Brain changes seen in youth football players without concussion.


Researchers have found measurable brain changes in children after a single season of playing youth football, even without a concussion diagnosis, according to a new study.

MR images of left inferior fronto-occipital fasciculus (top) before and (middle) after the playing season, and (bottom) the overlay. In the overlay (bottom), the red region is after the season and the blue region is before the season.

Researchers have found measurable brain changes in children after a single season of playing youth football, even without a concussion diagnosis, according to a new study published online in the journal Radiology.

According to USA Football, there are approximately 3 million young athletes participating in organized tackle football across the country. Numerous reports have emerged in recent years about the possible risks of brain injury while playing youth sports and the effects it may have on developing brains. However, most of the research has looked at changes in the brain as a result of concussion.

“Most investigators believe that concussions are bad for the brain, but what about the hundreds of head impacts during a season of football that don’t lead to a clinically diagnosed concussion? We wanted to see if cumulative sub-concussive head impacts have any effects on the developing brain,” said the study’s lead author, Christopher T. Whitlow, M.D., Ph.D., M.H.A., associate professor and chief of neuroradiology at Wake Forest School of Medicine in Winston-Salem, N.C.

The research team studied 25 male youth football players between the ages of 8 and 13. Head impact data were recorded using the Head Impact Telemetry System (HITs), which has been used in other studies of high school and collegiate football to assess the frequency and severity of helmet impacts. In this study, HITs data were analyzed to determine the risk weighted cumulative exposure associated with a single season of play.

The study participants underwent pre- and post-season evaluation with multimodal neuroimaging, including diffusion tensor imaging (DTI) of the brain. DTI is an advanced MRI technique, which identifies microstructural changes in the brain’s white matter. In addition, all games and practices were video recorded and reviewed to confirm the accuracy of the impacts.

The brain’s white matter is composed of millions of nerve fibers called axons that act like communication cables connecting various regions of the brain. Diffusion tensor imaging produces a measurement, called fractional anisotropy (FA), of the movement of water molecules in the brain and along axons. In healthy white matter, the direction of water movement is fairly uniform and measures high in FA. When water movement is more random, FA values decrease, which has been associated with brain abnormalities in some studies.

The results showed a significant relationship between head impacts and decreased FA in specific white matter tracts and tract terminals, where white and gray matters meet.

“We found that these young players who experienced more cumulative head impact exposure had more changes in brain white matter, specifically decreased FA, in specific parts of the brain,” Dr. Whitlow said. “These decreases in FA caught our attention, because similar changes in FA have been reported in the setting of mild TBI.”

It is important to note that none of the players had any signs or symptoms of concussion.

“We do not know if there are important functional changes related to these findings, or if these effects will be associated with any negative long-term outcomes,” Dr. Whitlow said. “Football is a physical sport, and players may have many physical changes after a season of play that completely resolve. These changes in the brain may also simply resolve with little consequence. However, more research is needed to understand the meaning of these changes to the long-term health of our youngest athletes.”

Acupuncture Causes Brain Changes in Patients With Hand Pain


Acupuncture appears to thicken the cortex of patients with idiopathic hand pain while alleviating their pain, a new study suggests.

The finding provides new evidence for a condition resembling carpal tunnel syndrome but with a different cause, said first author, Norman Kettner, DC, chair of radiology at Logan University in Chesterfield, Missouri.

“This needs further investigation,” he told Medscape Medical News.

Dr Kettner presented the finding here at the American Pain Society (APS) 54th Annual Scientific Meeting.

Typical symptoms of carpal tunnel syndrome include pain and paresthesia over median-nerve innervated regions of the hand. But while conduction is decreased in the median nerves of some of these patients, it is normal in others.

To understand the differences in these two groups, Dr Kettner and his colleagues assigned 15 patients with idiopathic hand pain and 21 patients with carpal tunnel syndrome to 16 acupuncture treatments over the course of 8 weeks.

The carpal tunnel syndrome group averaged 49.2 years of age, while the idiopathic hand pain group averaged 38.5 years of age.

Acupuncture consisted of electrical stimulation at 2 Hz in points PC7 and TW5, with manual acupuncture at three additional points among HT3, PC3, SI4, LI5, LI10, and LU5 chosen by practitioners on the basis of their diagnoses.

The researchers measured the patients’ nerve latency and velocity using electrophysiologic testing. They used MRI to measure cortical thickness.

At baseline, median nerve conduction latency was significantly higher for the carpal tunnel group, and median nerve conduction velocity was significantly lower than in the idiopathic pain group and a control group of 13 healthy people.

Differences in ulnar nerve conduction latency and velocity did not significantly differ among the groups.

Also at baseline, average cortical thickness in the bilateral insula was greater in the idiopathic hand pain group than in the carpal tunnel group.

The nerve conduction measurements did not change significantly after acupuncture treatment.

On the other hand, cortical thickness increased in the left S1, right posterior cingulate cortex/precuneus, and bilateral insula after acupuncture in the idiopathic hand treatment group but not in the carpal tunnel group.
Meanwhile, scores on the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) improved for both the idiopathic hand pain and the carpal tunnel syndrome groups. The improvements were statistically significant at the conclusion of the acupuncture treatment and 3 months later (P < .05).

While the idiopathic pain group improved more on the BCTSQ than the carpal tunnel group, this difference was not statistically significant.

Table. Changes in the Boston Carpal Tunnel Syndrome Questionnaire

Treatment Interval Idiopathic Hand Pain (n = 15) Carpal Tunnel Syndrome (n = 21)
Baseline 2.7 2.8
Postacupuncture 1.9 2.1
3-month follow-up 1.7 2.2

In the patients with idiopathic hand pain, the greater the increase in insula thickness, the greater the reduction in symptom severity.

“This will help characterize a subset of carpal tunnel patients,” said Dr Kettner. “One weakness of pain medicine is the failure to subtype patients.”

One could conclude from this study that carpal tunnel syndrome has a strong peripheral nerve component that affects brain functioning, while idiopathic hand pain does not, said Roger B. Fillingim, PhD, director of the Pain Research & Intervention Center of Excellence at the University of Florida in Gainesville.

“It is a small, short-term study, so we don’t want to jump to conclusions,” he told Medscape Medical News.

One question the study does not address is whether other types of treatment, such as exercise or transcutaneous electrical nerve stimulation, would have similar effects as acupuncture, he pointed out.