1. ABSTRACT # 23 Meridian Health Research Day: June 12, 2012
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A SYSTEMATIC REVIEW OF THE EVIDENCE FOR THE USE OF OMEGA-3 FATTY
ACIDS IN THE MANAGEMENT OF MILD TRAUMATIC BRAIN INJURY
Aggarwal P, Cabasso A, Rijhsinghani R
JSUMC
Background: In the United States the estimated incidence of traumatic brain injury is 1.4 million
people. These injuries are associated with 1.1 million emergency department visits and
approximately 235,000 hospitalizations, with direct and indirect estimated costs of up to $60
billion annually. Additionally, the U.S. Center for Disease Control and Prevention(CDC)
estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities annually.
The rate of concussion has been steadily increasing over the past 2 decades. Although the
immediate neurocognitive effects of sports-related concussion are well known, less is known
about the intermediate or long-term effects of sports-related concussion. Most sport-related
concussions typically resolve within a short time frame, managed with physical and cognitive rest
alone. However, clinicians who specialize in the assessment and management of this diagnosis
encounter patients with prolonged recovery courses, persistent symptoms, and significant deficits
in cognitive function. The past several years has seen a rise in the engagement of neuroscientists
in this field, helping to delineate the pathophysiolocal processes that take place during and
following a concussive episode. Simultaneously, scientists have been researching the sometimes
similar pathophysiologic events that take place in other chronic neurologic and neurocognitive
disorders such as Parkinson's Disease and Alzheimer's Disease, and have begun to look at
nutritional interventions that have the potential to alter the destructive cascade. Clinicians and
major University athletic programs have begun suggesting institution of omega-3 fatty acid
supplementation in the immediate post-concussion period, in an attempt to mitigate the
aftereffects of a concussion.
Methods: A literature review was conducted on the PubMed database, using keywords associated
with the purpose. The terms docosahexanoic, eicosapentanoic acid, fatty acids, and/or omega-3
fatty acids were cross-referenced with central nervous system disease, brain injury, concussion,
autism, parkinson's disease, alzheimer's disease, and encephalopathy. The results were compiled
and reviewed for clinical utility.
Results: Traumatic brain injury crossed with omega-3 fatty acids resulted in 24 studies,
conducted in animals, primarily rodents. The studies included supplementation both pre-head
injury and post-head injury. Several studies in both groups demonstrated protection of memory,
restored membrane homeostasis, restored neuronal signaling, and reduced markers of brain
injury. There were no controlled clinical studies evaluating the use of omega-3 fatty acid
supplementation in human models for the treatment of traumatic brain injury or concussion.
Conclusions: Mild traumatic brain injury is associated with metabolic, microstructural, and
vascular consequences which can lead to clinical sequelae. In animal studies, omega-3 fatty acid
supplementation significantly reduced traumatic axonal injury, with decreases in ischemic and
reperfusion injury. Based on this review, omega-3 fatty acid supplementation both pre- and post-
injury holds promise to potentially decrease severity of symptoms, and shorten the recovery
period after concussion. There is a need to translate these findings to the human model.