sports in the studies evaluated, risk of concussion is greatest in football and rugby, followed by hockey and soccer. The risk of concussion for young women and girls is greatest in soccer and basketball. An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion. The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with another concussion. There is no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet. Helmets should fit properly and be well maintained. Licensed health professionals trained in treating concussion should look for ongoing symptoms (especially headache and fogginess), history of concussions and younger age in the athlete. Each of these factors has been linked to a longer recovery after a concussion. Risk factors linked to chronic neurobehavioral impairment in professional athletes include prior concussion, longer exposure to the sport and having the ApoE4 gene. Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis. Signs and symptoms of a concussion include: Headache and sensitivity to light and sound Changes to reaction time, balance and coordination Changes in memory, judgment, speech and sleep Loss of consciousness or a "blackout" (happens in less than 10 percent of cases) "If in doubt, sit it out," said Jeffrey S. Kutcher, MD, with the University of Michigan Medical School in Ann Arbor and a member of the AAN. "Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain; treat it well." The guideline states that while an athlete should immediately be removed from play following a concussion, there is currently insufficient evidence to support absolute rest after concussion. Activities that do not worsen symptoms and do not pose a risk of repeat concussion may be part of concussion management. The guideline is endorsed by the National Football League Players Association, the American Football Coaches Association, the Child Neurology Society, the National Association of Emergency Medical Service Physicians, the National Academy of Neuropsychology, the National Association of School Psychologists, the National Athletic Trainers Association and the Neurocritical Care Society. To learn more about concussion, visit http://www.aan.com/concussion or download the Academy's new app, Concussion Quick Check, to quickly help coaches and athletic trainers recognize the signs of concussion. The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, concussion, Parkinson's disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

American Academy of Neurology Launches New App to Help Evaluate Sports Concussion at Games

ababb@aan.com — Mon, 18 Mar 2013 20:23:26 GMT

The American Academy of Neurology (AAN), the world's largest association of neurologists who treat brain injuries such as concussion, has launched a new app called "Concussion QuickCheck", to help coaches, athletic trainers, parents and athletes quickly evaluate if someone may have a concussion and needs to see a licensed health care provider, such as a neurologist, who is specialized in concussion. The app, which is available for iPad, IOS (Apple), Android, and mobile, was developed in partnership with the Academy's updated guideline for diagnosing and evaluating sports concussion. The announcement of the new app was made at the Academy's Annual Meeting in San Diego today in conjunction with the release of the 0TUupdated sports concussion guidelineU0T. Key information and tools in the "Concussion Quick Check" app include:

Common signs of concussion
Symptoms of concussion
Things the athlete may tell you
What to do if an athlete has a head injury during a game
What to do if it appears the athlete has a concussion
When an athlete should return to the game
Help finding a neurologist near you (GPS capability)
Help finding state laws on concussion
More about the Academy's new guideline for diagnosing, treating and managing sports concussion

"The American Academy of Neurology, the world's largest association of neurologists, is the trusted authority in managing sports concussion," said Christopher C. Giza, MD, with the David Geffen School of Medicine and Mattel Children's Hospital at UCLA and a member of the American Academy of Neurology, who helped develop the content for the Concussion Quick Check app. "We hope this easy-to-access tool will help coaches, athletic trainers, parents and athletes alike to quickly determine if an athlete shows signs of concussion and needs to see a licensed health care professional trained in managing concussion, such as a neurologist. It's a perfect tool to have on your iPad or smart phone when coaching or watching a game from the sidelines." Learn more at http://www.aan.com/concussion. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.