This week, our lead article, Concussions due to occupational or vehicular accidents lead to longer, more extensive recovery compared to sports concussions, is in the Statistics category.

In this newsletter: Opportunities, Therapies & Diagnostic Tools Under Research, Mental Health, Statistics, and CTE & Neurodegeneration Issues.

We appreciate the Concussion Alliance volunteers and staff who created this edition:
Writers: Zoe Heart, Ella Webster, Kira Kunzman, and Sneha Bansal

Editors: Malayka Gormally and Conor Gormally

Do you find the Concussion Update helpful? If so, forward this to a friend and suggest they subscribe.

Opportunities

Tuesday, January 14, 6 pm EST: A free webinar, Introduction to the Treatment of Concussions, presented by Dr. Charles Tator (Neurosurgeon), hosted by the Canadian Concussion Centre. Register in advance.

Wednesday, January 15, 4:00 pm PST: A free Weekly Meditation Class led by Diana Winston, Director of UCLA Mindful, and guests. The program is every Wednesday, 4:00 - 5:30 pm PT, except during the holidays. The Zoom link is here; no advance registration is required.

Thursday, January 16, 11 am PST: A free webinar, Navigating SSDI (Social Security Disability Insurance) & SSI (Supplemental Security Income): Understanding Disability Benefits, presented by Aliza Hauser, MA, CRC, PHR and hosted by the Brain Injury Alliance of Washington State. Register in advance.

Friday, January 24, 8 am PST: A free webinar, School-Based Supports for Students with Brain Injury, presented by Susan Davies, EdD, and hosted by The Center on Brain Injury Research and Training. Register in advance.

Call for study participants: military veterans who have had concussions and/or a traumatic brain injury, including any injury to your head or neck that caused you to lose consciousness or feel dazed/confused/experience a gap in memory. Read our blog post for more information on the Late Effects of TBI (LETBI) study. If you are interested, please contact Julia Kirschenbaum at julia.kirschenbaum@mountsinai.org, call us at 212-241-5152, or sign up online.

Therapies & Diagnostic Tools Under Research

Psychedelic ibogaine creates significant improvements in veterans’ chronic brain injury symptoms

A recent New York Times article has brought greater attention to the use of ibogaine, a psychedelic derived from the bark of iboga trees, as a growing treatment for US veterans suffering from symptoms of brain injury and PTSD. Despite its illegal status in the US, ibogaine (supplemented by a psychedelic called 5-MeO-DMT) has started to be used by thousands of American veterans a year through a clinic in Mexico. The treatment has consistently yielded effective results across a wide range of physical and emotional chronic brain injury symptoms, gaining a reputation among veterans struggling with brain injury symptoms. One SEAL officer told Times journalist Dave Phillips, "Guys want to get well, and they see this working."

According to New York Times reporter Dave Phillips, ibogaine is administered to veterans through an oral pill at a clinic in Tijuana, Mexico. The drug is known to cause harrowing psychedelic trips with side effects of vomiting, physical illness, and possible heart arrhythmia. For this reason, the clinic administers an intravenous magnesium solution to regulate patients' heartbeat, and a cardiologist monitors them during treatment. After their ibogaine treatment, patients receive 5-MeO-DMT, a powerful short-acting psychedelic nicknamed "the God molecule." Patients receive psychotherapy after their psychedelic treatments, but generally no additional substances. Veterans interviewed in the article reported dramatic improvement after just one ibogaine/5-MeO-DMT session. The NYT article references an animal study indicating that ibogaine "can spur the release of natural proteins in the brain that repair and reconfigure neural networks. That leads some researchers to consider it a potential treatment for traumatic brain injury."

The article emphasizes that veterans are seeking this treatment after finding the treatments available through the US healthcare system are ineffective. One green beret explains: "It does sound a little extreme, but I've tried everything else, and it didn't work." It also mentions the wide range of chronic brain injury symptoms the treatment has been found to alleviate, including struggles with sleep, concentration, depression, substance abuse, emotional control, and memory. Lastly, it points out that the growing use of psychedelics by veterans has led the Department of Veterans Affairs to fund psychedelic therapy research for the first time in over 50 years.

See our blog post on the landmark study on ibogaine published in Nature Medicine, which found that "participants experienced average reductions of 88% in PTSD symptoms, 87% in depression symptoms, and 81% in anxiety symptoms at one month after treatment." Standford University and the nonprofit Veterans Exploring Treatment Solutions supported the costs of travel and treatment for the veterans participating in the study.

