Like emergency workers rushing to a disaster scene, cells called microglia speed to places where the brain has been injured, to contain the damage by ‘eating up’ any cellular debris and dead or dying neurons. Scientists at the European Molecular Biology Laboratory (EMBL) in Heidelberg, Germany, have now discovered exactly how microglia detect the site of injury, thanks to a relay of molecular signals. Their work, published May 24, 2012 in Developmental Cell, paves the way for new medical approaches to conditions where microglia’s ability to locate hazardous cells and material within the brain is compromised. “Considering that they help keep our brain healthy, we know surprisingly little about microglia,” says Francesca Peri, who led the work. “Now, for the first time, we’ve identified the mechanism that allows microglia to detect brain injury, and how that emergency call is transmitted from neuron to neuron.” When an emergency occurs, cries can alert bystanders, who will dial the emergency number. A call will go out over the radio, and ambulances, police or fire engines in the area will respond as needed. In the brain, Peri and colleagues found, injured neurons send out their own distress cry: they release a molecule called glutamate. Neighbouring neurons sense that glutamate and respond by taking up calcium. As glutamate spreads out from the injury site, this creates a wave of calcium swallowing. Along that wave, as neurons take up calcium they release a third molecule, called ATP. When the wave comes within reach, a microglia cell detects that ATP and takes it as a call to action, moving in that direction – essentially tracing the wave backwards until it reaches the injury. . Lost alert: when microglia (green) cannot detect ATP (bottom), they don’t move to the injury site as they usually would (top).Photo credit: EMBL/Peri Scientists knew already that microglia can detect ATP, but this molecule doesn’t last long outside of cells, so there were doubts about how ATP alone could be a signal that carried far enough to reach microglia located far from the site of injury. The trick, as Peri and colleagues discovered, is the long-lasting glutamate-driven calcium wave that can travel the length of the brain. Thanks to this wave, the ATP signal is not just emitted by the injured cells, but is repeatedly sent out by the neurons along the way, until it reaches microglia. Dirk Sieger and Christian Moritz in Peri’s lab took advantage of the fact that zebrafish have transparent heads, which allow scientists to peer down a microscope straight into the fish’s brain. They used a laser to injure a few of the fish’s brain cells, and watched fluorescently-labelled microglia move in on the injury. When they genetically engineered zebrafish to make neurons’ calcium levels traceable under the microscope, too, the scientists were able to confirm that when the calcium wave reached microglia, these cells immediately started moving toward the injury. Knowing all the steps in this process, and how they feed into each other, could help to design treatments to improve microglia’s detection ability, which go awry in conditions such as Alzheimer’s and Parkinson’s diseases. Source: Sieger, D, Moritz, C., Ziegenhals, T., Prykhozhij, S. & Peri, F. Long-range Ca2+ waves transmit brain damage signals to microglia.Developmental Cell, published online 24 May 2012. Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

Coy Wire was a team captain for the Buffalo Bills (2002-2007) and the Atlanta Falcons (2008-2011) during his nine years in the NFL. An All-American Honors athlete at Stanford University, Coy was the first player to lead the Cardinal in both rushing and tackles. He was a recipient of the NFL’s Ed Block Courage Award. Q: What would you tell athletes about concussions? The NFL is in a state of evolution and recent changes will only make it safer for younger athletes. The league and the NFLPA (National Football League Players’ Association) have made huge strides to address the concussion issue, while maintaining the excitement of the game for both fans and players. It’s important that all athletes remember that you only get one brain and as we learn more about the long-term and adverse effects of contact sports and repetitive head injury, we know that smaller hits over the course of a career- even a high school career- can accumulate. Learn to recognize the symptoms of head trauma. You can have headaches or you might be slightly dizzy …these are all bearable and many athletes mask these symptoms by taking a Tylenol and then they go out and play again. But a concussion is not an ankle or shoulder injury…later in life you can have surgery on that ankle or have knee replacement surgery but you only get one brain. You can’t get a brain replacement. If you mask head trauma you can be risking increased problems in the future for Alzheimer’s or dementia. Head trauma has to be looked at very differently. Yes, in a way it’s a body part like a shoulder, but your brain must be treated very differently. You can ice and elevate an ankle but can’t do that with your brain. Real damage may show up later in life …and it’s not just football, it can happen in any sport. We used to look at toughness and playing through injuries as a badge of honor. That you were tough both mentally