Anticipating Extended Recovery from Concussions and the Potential for Multiple Subsequent Blows to the Head

University of Rochester Study Aims to Improve Concussion Diagnosis and Treatment in Children

The University of Rochester is leading a groundbreaking study to better understand the impact of concussions on children, particularly in the context of repeated head hits. The research, funded by a $10 million grant from the National Institute of Neurological Disorders and Stroke (NINDS), involves several institutions, including the University of California, Los Angeles (UCLA), Children's National Hospital in Washington, D.C., and the University of Pittsburgh Medical Center (UPMC).

Jeffrey Bazarian, M.D., a professor at the University of Rochester Medical Center, is at the forefront of this project. Bazarian is investigating blood-based biomarkers, specifically UCH-L1 and GFAP proteins, as a means to monitor brain health in those exposed to repeated head hits. These proteins, when present in the blood, could indicate biochemical evidence of cellular disruption, allowing for early detection of subtle brain injury before symptoms appear.

Kian Merchant-Borna, research faculty in Emergency Medicine at the University of Rochester, is also a key player in this study. Merchant-Borna managed a clinical trial that helped lead to a blood test for concussion diagnosis, the Banyan Brain Trauma Indicator®, which was approved by the Food and Drug Administration in 2018. Merchant-Borna is also working with industry partners to bring tools like blood tests to market, assisting with bridging the gap in concussion diagnosis, brain monitoring, and recovery.

The study focuses on children between the ages of 11 and 18. Participating student-athletes from the University of Rochester football team are outfitted with helmets containing accelerometers to record the number, direction, and force of head blows during each practice and game. In addition, these student-athletes also undergo brain scans and blood draws before and after the season for research purposes.

The labs collect blood samples and other neurocognitive data from participants and follow their recovery, evaluating them along the way. The ultimate goal is to develop an algorithm to help with the diagnosis and treatment of concussed children, and to pave the way for future therapies that could help children recover from concussions faster.

Not knowing what is happening in the brain can affect an individual's quality of life in the long term, as concussion recovery can be difficult to track and symptoms often dissipate before the brain is fully healed. Repeated head hits can compound each other, potentially leading to chronic traumatic encephalopathy (CTE), a neurodegenerative disorder. CTE is a serious disease that causes debilitating symptoms and premature death, and can only be diagnosed posthumously.

The NFL is also expanding its collection of data on head hits by putting sensors in the mouth guards of players at four major universities. This move is part of a larger effort to improve the understanding and treatment of concussions in sports.

The study aims to predict which children will have symptoms for three or more months after a concussion. Through this research, a single region of the brain, the midbrain, has been identified as useful for examining the impact of a concussion or repeated hits to the head. The glymphatic system, the brain's waste removal process, can become overwhelmed by repeated head hits, leading to permanent damage.

Merchant-Borna and Bazarian were awarded a U.S. patent for an algorithm that assesses the risk of changes and injury to brain white matter following repeated exposure to head impacts. This algorithm could be a significant step forward in the diagnosis and treatment of concussions in children.

Approximately 3 million people in the United States are diagnosed with a concussion annually, and the majority of these concussions are sports-related. The labs aim to make powerful connections and create a gateway for the enhancement of concussion treatment and diagnoses for the future.

Anticipating Extended Recovery from Concussions and the Potential for Multiple Subsequent Blows to the Head