Mental Health

Co-occurrence of depression and concussion worsens symptoms in collegiate athletes

A study by Owen Griffith et al. highlights that the co-occurrence of concussion and depression is “associated with significantly worse symptoms for both conditions.” Despite overlapping symptoms, these conditions are often treated independently, overlooking their additive effects; awareness of this connection could improve clinical outcomes, as highlighted by Aaron Wagner in a Pennsylvania State University press release. In the study published in Science Direct, neuropsychological screenings, and EEG recordings revealed that athletes with both a history of concussion and depression had significantly more disrupted brain connectivity and nearly double the reported symptoms of depression compared to those with either condition alone.

The researchers measured alpha waves, commonly known as “meditation waves,” via EEG to assess functional connectivity. Alpha waves, indicative of relaxed but awake states, provided a stable measure of neural activity. Those study participants with a history of concussion and a depression diagnosis had more abnormal alpha-band coherence than the healthy control group and study participants with a single diagnosis (either concussion or depression). In other words, the athletes with both conditions had greater disruption of functional connectivity; they had greater “disrupted synchronization of electrical activity between brain areas that generally fire closely together.”

Owen Griffith et al. examined 35 collegiate athletes across four groups: controls with no history of concussion or depression, those with a history of concussion only, those with depression only, and those with both conditions. The results of this EEG study suggest that individuals with pre-existing mental health conditions may require specialized and comprehensive concussion treatment plans, including adjusted recovery timelines. The study reinforces the need to move beyond a one-size-fits-all approach to concussion management, focusing on personalized care to enhance long-term health outcomes for athletes and the general population.

Statistics

Concussions due to occupational or vehicular accidents lead to longer, more extensive recovery compared to sports concussions

Concussions can occur in a multitude of settings—including in sports, the workplace, and motor vehicle accidents—but research has seldom compared the clinical characteristics of concussions across these three particular settings. A recent retrospective review conducted by McPherson et al. revealed that recovery took more than seven times as long for individuals with concussions due to work or vehicle accidents compared to those with concussions due to sports. Additionally, compared to individuals with sport-related concussion (SRC), the time between sustained injury and clinic visit was 5 times and 10 times longer for individuals with work-related concussion (WRC) and motor-vehicle concussion (MVC), respectively.

These findings, published in Brain Injury, could be a result of a variety of factors. One potential consideration is that WRC and MVC concussion patients were older, on average, which may have contributed to these patients requiring a more extensive recovery process than those with SRCs.

In this study, the authors reviewed electronic medical records from 281 patients with clinically diagnosed concussions: 144 SRC, 96 WRC, and 41 MVC. Researchers compared a multitude of aspects across patients, including demographics, clinical care, and patient outcomes. Notably, the data showed that patients who experienced WRCs or MVC-related concussions were significantly older than those who experienced SRCs; as a result, individuals with SRCs may have greater support from parents/guardians, fewer responsibilities (e.g., occupational demands) and may be less impacted by financial strain compared to older individuals with WRCs or MVC-related concussions. The study was limited by the difficulty of controlling for individual characteristics and confounding variables, and it encouraged further research to account for these aspects. This research underscores the need for clinical management guidelines for populations outside of sports, as many mTBI guidelines are aimed toward young athletes.

CTE & Neurodegeneration Issues

Study reveals cumulative CTE risk in ice hockey players: years of play linked to increased odds

A recent study published in JAMA Network Open provides compelling evidence that the risk of developing chronic traumatic encephalopathy (CTE) increases cumulatively with each year of ice hockey play, similar to findings observed in American football and rugby league players. The research found that for each additional year of ice hockey played, the odds of having CTE increased by 34%, with a corresponding increase in the severity of the condition.

Dr. Jesse Mez, primary author of the study and co-director of clinical research at the CTE Center at Boston University, emphasized the importance of these findings in an article in Healio, stating, "This is the first study to clearly establish a dose-response relationship between years of ice hockey play and chronic traumatic encephalopathy."

The study examined the brains of 77 deceased male ice hockey players from various levels of play, ranging from youth to professional, with a median age of 51 years. The researchers adjusted for modifying factors, including age at death, other contact sports played, age of first hockey exposure, concussion count, and hockey position.

While the study provides valuable insights, the sample size was small, especially for players participating in lower levels of play. Moreover, the sample consisted exclusively of White males, limiting the generalizability of the findings to more diverse populations and female hockey players.

Additionally, the researchers acknowledged that career duration is an imperfect proxy for repetitive head impact exposure. In this article published by MedPage Today, Dr. Mez theorized, "Ice hockey players skate quickly, and checking leads to impacts with other players, the ice, boards, and glass. We think years of play is a proxy for these impacts that are harder to measure directly, but are likely what are leading to the disease."

In conclusion, this study highlights the need for continued research into the long-term effects of ice hockey play on brain health and underscores the importance of implementing strategies to reduce the risk of CTE in hockey players at all levels. These findings provide crucial information for players, families, and clinicians to make informed decisions about participation in ice hockey and to better manage the health of former players.