and physically and that continuing to play while hurt brought you the respect of your peers. But we need to change the culture now, and that starts with you. You need to believe that it’s OK to miss a game or a week or longer. If you do have to sit out, it means you were playing hard and you took one for the team. You shouldn’t feel ashamed. And if you care about your friends and your teammates, keep them from harm.https:// If you see a friend of yours doing something to hurt themselves, like playing with a concussion, step up and help them. You’re doing them a huge injustice by allowing them to continue to play. You are your brother’s keeper. Become a hero in their life and help them realize what they probably know deep down inside anyway. Someday they’ll look back and know what you did for them, and they’ll respect you more, later in their lives. Be a leader and help change the game. Help create a new norm. Coy Wire is the author of Change Your Mind; 10 Unconventional Secrets to Retrain Your Brain; March 2012. He is an inspirational speaker and mind coach. For more information contact him at https://www.coywire.com/

New Findings Provide Important Data for Refining Diagnosis Postmortem analysis of the brains of ten professional athletes with chronic traumatic encephalopathy (CTE) provides new insights into the specific types of brain abnormalities associated with this diagnosis, reports a study in the July 2011 issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. The findings may help to refine the cellular criteria for making the postmortem diagnosis of CTE, provide initial clues as to some possible subytpes, and improve identification of cases. The study was led by Drs. Bennet I. Omalu and Julian Bailes of the Brain Injury Research Institute at West Virginia University.Detailed Information on Brain Abnormalities in CTE The researchers performed a detailed evaluation of autopsy brain specimens from 14 professional athletes and three high school football players who died unexpectedly. The goal was to take an in-depth looks at the cellular-level abnormalities associated with chronic traumatic encephalopathy (CTE)—a progressive neurodegenerative disease caused by repeated head trauma, seen especially in high-level competitive athletes. Patients with CTE develop mood disorders, cognitive dysfunction, and other psychiatric symptoms, typically occurring years after a history of repeated concussions. Drs. Omalu and Bailes have played a pivotal role in CTE research, having reported on the first three cases of CTE in American football players. Of the 14 professional athletes in the study, ten had autopsy brain findings consistent with a diagnosis of CTE. The CTE cases were seven football players, two wrestlers, and one boxer. Most died from non-natural causes—mainly suicide or trauma. The authors present a detailed analysis of the neuropathological findings in their cases of CTE. The main feature was "neurofibrillary tangles" (NFTs) and "neuritic threads" (NTs) scattered in different areas of the brain. The brains also show evidence of localized areas of brain trauma occurring amny years previously. Findings Suggest Possible 'Emerging' Subtypes None of the athletes with CTE had the characteristic brain atrophy (shrinkage) of Alzheimer's disease. None of the brains showed the widespread amyloid deposits typical of Alzheimer's disease, but some had scattered to frequent amyloid deposits. Although there are not yet enough cases to develop a true classification system, the authors identify some possible "emerging phenotypes" of CTE, based on the number and location of NFTs and NTs and amyloid deposits. The researchers also examined the brains of three high school football players who died of trauma sustained during competition. None of these young athletes met criteria for a diagnosis of CTE. However, one brain showed early, "incipient" abnormalities similar to those of CTE brains, likely related to repeated brain injury. Since the first reported case in 2002, there has been growing concern about CTE and other consequences of repeated head trauma and concussions in football players and other athletes. The findings have led to renewed discussion of the consequences of head trauma—not only in athletes, but also in other high-risk groups such as combat veterans. The Brain Injury Research Institute was created to study the short and long-term impact of brain injury and concussions and the development of CTE. Drs. Omalu and Bailes and colleagues hope their findings will contribute to further research into the neurological and psychosocial impact of CTE. In addition to proposing some possible subtypes of CTE, they suggest a set of pathological tests to be performed in diagnostic investigation of possible CTE. They believe that "CTE diagnosis and surveillance should become intrinsic components of routine patient care work-ups and routine hospital/medical examiner autopsies in high risk cohorts like athletes." Source: Study Takes a Closer Look at Brain Abnormalities in Athletes with CTE -- Lippincott Williams & Wilkins -- Newswise July 12, 2011 Questions/comments? Contact Jean Rickerson at Jean@SportsConcussions.org

