Morning blue light helps sleep in mTBI patients (2/20/20 newsletter)

Feb 22

The blue light device used in the research discussed in our Therapies section.

We are pleased to have Carleton College students and alumni working with Concussion Alliance. Contributors this week:

Editor: Galen Moller and Conor Gormally.
Contributors: Conor Gormally, Julian Szieff, Katie Taylor, Eloïse Cowen, and Malayka Gormally.

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Our article about blue light therapy is under the “Therapies” section.

Education

School teachers at a high risk of concussions and face work environments that challenge recovery

Between crowded classrooms and chaotic recesses, teachers work in an environment where they have to be constantly vigilant of their surroundings. According to an article from Canadian television and media organization CTV News, “teachers are suffering concussions at work due to accidents in the classroom or at recess, leaving many…with debilitating, long-lasting symptoms.” Dr. Charles Tator, director of the Canadian Concussion Centre at Toronto Western Hospital, asserts that “Teachers wouldn’t think it’s a high-risk job, but concussion is a significant risk at school.”

This trend was documented in a 2018 report by the British Columbia Teachers’ Federation that found that “teachers had a much higher rate of claims for head injuries than the provincial average.” Additionally, the loud, energetic, and fluorescent-lit classrooms that they work in are an unforgiving environment to recover in. However, recognition of this problem has brought increased awareness of the prevalence and seriousness of concussions as an injury.

Sports

CTE risk association with time

An article published by Fast Company reports on the specific timeline related to chronic traumatic encephalopathy (CTE). Although there is a significant association between repeated head trauma and CTE, the effect of time spent participating in contact sports on the risk of CTE has only recently been established. In the study, published in Annals of Neurology, Mez, McKee, et al. found that players who participated in their sport for four and a half years or less are ten times less likely to suffer from CTE than those who played longer. Players who participated for fourteen and a half years or more are ten times more likely to suffer from CTE than players who participated for less time.

Therefore, it could be more healthy to start contact sports at an older age, so as to limit the amount of time exposed to head trauma. The article also pointed out that each year is associated with a thirty percent increase in CTE risk. While current studies are limited by the fact that CTE can only be diagnosed after death, there is research studying PET scans to diagnose CTE in living patients. Some studies have investigated the possibility of a genetic predisposition to CTE. The research on CTE may still be relatively new, but it is significant for players in contact sports and parents of players in contact sports. You can read more about this study on our blog post.

Cannabis

Study finds CBD & THC comparably effective to opioids for long-term chronic neuropathic pain

Long-term pain is a fact of life for many people with persistent post-concussion symptoms, so, while neuropathic pain and post-TBI pain are not directly linked, additional evidence to support an alternative to opioids for chronic pain is worth consideration. A study published in Neuropsychopharmacology found that CBD and THC, consumed orally by mice, provided relief of chronic neuropathic pain with greater long-term efficacy than morphine. Their findings add to the body of evidence supporting CBD and THC as effective treatments for chronic pain, and safer alternatives to opioids.

The study used a novel, non-invasive method of measuring pain from allodynia (induced pain responses from repeated non-painful stimulus) by recording and counting ultrasonic clicks made by the mice. They found that the mice self-regulated their intake of the medications to keep their blood-THC levels relatively constant throughout similar periods of the day. This finding suggests that “mice receiving THC gels were not feeding less frequently, but were consuming less during each bout.”

While there were variances in the number of ultrasonic clicks after neuropathic pain, “the effect of THC, CBD, or morphine in reducing the number of clicks remained significant” compared to control capsules. However, within the 7-day ingestion period, the mice in the morphine group developed a higher tolerance than the THC group, while the CBD group showed no signs of tolerance. Abraham et al. believe that their research shows the potential for CBD and THC to act as successful alternatives to opioids in the treatment of long-term chronic pain. “Specifically, CBD may represent a viable therapeutic option because of its low psychoactive profile, lack of efficacy in a pain-free state, and long-lasting reduction in allodynia in chronic pain.”

