Mild Traumatic Brain Injury in Contact Sports: Are They Really Mild?<br />Julian E. Bailes, M.D.<br />Professor and Chairm...
Disclosure<br />Research Funded by and J. Bailes consultant for Martek Biosciences, Inc.<br />Research Funded by BHR Pharm...
Roethlisberger’s Injury Highlights Nerve Center for Head Trauma<br />By ALAN SCHWARZ<br />Published: January 1, 2009<br />
“The football fields of our nation have been a vast proving ground or laboratory for the study of tragic neurological sequ...
What is a Concussion?<br />Temporary disruption of normal brain function<br />Also called Mild Traumatic Brain Injury (MTB...
Cellular Injury from MTBI<br />Neuronal membrane disruption opens voltage-dependent K+ channels<br />Widespread release of...
Ultrastructural injury<br />Neurofilaments and microtubules provide framework for axonal transport<br />Anterograde/retrog...
Mechanoporation<br />Straight line forces do not cause MTBI<br />Head motion, more than head contact causes MTBI<br />Rota...
Acceleration-Deceleration Injury:  Brain movement within skull<br />Rotation:  Never prevented, perhaps increased, by helm...
KE=1/2M XV2<br />HIC= V1-V2/HD<br />
Cumulative Effects in Collegiate Athletes<br />3 concussions: 3X’s risk of future events<br />1 in 15: 2nd concussion same...
Center for the Study of Retired AthletesKevin Guskiewicz, PhDJulian E. Bailes, MDUniversity of North Carolina at Chapel Hi...
Life After Football: <br />Health of NFL Retirees<br />Funded by:<br />NFL Players Association<br />Office of the Vice-Cha...
Dementia Risk Seen in Players in N.F.L. Study <br /><ul><li>                                  </li></ul>By ALAN SCHWARZ<br />
Retire: Are Some Players Vulnerable to Dementia?<br />
Chronic Traumatic Encephalopathy<br />
DORSAL AND BASAL PERSPECTIVES OF CTE BRAIN<br />
Concussion: Is There Any Hope for Prevention?<br />
Fluid Percussion Model<br />application of a fluid pressure pulse to the intact dura through a craniotomy <br />replicates...
Impact Acceleration Injury<br />Weight drop onto steel helmet affixed to skull<br />Produces reliable and reproducible inj...
32<br />Confidential Information<br />Remyelination<br />Vasogenic<br />Edema<br />Mitochondrial<br />Recoupling<br />Redu...
Omega-3 Supplementation<br />	Recent evidence from animal studies suggests that supplementation with omega-3 fatty acids (...
DHA facilitates brain function at optimal levels<br />Neuronal networks<br />Brain<br />Ptds<br />PE, PS<br />Connectivity...
 attention
 memory
 decision making
 psycho-motor</li></ul>Psycho-motor function<br /><ul><li> vision, hearing, tactile
 info processing, focus
 info storage, recall, learning
 adaptation/problem solving
 coordination/language/communication</li></ul>= Cognition<br />+<br />Brain<br />performance<br />level<br />
Immunohistochemistry<br />Sham injured animals demonstrate paucity of APP positive axons with <br />Retraction bulb morpho...
Immunohistochemistry<br />Animals subjected to impact acceleration injury demonstrate APP positive axons with retraction b...
Immunohistochemistry<br />Animals subjected to impact acceleration injury and supplemented with 10mg/kg/day DHA following ...
DHA Post-Injury Treatment<br />
AA/EPA Ratio  <br />% Change in AA/EPA ratio from baseline<br />
Caspase 3<br /><ul><li>p<0.05 high dose vs no treatment</li></li></ul><li>Immunohistochemistry<br />Likewise, animals subj...
DHA Pre-Injury Treatment<br />
Morris Water Maze<br /><ul><li>p<0.05 high dose vs no treatment in both latency and error</li></li></ul><li>
Are Helmets The Answer?<br />
X<br />Abating Traumatic Brain Injury<br />A SLOSH Approach<br />
SLOSH<br />In fluid dynamics, the movement of a liquid or semi-solid inside another object<br />First described by NASA, t...
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Mild TBI in Contact Sports: are they really mild?

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  • As a physician, I recently reviewed the State of the Art Medical Care for TBI…I see no appreciable advances since my training in 1986! If we can’t treat TBI…we MUST prevent it!
  • Bailes, Julian

    1. 1. Mild Traumatic Brain Injury in Contact Sports: Are They Really Mild?<br />Julian E. Bailes, M.D.<br />Professor and Chairman<br />Department of Neurosurgery<br />West Virginia University School of Medicine<br />
    2. 2. Disclosure<br />Research Funded by and J. Bailes consultant for Martek Biosciences, Inc.<br />Research Funded by BHR Pharma, Inc.<br />
    3. 3.