Alzheimer’s disease and Chronic Traumatic Encephalopathy (CTE) are both “neurodegenerative diseases.” That is, they are brain diseases that result in the progressive destruction of brain cells, eventually leading to cognitive, behavioral, and other impairments. Both diseases also lead to dementia. The distinction between Alzheimer’s and dementia is very often misunderstood, even by many doctors. “Dementia” is a clinical syndrome defined by memory and other cognitive impairments that are severe enough to cause difficulties in social and/or occupational functioning (i.e., reduced independence in functioning). Dementia is not an illness or a disease. Dementia is not a “mild” form of Alzheimer’s. Rather, it is analogous to “fever,” in that it tells you that you are sick, but doesn’t say what is causing the problem. Similarly, dementia means that there is something wrong with the brain’s functioning, but not what is causing it. Several illnesses and diseases can lead to dementia, including Alzheimer’s disease which accounts for approximately 75% of all cases of dementia. However, several other neurodegenerative diseases result in dementia, including CTE. Alzheimer’s and CTE are distinct diseases. Both Alzheimer’s and CTE can only be accurately diagnosed postmortem through a neuropathological examination of the brain. There have been several new scientific breakthroughs over the past few years that now allow doctors and scientists to be much more accurate in diagnosing Alzheimer’s during life. However, at this time, there is no method of diagnosing CTE during life, although our group at the Boston University Center for the Study of Traumatic Encephalopathy (CSTE) recently received a grant from the National Institutes of Health to begin developing these types of tests. One of the major differences between Alzheimer’s and CTE involves what causes each of the diseases. There is no known specific risk factor that leads to Alzheimer’s. For CTE, however, it is believed that repetitive brain trauma (including concussions and subconcussive blows to the head) is a necessary, but not sufficient risk factor. That is, everyone that has been found to have CTE in postmortem examination has had a history of repetitive brain trauma, including athletes (e.g., football and hockey players, boxers and wrestlers), as well as others, such as combat military personnel, developmentally disabled individuals who repeatedly bang their heads, and victims of domestic abuse. Boxers and football players (especially lineman) appear to be the most likely to get the disease because of the repetitive brain trauma exposure. But, it is important to note that not everyone with a history of repetitive brain trauma will develop CTE. Our center is currently conducting research into the other potential additive risk factors, such as genetics, age of initial brain trauma exposure, frequency and overall duration of exposure, etc. This research will hopefully lead us to understand why one person gets the disease and another person does not. This line of investigation, along with our new study to develop methods of diagnosing CTE during life, will eventually lead to effective treatments and prevention strategies. Robert A. Stern, Ph.D. is a Professor of Neurology and Neurosurgery; Co-Director, Center for the Study of Traumatic Encephalopathy; Director, Clinical Core, BU Alzheimer's Disease Center, Boston University School of Medicine.

ANN ARBOR -- A grant from the NCAA will kick off a groundbreaking, long-term study of concussion and other head injuries among athletes, led by University of Michigan researchers and their colleagues around the country. The NCAA will provide $400,000 to begin to fund a longitudinal study by the National Sport Concussion Outcomes Study Consortium, a new group that includes three founding members from the University of Michigan: Jeffrey Kutcher, M.D., associate professor of neurology; James T. Eckner, M.D., assistant professor in physical medicine and rehabilitation; and Steven Broglio, Ph.D., assistant professor of kinesiology. With the NCAA grant, the Consortium will study more than 1,000 male and female college athletes who compete in 11 sports at three schools. Researchers hope to track those athletes throughout their lifetime to monitor long-term effects of head injuries.But the Consortium has even bigger plans. Kutcher says the group is seeking funding to expand the effort and begin enrolling athletes as early as high school, then follow them through college and even into professional careers. "We're hoping this could become a Framingham heart study for sports concussion," says Kutcher, referring to the study that began in 1948 with more than 5,000 people and has led to the identification of major cardiovascular disease risk factors."This study will be essential to improving our understanding of the risk to brain health for those who play sports. There is no data like this, it's groundbreaking. It will define the landscape." Kutcher and the U-M faculty founded the Consortium with Kevin Guskiewicz, Ph.D., chair of the Department of Exercise and Sport Science at the University of North Carolina; Chris Giza, M.D., of the Department of Neurology at UCLA; and Michael McCrea, Ph.D., professor of neurosurgery and neurology and director of brain injury research at the Medical College of Wisconsin. "There's a tremendous need for data that describe both the short and long-term health consequences