Diagnostics

Concussion risk and migraine history

A recent study published by the Clinical Journal of Sports Medicine, written by James T. Eckner, MD, MS, et al. examined migraine headaches as a possible risk factor for concussions. While this study did find a significant association between migraine headaches and concussions, it was not possible to determine a causal relationship between migraines history and concussion risk. The correlations between both prior history of concussions and concussion risk, as well as prior history of migraines and concussion risk, were stronger than the central relationship being studied.

Although there is not a proven mechanism that causes migraines following concussions, this relationship could be related to beta-endorphin levels in the brain. These levels increase both after a concussion and in conjunction with medication overuse, which could be related to pain hypersensitivities. The study was also limited by the fact that migraines are a symptom of concussion, which can cause misdiagnosis. Furthermore, patients with a migraine history may experience more head-trauma related symptoms, falsely inflating the association between concussions and migraines. Further research is required to determine the specific relationship between concussion risk and migraines, but there is a significant association with migraine history and concussions.

Therapies

Blue light in the morning shown to help mTBI patients fall asleep and decrease daytime sleepiness

Sleep difficulties relating to concussion are challenging to treat because they are not only symptoms of concussion, but also exacerbating factors. New research from Kilgore et al. in the Journal Neurobiology of Disease has found compelling evidence for the use of blue light as a treatment for sleeping problems in mTBI patients. Examining 32 participants over six weeks, the researchers from the University of Arizona found that 30 minutes of blue light exposure in the first 2 hours after waking had significant effects on patients’ sleep and wakefulness. Compared to their pre-treatment, patients exposed to blue light (as opposed to amber light) in the morning fell asleep an average of 1 hour earlier, had less daytime sleepiness, and showed neuroanatomical changes associated with better cognitive performance.

This study is limited by its small sample size and difficulty evaluating sleep but shows enormous potential for sleep therapy and a new area of potential mTBI research. The study finding of increased structural connectivity of axonal pathways, correlated with improved cognitive performance after blue-light treatment, is of particular interest. The device used in this study (Phillips energy light 3321) is now discontinued; however, its technical specifications, which can be found on the device website, can be used as guidelines for locating an alternative. The Phillips website says that goLITE BLU 3422 and goLITE BLU 3432 are similar products to the energy light 3321.

Veterans

Research on veterans with blast-related concussions identifies potential biomarkers for diagnosing chronic mTBI

Researchers from the Institute for Systems Biology (ISB), working with the Puget Sound VA, have identified "blood-based biomarkers of repetitive mTBI in the chronic state." Their study was published in the Journal of Neurotrauma and discussed in an article on the ISB website. According to lead researcher Dr. Vias Ghai, "Diagnostic tools are urgently needed to correctly identify those individuals with chronic mTBI, as this condition can potentially develop into more serious neurodegenerative diseases, such as chronic traumatic encephalopathy (CTE)."

The study compared Iraq and Afghanistan war veterans with blast-related chronic mTBI, deployed veteran non-TBI controls, and civilian controls. They found that numerous microRNAs had "significantly changed in the chronic mTBI cohort compared to control groups." These changes affected "pathways involved in neuronal function, vascular remodeling, blood-brain barrier integrity, and neuroinflammation." They also found an elevated level of an enzyme (MME/Neprilysin), which is associated with clearing amyloid from the brain; increased amyloid deposits are associated with neurodegenerative diseases such as CTE and Alzheimer's. The researchers believe their work will help develop clinical biomarkers for chronic mTBI.

Mental Health

Suicide now the leading cause of TBI-related deaths in the United States

Suicide is now the leading cause of TBI-related death, having overtaken auto accidents in the last decade. A 32% increase in TBI-related suicide by whites contributed to this shift; 97% of the TBI-related suicides were by firearms. According to a Center for Disease Control (CDC) Morbidity and Mortality Weekly Report, there were 61,131 TBI-related deaths in the United States in 2017, which is 2.2% of all deaths that year. After suicide, falls were the "the second-leading cause of TBI-related deaths and have been increasing in number and rate, particularly among older adults." In general, TBI-linked deaths are significantly higher for males and American Indians/Alaska Natives.

