According to a Ben Gurion University of the Negev research group, professional football players for the first time have been found to have brain damage from mild “unreported” concussions. Published in the current issue of the American Medical Association’s JAMA Neurology, the Ben Gurion study could improve decision-making about when an athlete should “return to play.”
The new, enhanced MRI diagnostic approach was, for the first time, able to identify significant damage to the blood-brain barrier (BBB) of professional football players following “unreported” trauma or mild concussions.
Dr. Alon Friedman at the Ben-Gurion University Brain Imaging Research Center discovered the new diagnostic approach. “Until now, there wasn’t a diagnostic capability to identify mild brain injury early after the trauma,” he said.
“In the NFL, other professional sports and especially school sports, concern has grown about the long-term neuropsychiatric consequences of repeated mild Traumatic Brain Injury (mTBI) and specifically sports-related concussive and sub-concussive head impacts,” he added.
The paper describing the new diagnostic was published by researchers at Ben-Gurion University of the Negev (BGU) and Soroka University Medical Center. It details using Magnetic Resonance Imaging (MRI) for detection and localization of vascular pathology and blood-brain barrier breakdown in football players.
“The goal of our study was to use our new method to visualize the extent and location of BBB dysfunction in football players using Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) on a Phillips 3-T Ingenia. Specifically, it generates more detailed brain maps showing brain regions with abnormal vasculature, or a ‘leaky BBB,’ ” said Dr. Friedman.
Study participants included 16 football players from Israel’s professional football team, Black Swarm, as well as 13 track and field athletes from Ben-Gurion University who served as controls. All underwent the newly developed MRI-based diagnostic.
“The group of 29 volunteers was clearly differentiated into an intact-BBB group and a pathological-BBB group,” Friedman explains. “This showed a clear association between football and increased risk for BBB pathology that we couldn’t see before. In addition, high-BBB permeability was found in six players and in only one athlete from the control group.”
Friedman also indicated that repeated, mild concussive events might impact some players differently than others. This level of diagnosis of individual players can provide the basis of more rational decision-making on “return to play” for professionals as well as amateurs of any age, he pointed out.
“Generally, players return to the game long before the brain’s physical healing is complete, which could exacerbate the possibility of brain damage later in life,” says Friedman.
A decade of research in the BGU Laboratory for Experimental Neurosurgery has shown that vascular pathology, and specifically dysfunction of the blood-brain barrier (BBB), plays a key role in brain dysfunction and degeneration, and may be an underlying cause of neurodegenerative complications after brain injuries.
The BBB is a highly selective permeable membrane that separates circulating blood from extracellular fluid. It protects the brain by preventing many dangerous substances from penetrating, and therefore is not meant to be damaged.
Medical researchers, including Friedman’s group at BGU, are working to discover ways to find drugs that will target the BBB and facilitate its repair, ultimately allowing for the prevention of Alzheimer’s disease and other brain-related diseases.
The Ben Gurion University study was supported by the European Union’s Seventh Framework Program and the Israel Science Foundation.