Addressing the unknowns of concussion

Arthur Brown, Schulich School of Medicine & Dentistry professor and investigator at Robarts Research Institute, and Greg Dekaban, Director of Molecular Medicine at Robarts, are part of a multidisciplinary team working to investigate and develop new ways to treat concussions and to arrest the short- and long-term devastating consequences of the injury. Their research will receive $500,000 from the National Hockey League Players’ Association, which will serve as the foundation of a $3.125 million fund.

Special to Western NewsArthur Brown, Schulich School of Medicine & Dentistry professor and investigator at Robarts Research Institute, and Greg Dekaban, Director of Molecular Medicine at Robarts, are part of a multidisciplinary team working to investigate and develop new ways to treat concussions and to arrest the short- and long-term devastating consequences of the injury. Their research will receive $500,000 from the National Hockey League Players’ Association, which will serve as the foundation of a $3.125 million fund.

Decades ago, if you suffered a sports-related concussion, you were likely advised to ‘walk it off.’ But that’s no longer the case, as research continues to reveal the seriousness of the injury.

“It’s a mild brain injury. But there’s probably nothing true about saying ‘mild injury’ – you get one brain, that’s your brain for life, and you want to protect it,” said Arthur Brown, Schulich School of Medicine & Dentistry professor and investigator at Robarts Research Institute.

“Recently, we’ve come to appreciate that if you’ve had a concussion, it is a serious event, and it needs to be treated properly,” he continued, noting there are still many unknowns when it comes to the diagnosis, short-term treatment and long-term consequences of concussion.

On Wednesday, the National Hockey League Players’ Association (NHLPA) stepped in to help Brown’s team address some of concussion’s unknowns.

The NHLPA is giving $500,000, which will serve as the foundation of a $3.125 million fund to enable a team of researchers, led by Brown, to develop new ways to treat concussions and arrest the short- and long-term consequences of the injury.

The funding announcement was made at See the Line, an annual multidisciplinary event focused on concussion research and awareness held at Western.

“We need to know how to deal with it. It’s probably come to the forefront because of high-profile sports, and elite athletes who have had concussions, and had to withdraw, and then return to play,” Brown said.

“It’s not only a problem for elite and professional athletes – we want our kids to be able to play football, soccer and hockey. We may never be able to get rid of the risk of concussion, but we need to know when it happens, how to deal with it and how to evaluate it.”

Brown has been working with Greg Dekaban, Director of Molecular Medicine at Robarts, and Michael Strong, Schulich Dean. Their work has led to the development of a program focused on three key areas: immunomodulation (treatment of injury-induced inflammation); neuro-restoration (maximizing the regenerative capacity of nerves after injury has occurred); and prevention of concussion-related dementia.

Medical experts now agree concussions are serious injuries and may be associated with long-term conditions such as depression, early onset dementia and Alzheimer’s. In Canada, more than 160,000 people experience a concussion every year, half of which are sports-related. There are currently no treatments to ensure recovery from concussion or clinical indices to determine when an injured athlete can safely return to play.

“We’re trying to see if there are diagnostic tools we can develop to determine there’s a concussion, and when these changes in inflammatory response come back as normal, we can say it’s safe for that player or that person to return to normal activities,” Dekaban explained, noting the team’s work relates to developing potential therapeutics that might lessen the impact, or hasten the recovery from concussion.

Essentially, the team is working on an antibody as part of a strategy to block the influx of inflammatory cells into the injured part of the brain or spinal cord. It’s a non-invasive therapy, Dekaban said.

“People have to understand it’s not like trying to understand liver dysfunction, where you can take a biopsy and sample what’s going on. We can’t do that with the brain. So, studies are more difficult to interpret. A lot of times you’re asking people how they feel, and there’s a lot of subjectivity about how people report things,” he said.

The donation from the NHLPA, and subsequent funding, will help the research team get closer to clinical trials, Dekaban added.

“Part of the problem with concussion is there are no real set standards on how to treat them. There are general rules physicians follow. But because it’s difficult to diagnose a concussion, to confirm one has taken place, there’s a lack of set regulatory guidelines for how you should deal with them because the knowledge isn’t there,” he said.

“Probably, the majority of concussions are unreported. So, we don’t know how to identify them, we don’t know how to evaluate them, how someone’s doing, and we don’t know if someone’s getting better, or if they need more rest. We don’t know how to stop some of the long-term consequences of concussions,” Brown added.

Brown and Dekaban agree – this is the perfect place for this type of research.

“There are so many questions, and how do you attack that? You really need a team. One of the great things about Western and London, in general, is we have a critical mass, we’re big enough but we’re not too big,” Brown said.

“We’re big enough to have the depth – world-class researchers in imaging, clinicians at Fowler Kennedy (Sport Medicine Clinic), like Lisa Fischer, who have a huge amount of experience treating athletes with concussion. We have the clinical side, medical side, people who do biomarkers, people who look at cellular biomarkers that tell us if someone’s had a concussion and how they’re doing.

“You need people who also have an eye to look how the injury can be treated. You really need a whole team to come together, and that’s one of the things we can do here.”