Improved Approach

August 4, 2017

As research continues to examine the effects of concussions, scholars are outlining areas where further work is needed. A recent article published in Neuron discusses some of the issues surrounding sports neurotrauma and how the field of neuroscience can help.

“The field of sports neurotrauma has been hampered by qualitative definitions, oversimplication of injury and outcomes, pre-existing bias among stakeholders, and a reliance on retrospective observational studies,” the authors, led by Christopher Giza, MD, Professor of Pediatric Neurology and Neurosurgery at UCLA Health System, Professor at UCLA Brain Injury Research Center, and Director of UCLA’s Steve Tisch BrainSPORT Program, write in Neuron. “Nonetheless, innovative new technologies, when rigorously coupled with clinical correlates and biological mechanisms, offer tremendous opportunity for future advances. Bringing more rigorous experimental designs that include proper controls and prospective longitudinal follow-up, and incorporating preclinical translational studies, will more definitely prove or disprove our prior suppositions and lead to better, fact-based practice guidelines.” 

There are three areas where Dr. Giza and colleagues suggest improvements can be made with the help of neuroscience. First, they insist a definition of acute and chronic concussion needs to be agreed upon. Although awareness of concussion has increased over the past several years, a lack of clarity regarding the injury and its distinctions remain.

“One of the things that will help us on the acute diagnosis of concussion would be if we moved away from the current understanding of concussion as a black-or-white, yes-or-no answer,” Dr. Giza told ScienceDaily. “There are scenarios when we can be more certain, clinically, that we’re making the correct diagnosis. If there’s a clear impact event, there’s a typical constellation of symptoms that occurs in temporal relationship to the impact, and that symptom pattern has a time course consistent with what we see in concussion in terms of peaking early followed by gradual improvement, then we can diagnose confidently.”

Second, Dr. Giza believes that an accurate diagnosis is essential for treatment. One of the problems currently seen with diagnosing concussion is the lack of symptoms’ clarity. In other words, the symptoms an individual experiences may be due to a number of other conditions. For example, some symptoms may be due to dehydration, neck strain, hyperthermia, or migraine.

“We need to prioritize what we think sounds like a definite concussion vs. probable vs. possible and even recognize that there were syndromes with neurological symptoms that occur after impact that are something more than a concussion,” said Dr. Giza. “There are rare patients who have cerebral edema—sometimes, we call it second impact syndrome, which is another ambiguous term—but that’s not a concussion.”

The third area where neuroscience may help in refining concussion diagnosis and treatments is through animal research. This could be particularly useful in developing treatment plans in a relatively short amount of time and in seeing the effects of repeated injury.

“In the clinical concussion world, many of the research protocols are observational, but I think laboratory neuroscience can inform in terms of how important is the time between injuries and how much cognitive or physical activity should there be during the recovery period,” said Dr. Giza.