The leading cause of TBI-related deaths varies by population groups. The leading cause of TBI-related deaths for American Indians and Alaska Natives is car crashes; for black Americans, it is TBI-related homicide; for Hispanics, it is TBI-related deaths from accidental falls. The study suggests "tailored prevention efforts might be needed to help reduce the prevalence of TBI among different groups at risk for injury." Study authors Jill Daugherty, PhD, et al. conclude that "health care providers can play an important role in assessing patients at increased risk for suicide and providing appropriate interventions." Also, researchers suggest that "Reducing access to lethal means among persons at risk for suicide is an important approach to creating protective environments," according to an article in U.S.News.

Statistics

Colorado study deems concussions a “significant health care burden” for collegiate health care centers

In a study published in JAMA Network Open, Breck, DO, et al. analyzed concussion diagnoses over three years at a large public university. Taking data from concussion diagnosis and treatment at the student health care center as well as from varsity athletic trainers, the authors found that reported concussion incidence at the university was over twice as high as estimates of concussion incidence in the general population by the WHO and the CDC. Additionally, as not all concussions are diagnosed and not all students with concussions received treatment at one of the study’s two data sources, Breck et al. believe that their calculated incidence is likely an underestimate.

Despite the inclusion of varsity athletes in their dataset, only 35% of the concussions were sport-related, and the plurality of incidences came from falls (37%). This study hopefully marks a significant move forward in the conversation about concussions on college campuses, which has historically been dominated by varsity athletics and sports concussions. In the population studied, a concussion diagnosis was almost twice as likely to have been from a non-sport incident than a sports-related one. It is essential to promote recognition and awareness both that college students may be at a higher risk of concussion than the general population, and that concussions may be more likely to occur off the field than on it. Read more about their findings in the statistics section of our 1/9/20 newsletter.

Women's Health

Concussion advocates push for mandatory helmets for women’s lacrosse

An article published by NBC Bay Area captures a snapshot of the conversation on mandating helmets in women’s lacrosse. US Lacrosse set a standard for headgear in the women’s game two years ago but has yet to mandate that all players wear helmets. The governing organization says it needs more data on the efficacy of helmets for concussion prevention. Meanwhile, advocates, researchers, and even states are pushing the conversation forward.

Dr. Dawn Comstock of the Colorado School of Public Health points to the rate of concussions due to contact with the head from a stick or ball, which is over 70% and three times the rate of similar concussions in men’s lacrosse, where helmets are mandatory. Meanwhile, the Bay Area organization Brain Safety Alliance, founded by a father and daughter with lacrosse backgrounds, is pushing to institute mandatory helmet use across women’s lacrosse. The organization recently convinced three Northern California clubs to institute mandatory helmet rules. Moving forward, Dr. Comstock, Brain Safety Alliance, and US Lacrosse will look to Florida, the first state to mandate helmet wear, to provide a crucial influx of data on concussion rates in the sport.

Culture

New book highlights the conflicts of interest and meddling of the NFL in brain injury research

Former Obama administration OSHA official, David Michaels, has published a book about "various industries' strategies to suppress data on their own inherent dangers." As reported in the Daily Mail, one chapter of The Triumph of Doubt: Dark Money and the Science of Deception focuses on the NFL's inherent conflicts of interests and meddling in brain injury research and its use of "tobacco industry tactics" to prevent negative publicity and sow confusion. While David Michaels doesn't accuse the NFL of directly lying, he lays heavy blame for its conflicting interests, which have led to conflicted researchers who are paid by the NFL, and delays in research. For example, numerous members of the NFL's Mild Traumatic Brain Injury (MTBI) Committee were medical consultants for NFL teams or were otherwise connected to the league. These fundamental conflicts have, according to Michaels, delayed better treatment and information by over ten years.

Additionally, the NFL has attacked researchers critical of the league, asked for research papers to be retracted, and attempted to thwart the NIH from awarding CTE research funding to Boston University, whose researchers were critics of the league. Emphasizing the need for unbiased research, Michaels says, "This track record underscores the need for independent science and independent research… if you hire a scientist to find something and say their income is dependent on them finding it, they're more likely to find it."