Imaging agent could reveal chronic traumatic encephalopathy in living brain 

AUTHORS: LAUREN PULLING
In a proof-of-concept study, researchers from the Icahn School of Medicine at Mount Sinai (NY, USA) have demonstrated the use of an experimental PET tracer in the diagnosis of chronic traumatic encephalopathy (CTE) in the living brain. At present, diagnosis is only possible after death, but this new study could pave the way for the development of an effective diagnostic tool for living patients.
In the study, published in Translational Psychiatry, the research team investigated the use of an experimental PET imaging ligand, [18F]T807/AV1451, which they hoped would provide antemorten detection of tauopathies that are characteristic of CTE.
The team investigated the use of T807 in a 39-year old retired NFL player who had experienced 22 previous concussions and exhibited some of the behavioral characteristics of CTE, including emotional lability and irritability. Following administration of T807 and PET scanning, the player was demonstrated to exhibit the pathognomonic tau pathology of CTE.
“Our study participant’s scan is the first to reveal during life a pattern of tau imaging that outlines the wrinkles and folds of the living brain, just like the ‘pathognomonic pattern’ described by the NINDS panel as diagnostic of a brain with CTE,” commented Sam Gandy, Director of the Center for Cognitive Health and NFL Neurological Care Program at the Icahn School of Medicine and senior study author. “When fully validated, this new ligand has the potential to be used as a diagnostic biomarker and represents an exciting development in the detection and tracking of CTE.”
“This research is in its infancy,” added Dara Dickstein (Icahn School of Medicine), first author on the study. “Whether or not the pathology can be reversed or halted is something we have yet to determine and these new tauopathy PET scans may be able to help in this endeavor.”
Looking ahead, a research team led by Drs Gandy and Dickstein at Mount Sinai is now studying a further 24 patients. They aim to establish a clinical trial in early 2017 to investigate further the use of T807 in the diagnosis of CTE patients who may respond to an anti-tauopathy treatment currently being studied for Alzheimer’s disease and other neurodegenerative disorders.
“These findings demonstrate that we may now have the first biomarker for the detection of CTE through tau imaging,” concluded Howard Fillit, Chief Science Officer of the Alzheimer’s Drug Discovery Foundation. “This may prove significant as an early diagnostic tool for those who suffer repeated traumatic brain injuries. It may also help us better understand the similarities in disease processes between CTE, Alzheimer’s and other neurodegenerative diseases, and determine whether repeated head injuries may lead to the onset of Alzheimer’s.”

Advertisements

Concussion Recovery May Be Slower Than Current Estimates

The following report on some new research confirms a few things for me. The first is that previous research showing that younger athletes recover slower than older athletes is confirmed here.

Secondarily, and more important to this particular blog is that someone getting a concussion needs significant interventions to speed recovery and reduce the potential long term effects of brain injury. 

The three best interventions that I am aware of to date are:

1-Nutritional

2-Functional Neurology (developed by Dr Carrick a chiropractic neurologist in Atlanta)

3-Neurofeedback

By:Laird Harrison (excerpt)

June 09, 2015
SAN DIEGO — Recovery from a concussion might take much longer than the previously established 7 to 14 days, a new study shows.

“More and more people are starting to realize that you need to take a comprehensive approach so that you don’t send a kid back who might be recovered on one measure but not another,” said Anthony Kontos, PhD, from the University of Pittsburgh.

In fact, in the study conducted by Dr Kontos and his colleagues, athletes took 3 to 4 weeks to recover, and women took longer than men.

The established 7- to 14-day recovery period — reported in peer-reviewed journals and a consensus statement (Br J Sports Med. 2013;47:250-258) — was estimated from studies of male American football players that looked only at neurocognitive tests and symptoms, he explained.

To test the accuracy of this, Dr Kontos’s team followed 24 female and 42 male high-school and college athletes after a diagnosis of concussion in accordance with established medical guidelines. Mean age of the athletes was 16.5 years.

Dr Kontos presented the findings here at the American College of Sports Medicine 62nd Annual Meeting.

The athletes were tested every week for 4 weeks after the diagnosis. Measures of symptoms, verbal memory, visual memory, visual motor processing speed, reaction time, dizziness, and vestibular and oculomotor symptoms were self-reported.

The biggest improvements in self-reported symptoms occurred in the first 2 weeks, but they continued to improve up to 4 weeks.

Vestibular and oculomotor symptoms lasted 1 to 3 weeks, and verbal memory impairment continued up to 4 weeks.