of concussions," says Kutcher, who also is director of the Michigan Neurosport Concussion Program at U-M. "There are some hints, and a series of case reports in the literature, but no well-controlled study that addresses the long-term questions. To do that study, and do it correctly, requires following a population of athletes over time and documenting their brain function, while controlling for other variables." David Klossner, the NCAA's director of health and safety, said supporting the consortium's study will aid efforts to promote a safe competitive environment. "The NCAA is seeking to foster innovative research among its member universities to increase knowledge about the short-term and long-term neurological consequences of playing sports," Klossner said. "In addition to monitoring trends in concussions through the Association's injury-surveillance system, this research is another important step to enhance student-athlete safety." In this first phase of the study, the Consortium researchers will study athletes in contact sports ihttps:// football, soccer, basketball, ice hockey, and lacrosse; women's water polo, soccer, basketball, field hockey, and lacrosse. Non-contact sport participants also will be recruited from the track and field and swimming and diving teams. Kutcher believes the data the study collects will provide a more comprehensive understanding of concussions. The short-term effects have been examined for several years, and technological advancements have helped improve the understanding of impacts on the brain by using shock sensors embedded in players' helmets. "There has been https://rable attention paid to concussion recently, by the media and others, spurred by reports of National Football League players, hockey players — people who have had a long history of contact — having a very particular kind of dementing illness," says Kutcher. "But that story is only beginning to be told. We need to do the appropriate research to figure out the scope of the problem." Kutcher also directs the NBA's concussion program, is a consultant to the NHL Players Association and the team neurologist for the University of Michigan Athletic Department. He has been instrumental in crafting the concussion policies of the NCAA, Big Ten and Mid-American Conference. He has testified before U.S. Congress on helmet and equipment safety. For more information and free online courses about recognizing and responding to concussions, go to https://www.michiganneurosport.com/ SOURCE University of Michigan Health System Read more here: https://www.sacbee.com/2012/03/14/4336415/groundbreaking-long-term-study.html#storylink=cpy Photo: Wikimedia Commons

Shepherdstown, W.V. — Senator Jay Rockefeller convened a roundtable discussion at Shepherd University's Wellness Center on Friday with medical experts, sports professionals, coaches, and parents to help raise awareness of many of the causes and impacts of concussions and head injuries in young athletes. He also highlighted problems with the marketing of some sports safety equipment which claim to prevent concussions among athletes. “We all have a responsibility to make sure that kids who play sports are as safe as they can be,” said Rockefeller. “Much of the conversation about concussions has focused on professional athletes, but it affects so many children on the field, court, mat, or track. Last October, I chaired a Senate hearing to help raise awareness about concussions in youth sports, but our job is not done. We need to make sure that everyone in West Virginia knows how to reduce the number of concussions, since they can have long-term consequences for our children’s health. “Playing sports doesn’t just make kids stronger and healthier. It also teaches them important values – hard work, leadership, and the importance of working together. I encourage everyone here today to tell their friends and family about how to better protect student athletes so that we can reduce injuries, increase awareness about some false marketing of sports equipment, and make sure our kids stay healthy.” The roundtable provided an opportunity to discuss the dangers of concussions for young athletes, the steps that parents and coaches should take to protect young athletes from concussions, and the limitations of sports equipment in preventing concussions. The discussion included medical experts from West Virginia to discuss the dangers and frequency of concussions for young athletes, sports officials from the state to explain the steps currently being taken to protect young athletes from concussions on the field, and representatives from the Consumer Product Safety Commission and the Federal Trade Commission to discuss the role of the federal government in creating safety standards for products and investigating marketing claims made by manufacturers. On October 19, Rockefeller, Chairman of the Senate Committee on Commerce, Science, and Transportation, held a hearing on concussions and the marketing of sports equipment to increase awareness of both the dangers of concussions for athletes participating in sports at all levels and the misleading marketing claims about concussions made by sports equipment manufacturers. Rockefeller convened the hearing because much of the discussion on concussions had largely focused on the dangers of concussions at the professional level, even though a significant percentage of those suffering concussions are children and high school students participating in sports, especially contact sports like soccer, football, and hockey. Click here to view video of the hearing Source: Senator Jay Rockefeller Questions/comments? contact Jean Rickerson at Jean@SportsConcussions.org

