‘Brain Games’ on preventing, diagnosing sub-concussive brain trauma

Tuesday 13 May, presented at NYC MedTech-the NYC Medical Technology Forum, at Troutman Sanders LLP, Chrysler Building, New York City

In a packed (agenda and attendees) two hour evening meeting, three presenters detailed the latest research on the clinical signs of chronic traumatic encephalopathy (CTE), along with new technologies for detecting it as it happens and diagnosing it plus monitoring recovery: Robert Stern, PhD, professor of neurology and neurosurgery at the Boston University School of Medicine and a leading clinical researcher on CTE (as our long-time readers know) ; Isaiah Kacyvenski, head of the sports segment of electronics designer MC10 which developed the Checklight head impact indicator for Reebok; and Uzma Samadani, MD, PhD, co-founder of Oculogica which presented at ELabNYC a few weeks ago.

Dr. Stern’s presentation reviewed his clinical work with primarily NFL players in how CTE manifests in both behavior patterns and the brain. His focus remains on sub-concussive trauma, the ‘bottom of the iceberg’ in his analogy, and its cumulative, long-term effects.  Repetitive brain trauma–neuronal shearing which is produced by linear, lateral and rotational forces to the head–produce a cascade of brain changes leading to destruction of brain tissues that show as dark patches on post-mortem samples and scans. These differ from Alzheimer’s disease in the abundance of tau protein distributed fairly early in life around the brain’s blood vessels and in the depths of the cortical sulci, where Alzheimer’s signature beta amyloid does not locate. Dr. Stern’s research also incorporates the behavioral changes that precede diagnosis: the emotional ‘short fuse’, the difficulty in memory, accidents, suicide, drastic changes in behavior and impulse control. There are many examples of degeneration and early death among players [TTA 6 Dec 12 which also refers to Dr. Stern’s research published in Brain; also see TTA 5 June 2013 on his German Center presentation which has additional background on his and his team’s research.]

In addition to the work he has done relating to (American) football (he is on the NFL Players Association brain injury committee and his research was instrumental in the PA’s lawsuit against the NFL), he studies other contact sports such as hockey (brain injury clusters among the ‘enforcers’), soccer (football everywhere ex US), baseball (pitchers ‘beaning’ batters) and rugby (rough and unprotected all over, making this sport a favorite of orthopedic surgeons). Routinely, football players experience 20-30G blows up to 1,000 times per year of play which are not prevented by those impressive helmets designed to protect against skull fracture.) These repetitive blows start in junior football in boys as young as 8 or 9. In no-helmet soccer, the danger is in heading the ball; the force can be 15Gs. It seems that all you need is adequate (not high) G force to create neuronal changes, but detection is difficult because these events have no immediate physical symptoms.

The research around CTE has produced changes in the practice of contact sports and protection against head blows. Texas is synonymous with high school football, but even they have restricted the amount of full-contact practices both during and pre-season (Forbes); California and Arizona also adopted similar rules (NPR) with Illinois the latest in April (Breitbart).

Dr. Stern’s newest research is not yet published, but he shared two preliminary findings and overall status with this audience of clinicians, academics, attorneys, investors:

  • Football players who started in the game before the age of 12 had three times the likelihood of self-reported executive function problems: changes in mood, behavior, cognition.
  • CTE has been found in a developmentally disabled person who is a repetitive head banger.
  • Among soldiers, blast trauma in combat may be leading to CTE.
  • The next step is to find biomarkers (the Dr. Inga Koerte research)–the DETECT study using lumbar puncture– and brain imagery (early PET scan, Siemens) to locate abnormal tau levels so that CTE can be diagnosed earlier and more definitively.

Dr. Stern concluded that his work has only reached the ‘infant stage’ of development. Questions which badly need answers: Is CTE common? Why do some contact sports athletes get it and others never do? What are the risk factors? Genetics? Exposure? Far larger sample sizes–and funding–are needed, and unfortunately NIH funding has grown scarce.

[A note to the Howard Hughes Medical Institute: Mr. Hughes was the poster child for head trauma due to at least 14 airplane and car crashes. Could this have led to his bizarre behavior over years, culminating in debilitating mental illness? You should be funding this research.]

Beyond the research

click to enlargeMC10 develops electronics which are stretchable and wearable for sports and fitness, consumer health and medical products. If this sounds familiar, the company’s co-founder and ‘father of conformal electronics technology’ is John Rogers, professor at the University of Illinois, Champaign-Urbana. [More here on his stretchy sensor patches powered by tiny biodegradable batteries.] Isaiah Kacyvenski presented an overview of their new product to detect head concussion, the Reebok Checklight, which premiered at International CES [TTA 15 Nov 13] and retailing for about $150. Where the breakthrough in adoption could be is reduction in insurance liability, but further and wider research will have to be done to accumulate the data. Mr. Kacyvensky is a former NFL player (with six concussions), graduating from Harvard with a pre-med degree and post-NFL, a Harvard Business School MBA.

This Editor profiled Oculogica at the ELab Pitch Day [TTA 17 Apr] and on 2 May in our overview of concussion diagnostics. Dr. Uzma Samadani primarily discussed the neurodiagnostics science behind the development of EyeBox CNS. The idea came from tracking eyes watching TV. What it does is quantify the physiologic tracking of eyes moving together (convergence). In about 220 seconds, a normal person’s eyes will track a box pattern about five times. Not only in head trauma but also in brain tumors and other disorders that impact neurologic function, this tracking can be disrupted. EyeBox also can track recovery time–the time it takes for the eyes to revert back to a box pattern. Early subject studies are finding a wide variation, much greater than expected, in recovery.

Credit for this exemplary meeting goes to John Lieberman, CPA of Perelson Weiner LLP, founder of NYC MedTech, for his excellent organization and host Heather Ettinger of Troutman Sanders LLP for their hospitality. 

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