The male athletes were 2.5 times more likely than the female athletes to have recovered by week 4, which was statistically significant (P < .006).

In addition, females reported more dizziness and more vestibular and oculomotor symptoms than males.

The study ran out of funding after 4 weeks, but some imaging studies have suggested abnormalities beyond that time period, said Dr Kontos.

On the basis of these findings, clinicians should use more than one measure to assess whether an athlete has recovered from a concussion, he said. “It’s not a homogenous injury. You need to do a thorough, comprehensive exam.”

After the presentation, some audience members pointed out that the results confirm their experiences as team physicians. “We’ve always known that 2 weeks was not reasonable,” said one.

More Concussion Info From the Dr. Carrick Interview

Please describe the diagnostic procedures and treatment that you offer those suffering from a concussion and is there a different approach to an acute concussion vs. chronic concussive symptoms or post concussion syndrome?
>
We marry standard testing to advanced functional testing. We establish baselines of brain function and compare that to normals and use the baseline as a measurement of change. We will know immediately if our patients are improving, getting worse or having no change. We can then change our approaches to do the best for the brain injured patient. Our therapies are very robust. For instance, we don’t stop our treatments in the Brain Center, we put our hockey players on the ice, football players on the field, baseball players on the diamond, martial artists on the matt and have practical back to sport training that involves the sport specifically as well as other cross training necessary to improve performance.

More Concussion Info From Dr. Carrick’ s Interview for Official Karate Magazine

Dr. Rubenstein: Since the traditional medical community has no specific tests such as MRI’s for concussion, how do you personally diagnose and understand what is happening in a patient with a concussion?

Dr. Carrick:
We do utilize MRI and other specialized imaging tests in association with sophisticated tests of memory, verbal and auditory testing similar to the types of tests other specialists use in concussion. But we go further with functional testing of the brain that includes measurements of the speed and accuracy of eye movements. These are really windows of brain function and now we have the technology to measure them exactly. We also measure balance and the center of pressure of the person’s whole body when they do a variety of things to stress their brains. For example, we have people do math and see if their center of pressure or stability changes. We have one of the best concussion labs in the world and it takes us several hours to complete the testing that allows us to help people. The development of advanced computerization of diagnostic testing allows us to do better job now than we ever could have done in the past and we hope to be able to learn and develop more in the future.
>

Excerpt From My Soon to be Published Interview with Dr. Carrick Developer of Functional Neurology

Hello Dr. Carrick, Thank you so much for agreeing to this interview and taking time out of your busy teaching, treating and lecturing schedule to talk to our readers about concussion. I have to say…. you are one of my biggest heroes in healthcare.
>
> Could you please give us your background relating to your expertise in the treatment of concussion and other traumatic brain injuries?

I have had a specialty practice of functional neurology for 35 years and have a special interest in traumatic brain injury. My background is central to Chiropractic applications with several Fellowships in a variety of Brain Specialties and a PhD specialty in the neurophysicological aspects of learning. I have been fortunate to have had extensive experience in this clinical area and have a very vibrant clinical team that has resulted in patients being referred to me from around the globe. We attend professional athletes, Olympians, National and Collegiate level athletes from many countries.

> I also understand that you have been involved in the martial arts for many years. Could you tell us about that.?
>
I have a 3rd degree black belt in Shotokan Karate. The martial arts have been central to my life since I was a young man, allowing me to understand movement and motor control at a level that I might not have appreciated from clinical studies alone. The dedication and discipline of training has certainly transferred to other aspects of my personal and professional life.
>
> What is your definition of a concussion and what is actually going on in the brain?

A concussion is a traumatic brain injury that changes the way your brain works. Most concussions result in a temporary loss of function and usually people will have headaches and problems with concentration. We find that balance and coordination are usually impaired and people might have problems remembering things. Memory, balance and coordination. Concussions don’t usually result in brain damage that we can see, so the CT scans and MRI tests are usually normal. But, the function, or how the brain communicates with itself and the rest of the body is impaired. We do have changes in the brain that are difficult to see with our diagnostic instruments but now we have some pretty sophisticated tests that will allow us to know the functional state of the brain. We are able to measure function fairly accurately and establish a baseline of testing that allows us to realize if our treatments are going to make a difference. Martial artists understand function better than most athletes. Speed, accuracy, balance and coordination are all brain functions that can be changed with training. Our treatment of concussions is really training the brain to do things better and restoring function. Usually we get our patients better than they were before their concussions.