Patients vary widely in their response to concussion , but scientists haven't understood why. Now, using a new techniquefor analyzing data from brain imaging studies, researchers atAlbert Einstein College of Medicine of Yeshiva University andMontefiore Medical Center have found that concussion victims haveunique spatial patterns of brain abnormalities that change overtime. The new technique could eventually help in assessing concussionpatients, predicting which head injuries are likely to havelong-lasting neurological consequences, and evaluating theeffectiveness of treatments, according to lead author Michael L.Lipton, M.D., Ph.D., associate director of the Gruss MagneticResonance Research Center at Einstein and medical director ofmagnetic resonance imaging (MRI) services at Montefiore. Thefindings are published in the online edition of Brain Imaging and Behavior. The Centers for Disease Control and Prevention estimates that morethan one million Americans sustain a concussion (also known as mild traumatic brain injury , or mTBI) each year. |
Concussions in adults result mainly frommotor vehicle accidents or falls. At least 300,000 adults andchildren are affected by sports-related concussions each year.While most people recover from concussions with no lasting illeffects, as many as 30 percent suffer permanent impairment -undergoing a personality change or being unable to plan an event. A2003 federal study called concussions "a serious public healthproblem" that costs the U.S. an estimated $80 billion a year.
Previous imaging studies found differences between the brains ofpeople who have suffered concussions and normal individuals. Butthose studies couldn't assess whether concussion victims differfrom one another. "In fact, most researchers have assumed that allpeople with concussions have abnormalities in the same brainregions," said Dr. Lipton, who is also associate professor ofradiology, of psychiatry and behavioral sciences, and in theDominick P. Purpura Department of Neuroscience at Einstein.
"Butthat doesn't make sense, since it is more likely that differentareas would be affected in each person because of differences inanatomy, vulnerability to injury and mechanism of injury." In the current study, the Einstein researchers used a recentlydeveloped MRI technique called diffusion tensor imaging (DTI) on 34consecutive patients (19 women and 15 men aged 19 to 64) diagnosedwith mTBI at Montefiore in the Bronx and on 30 healthy controls.The patients were imaged within two weeks of injury and again threeand six months afterward. The imaging data were then analyzed using a new software toolcalled Enhanced Z-score Microstructural Assessment Pathology(EZ-MAP), which allows researchers for the first time to examinemicrostructural abnormalities across the entire brain of individualpatients. EZ-MAP was developed by Dr. Lipton and his colleagues atEinstein.
DTI detects subtle damage to the brain by measuring the directionof diffusion of water in white matter. The same technology was usedby Dr. Lipton and his team in widely publicized research on morethan 30 amateur soccer players who had all played the sport sincechildhood. They found that frequent headers showed brain injurysimilar to that seen in patients with concussion.
The uniformity of diffusion direction - an indicator of whethertissue has maintained its microstructural integrity - is measuredon a zero-to-one scale called fractional anisotropy (FA). In thelatest study, areas of abnormally low FA (reflecting abnormal brainregions) were observed in concussion patients but not in controls.Each concussion patient had a unique spatial pattern of low FA thatevolved over the study period. Surprisingly, each patient also had a unique, evolving pattern ofabnormally high FA distinct from the areas of low FA. "We foundwidespread high FA at every time point, all the way out to sixmonths and even in patients more than one year out from theirinjury." said Dr. Lipton.
"We suspect that high FA represents aresponse to the injury. In other words, the brain may be trying tocompensate for the injury by developing and enhancing other neuralconnections. This is a new and unexpected finding." At present, diagnosis of concussions is based mainly on the natureof the patient's accident and the presence of symptoms including headache , dizziness and behavioral abnormalities. DTI, combined with EZ-MAPanalysis, might offer a more objective tool for diagnosingconcussion injuries and for predicting which patients will havepersistent and progressive symptoms. Additional References Citations.
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