Concussion Epidemiology, Natural History and Long Term Outcomes
Concussion—also known as mild TBI-- is a growing public health problem affecting over 3.8 million Americans annually and resulting in over 2.2 million emergency department visits each year. Between 2010 and 2015, diagnoses for concussion and post-concussion syndrome increased by 43% and 81%, respectively. These conditions produce symptoms such as headache, dizziness, difficulty with memory and concentration, difficulties with balance, and fatigue that are potentially disabling. Disability resulting from concussion costs the US nearly $17 billion each year.
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Sex Differences in Outcome after Concussion
Multiple studies in humans indicate that women have worse outcomes than their male counterparts after concussion. The observation that worse outcome for women was most pronounced during childbearing years was revealed by research in the Bazarian lab and suggested that sex hormones such as estrogen or progesterone were playing a roll. The Bazarian lab subsequently demonstrated that outcome was related to the menstrual cycle phase at the time of injury.
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Effects of Concussion and Repetitive Head Hits on Brain Structure and Function
Because the clinical diagnosis of concussion, which relies on symptom self-report, is considered unreliable, an alternative reference standard for this injury is needed. This is a fundamental problem for researchers trying to determine the epidemiology and natural history of concussion, as well as for clinicians attempting to accurately diagnose and manage those with an injury. The Bazarian lab has developed diffusion tensor imaging as a reference standard for clinically significant axonal injury after concussion. This has allowed us to determine the value of blood-based biomarkers—such as S100B, tau, GFAP and UCH-L1-- which are ultimately more practical and economical.
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Linking Head Impact Exposures to Changes in Brain Structure and Function
We were one of the first research groups to demonstrate that repetitive sub-concussive head hits after a single collegiate football season, where the number of hits ranged from 431-1850, resulted in brain white matter changes on diffusion tensor imaging. These changes were similar to ones detected after concussion, which were thought to be a result of traumatic axonal injury. We subsequently demonstrated that these axonal injury-like white matter changes correlated to cumulative head impact forces measured by helmet-based accelerometers, suggesting a causal link to repetitive sub-concussive head hits.
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Optimizing Outpatient Treatments for Concussion
Despite a common belief that concussions are not treatable, multiple symptom-based treatments do exist. Since 2007, at least 6 consensus-based guidelines have been published recommending a variety of pharmacologic and non-pharmacologic interventions to treat the symptoms of concussion, such as analgesics for post-traumatic headache, vestibular rehabilitation for dizziness, and neuro-stimulants for difficulties with memory and attention.
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