    4. 4. Roethlisberger’s Injury Highlights Nerve Center for Head Trauma<br />By ALAN SCHWARZ<br />Published: January 1, 2009<br />
    5. 5. “The football fields of our nation have been a vast proving ground or laboratory for the study of tragic neurological sequelae of head and neck trauma in man” Richard Schneider 1967<br />
    6. 6. What is a Concussion?<br />Temporary disruption of normal brain function<br />Also called Mild Traumatic Brain Injury (MTBI)<br />Caused by a blow or motion to the head<br />Results in brain movement inside skull<br />From collisions, falls, striking objects/ground<br />90% occur without losing consciousness<br />Continuing to play results in vulnerability to more injury, chronic disability or even death<br />Brain scans usually normal<br />
    7. 7. Cellular Injury from MTBI<br />Neuronal membrane disruption opens voltage-dependent K+ channels<br />Widespread release of glutamate<br />Thru NMDA receptors, increase occurs in intracellular Ca++<br />Mitochondrial injury leads to impaired respiration, reactive O2 species, <br />Oxid cellular injury, ATP failure, <br />abnormal glucose metabolism<br />Caspase-mediated apoptosis<br />
    8. 8. Ultrastructural injury<br />Neurofilaments and microtubules provide framework for axonal transport<br />Anterograde/retrograde movement of membrane materials to/from somata<br />Molecular motors kinesins/dyneins <br />Both mechanical damage & delayed/progressive ultrastructural injury from proteolysis by intracellular calpains<br />Axonal transport is interrupted<br />
    9. 9.
    10. 10. Mechanoporation<br />Straight line forces do not cause MTBI<br />Head motion, more than head contact causes MTBI<br />Rotational, angular forces cause tension force vectors which affect the neuron<br />A traumatic membrane defect occurs<br />The brain attempts to “self-seal” these porations<br />
    11. 11.
    12. 12. Acceleration-Deceleration Injury: Brain movement within skull<br />Rotation: Never prevented, perhaps increased, by helmets<br />
    13. 13. KE=1/2M XV2<br />HIC= V1-V2/HD<br />
    14. 14. Cumulative Effects in Collegiate Athletes<br />3 concussions: 3X’s risk of future events<br />1 in 15: 2nd concussion same season (usually within 7-10 days)<br />Each concussion takes longer to recover<br />Based on symptom duration, 69% moderate & 15% severe<br />
    15. 15. Center for the Study of Retired AthletesKevin Guskiewicz, PhDJulian E. Bailes, MDUniversity of North Carolina at Chapel HillWest Virginia University School of MedicineNational Football League Players’ Association<br />
    16. 16. Life After Football: <br />Health of NFL Retirees<br />Funded by:<br />NFL Players Association<br />Office of the Vice-Chancellor for Research, UNC-CH<br />Department of Exercise & Sport Science, UNC-CH<br />Injury Prevention Research Center, UNC-CH<br />
    17. 17.
    18. 18.
    19. 19.
    20. 20. Dementia Risk Seen in Players in N.F.L. Study <br /><ul><li>                                  </li></ul>By ALAN SCHWARZ<br />
    21. 21. Retire: Are Some Players Vulnerable to Dementia?<br />
    22. 22. Chronic Traumatic Encephalopathy<br />
    23. 23. DORSAL AND BASAL PERSPECTIVES OF CTE BRAIN<br />
    24. 24.
    25. 25.
    26. 26.
    27. 27.
    28. 28.
