Many of you know that I am a Philadelphia Eagles fan, so I was interested to read about the use of functional magnetic resonance imaging (fMRI) to do neurological clinical trial research on concussions in football players.
Sports Illustrated raised the awareness of the impact of concussions in a series of articles in their November 1st issue, including the iconic cover of the magazine.
Functional MRI measures changes in cerebral blood flow associated with brain activity. The MRI is able to detect changes in blood oxygenation since hemoglobin is magnetic when oxygenated, but paramagnetic when deoxygenated. Using Blood Oxygen Level Dependence (BOLD) as the MRI contrast agent, changes in brain oxygen consumption associated with thoughts and mental activity can be detected.
fMRI Imaging in Concussion Research
A team of researchers from Purdue University led by Thomas Talavage used fMRI to assess brain trauma associated with high school football. Using fMRI imaging while taking a computerized neurocognitive exam that tests memory and concentration (ImPACT test), they showed evidence of functional impairment in players who had received multiple head hits, but did not exhibit clinical signs of concussion. In particular, repetitive hits led to a decline in activity in the dorsolateral prefrontal cortex, associated with visual memory. The Purdue research is to be published in the Journal of Neurotrauma.
Source: Talavage et al, Journal of Neurotrauma. “50% of players with no clinically-observable impairments still show significant alterations during in-season fMRI.”
It will be interesting to see how schools and colleges who owe a duty of care to their students react to the findings of non-visible brain trauma from playing football.
Given its wide availability, non-invasiveness and absence of radiation exposure, fMRI is well suited to clinical research. However, the challenge with multi-center clinical trials is not only getting the MRI scanners calibrated or at least the calibration monitored, but also the stimulus given to each subject has to be identical in the identical format, etc. This is very difficult to replicate. It is therefore, not widely used in pharmaceutical clinical trials. However, I expect we will see further research on football players using fMRI imaging to better identify players at risk and how to play the game safer and without causing any long-term disability.
- Functionally-Detected Cognitive Impairment in High School Football Players Without Clinically-Diagnosed Concussion Thomas M. Talavage, Eric Nauman, Evan L. Breedlove, Umit Yoruk, Anne E Dye, Katie Morigaki, Henry Feuer, Larry J. Leverenz. Journal of Neurotrauma. -Not available-, ahead of print. doi:10.1089/neu.2010.1512.