Researchers at Nationwide Children's Hospital in Columbus, Ohio, found that of the 14,635 high-school sports injuries reported during the 2008-2010 school year, 13% were concussions. The majority of them were uncomplicated, in fact, 40% of the students who suffered concussions saw their symptoms disappear within three days. Most returned to play within three weeks, but a significant number -- about 25% -- returned to play the same day they were injured, a situation many state concussion laws are designed to address. "This improper practice was widespread," noted researchers Mallika Marar, Natalie McIlvain, Sarah Fields and R. Dawn Comstock, who found it in 12 of the 20 sports they studied. "This clearly violates the consensus statement on sports-related concussion, which recommends that no adolescent athlete who sustains a concussion should return to play on the day of the injury,"reported WPTV.com. Other findings included: Most common symptoms: headache (94.2%), dizziness (75.6%) and difficulty concentrating (54.8%) More than one: Eleven percent had suffered concussions before, highest rate of recurrence was boys' wrestling (20%) Most by number: football (47%) followed by girls' soccer (8.2%) Most common practices/games: games; exception was cheerleading, participants were 10x more likely to be hurt during practice Most by gender: boys; although concussions in girls' sports represented a higher number of overall injuries Most common occurrence: athlete-to-athlete contact; girls were more likely to suffer a concussion from striking the ground or being struck by another players' piece of equipment such as a hockey stick The study was published in the January edition of the American Journal of Sports Medicine. Source: Study: High school athletes return from concussion too soon -- WPTV.com Questions/comments? Contact Jean Rickerson at Jean@SportsConcussions.org

The first of three private screenings was held in Chicago on May 15th for "Head Games," a documentary on the sports concussion crisis. From acclaimed director Steve James (Hoop Dreams, The Interrupters) and award-winning producer Bruce Sheridan, Head Games takes a deeper look at the devastating and long-term effects of concussions in all sports. Inspired by events from the book Head Games written by Christopher Nowinski, the film offers eye-opening insight and cutting-edge science on head trauma from the nation’s leading medical experts. Additional screenings will be held June 6 at the Boston University School of Medicine Albany Street Auditorium and June 7 in Philadelphia at the Translational Research Center (TRC) Rubenstein Auditorium. Watch the trailer Questions/comments? contact Jean Rickerson at Jean@SportsConcussions.org

MUNCIE, Ind. -- Student-athletes will receive financial assistance to help defray the costs of baseline testing from a fund named for the late Chicago Bears' Dave Duerson who committed suicide a year ago. An autopsy revealed Duerson suffered from chronic traumatic encephalopathy (CTE), a degenerative brain disease. CTE is associated with repetitive head trauma and can affect judgement, mood, impulse control and memory. Computerized neuropsychological concussion tests, known as "baseline" tests, are typically taken by student-athletes prior to the beginning of their sports season on a computer at home, in a school computer lab or in a doctor's office. Structured similar to a computer game, a student-athlete will complete various online exercises that measure memory, reaction times and cognitive processing speeds. If an injury occurs the test is retaken and baseline scores are compared to post-injury values. The difference between the two can give trained medical professionals a look at potential issues that need further evaluation prior to clearing a student-athlete to return to activity. "The baseline testing gives everyone a free opportunity to pre-test," Central High School football coach John Hochstetler said. "The post-test comes with a fee, and that's where some of our youngsters run into challenges," according to The Star Press. The Dave Duerson Muncie Community Schools Athletic Safety Fund will assist injured athletes who can't afford the post-injury test at two middle schools and two high schools beginning with the 2012-2013 season. Duerson played football, basketball and baseball at Northside High School in Muncie, Ind. He went on to play for Notre Dame where he received All-American recognition in 1981 and 1982 before entering the NFL. Duerson played for the Chicago Bears, New York Giants, and the Arizona Cardinals. He earned two Super Bowl championship rings and was selected to four consecutive Pro Bowls from 1986-1989 during his eleven-year career in the NFL. Duerson was the NFL 'Man of the Year' in 1987. Source: Duerson fund will assist Muncie athletes -- The Star Press April 1, 2012 Questions/comments? contact Jean Rickerson at Jean@SportsConcussions.org