    29. 29. Concussion: Is There Any Hope for Prevention?<br />
    30. 30. Fluid Percussion Model<br />application of a fluid pressure pulse to the intact dura through a craniotomy <br />replicates clinical contusion without skull fracture <br />petechial hemorrhage in the brain parenchyma, axonal damage, subarachnoid hemorrhage, tissue tears followed by focal necrosis and cell loss, and characteristic vascular damage at the gray/white interface defined as “gliding contusion” <br />
    31. 31. Impact Acceleration Injury<br />Weight drop onto steel helmet affixed to skull<br />Produces reliable and reproducible injury<br />High yield of traumatically injured axons in white matter tracts<br />
    32. 32. 32<br />Confidential Information<br />Remyelination<br />Vasogenic<br />Edema<br />Mitochondrial<br />Recoupling<br />ReducesCerebral<br />Edema<br />Progesterone<br />Cytotoxic<br />Edema<br />Enhances<br />GABA<br />Increases Bcl2<br />AkT-P<br />Antagonizes<br />Sigma Receptor<br />Possible Mechanisms of Action<br />Reduces<br />Inflammatory<br />Cytokines<br />Reduce Apoptosis<br />Blocks<br />Excitotoxicity<br />Decreases free radicals & lipid peroxidation<br />Study funded by BHR Pharma, Inc<br />
    33. 33. Omega-3 Supplementation<br /> Recent evidence from animal studies suggests that supplementation with omega-3 fatty acids (particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)) improves functional outcomes following focal neural injury. <br />Wu, A., Ying, Z. and Gomez-Pinilla F, “Dietary omega-3 fatty acids normalize BDNF levels, reduce oxidative damage, and counteract learning disability after traumatic brain injury in rats,” J. Neurotrauma 21:10 1457-67 (2004). <br />
    34. 34. DHA facilitates brain function at optimal levels<br />Neuronal networks<br />Brain<br />Ptds<br />PE, PS<br />Connectivity, plasticity<br />-neurite outgrowth<br />-spine formation<br />-synapse<br />-myelination<br />Vision<br />-light/dark adaptation<br />-acuity/focusing<br />Neurotransmission<br /> -synthesis<br /> -packaging<br /> -release<br /> -reception<br />Neuron processing ctr<br /><ul><li> perception
    35. 35. attention
    36. 36. memory
    37. 37. decision making
    38. 38. psycho-motor</li></ul>Psycho-motor function<br /><ul><li> vision, hearing, tactile
    39. 39. info processing, focus
    40. 40. info storage, recall, learning
    41. 41. adaptation/problem solving
    42. 42. coordination/language/communication</li></ul>= Cognition<br />+<br />Brain<br />performance<br />level<br />
    43. 43. Immunohistochemistry<br />Sham injured animals demonstrate paucity of APP positive axons with <br />Retraction bulb morphology<br />
    44. 44. Immunohistochemistry<br />Animals subjected to impact acceleration injury demonstrate APP positive axons with retraction bulb morphology at 30 days<br />
    45. 45. Immunohistochemistry<br />Animals subjected to impact acceleration injury and supplemented with 10mg/kg/day DHA following impact injury demonstrate fewer APP positive axons with retraction bulb morphology at 30 days<br />
    46. 46. DHA Post-Injury Treatment<br />
    47. 47. AA/EPA Ratio <br />% Change in AA/EPA ratio from baseline<br />
    48. 48. Caspase 3<br /><ul><li>p<0.05 high dose vs no treatment</li></li></ul><li>Immunohistochemistry<br />Likewise, animals subjected to impact acceleration injury and pre-supplemented with 40 mg/kg/day DHA demonstrate fewer APP positive axons with retraction bulb morphology at 30 days<br />
    49. 49. DHA Pre-Injury Treatment<br />
    50. 50. Morris Water Maze<br /><ul><li>p<0.05 high dose vs no treatment in both latency and error</li></li></ul><li>
    51. 51.
    52. 52.
    53. 53.
    54. 54.
    55. 55.
    56. 56. Are Helmets The Answer?<br />
    57. 57.
    58. 58. X<br />Abating Traumatic Brain Injury<br />A SLOSH Approach<br />
    59. 59. SLOSH<br />In fluid dynamics, the movement of a liquid or semi-solid inside another object<br />First described by NASA, this sloshing effect can cause severe problems with vehicle stability/control due to a propensity to absorb external energy.<br />In human anatomy terms, the vehicle or the container (skull) and its contents (brain) the semi-solid fluid-behaving matter<br />Oscillation occurs only when the vehicle is partially filled<br />
    60. 60. What is the Teleological Function of the Omohyoid Muscle?<br />
    61. 61. Jugular Compression Device<br />Failsafe:<br />Non-compressible vertebrals<br />The Quenckenstadt Maneuver<br /> has been safely used for nearly 100 years<br />
    62. 62. Brainstem APP Region of Interest<br />
    63. 63. RESULTS<br />
    64. 64. Concussion-Changes Coming<br />Brain Injury Assoc: 3.8 million sports and recreation-related concussions in U.S. yearly<br />More concussions or greater recognition?<br />Baby boomers want to prevent chronic injuries<br />Increased awareness and structured approach at every level<br />Congressional hearings<br />Recognition: younger brains still developing<br />State legislation: OK, TX, WA, NM, VA, others-pending in 26 states<br />
    65. 65. Concussion Management<br />Diagnosed concussion (certainly LOC) precludes RTP same day<br />Player should be completely asymptomatic with normal neurological examination<br />Neuropsychological testing<br />Sometimes symptoms become more obvious later<br />Treatment: physical and mental rest<br />Rest period: 7-10 days, until no symptoms<br />Avoidance of alcohol, caffeine, dehydration<br />Omega-3 Fatty Acids-DHA<br />Neck strengthening exercises<br />

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