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Repetitive subconcussive head impact – Magnetic Resonance Spectroscopy in young athletes
Repetitive subconcussive head impact – Magnetic Resonance Spectroscopy in young athletes
While sports around the world and its beneficial effects on body and mind and overall health are commonly acknowledged, many sports have faced an increased focus on player’s safety and health over the last few years. Researchers around the world are looking more closely at sports with potential detrimental effects on the body, brain and long-term-trajectories. The United States National Institute of Health (NIH) just recently publicly concluded that repetitive traumatic brain injuries can cause chronic traumatic encephalopathy (CTE) despite the resisting position of many official sport governing bodies of contact sports1. Soccer, being one of the most played sports, globally and nationally, has also been more closely looked at. Soccer players are not only at risk of unintentional tackles and collisions but face the challenge of heading the ball as intended part of games and practice. Many soccer players start practicing headers at a young age and continue to perform headers throughout their career. While there is some research hinting at increased risk for soccer players and other athletes of contact sports of developing neurodegeneration of the brain, it is important to understand the changes when they begin to be detectable and possibly reversible. The brain, as a remarkable sensitive, yet robust organ, is the main focus of this thesis. As part of a larger study called RepImpact, its main objective was the study of the effect of headers at a young age (14-16 years old); looking at the brain itself, its structure, pathways and its metabolites, but also at motor and balance skills, cognitive performance as well as blood and saliva markers. In order to detect early effects and minimal changes of repetitive subconcussive head impacts such as headers, Magnetic Resonance Spectroscopy (MRS) as a sequencing part of Magnetic Resonance Imaging (MRI) was used to detect changes in brain metabolites. This dissertation focused on brain metabolites of young soccer players and controls from Germany and possible changes before, during and after season, as well as in comparison to controls. Typical developmental changes of the brain – as seen through changes in metabolite levels of total N-acetylaspartate (tNAA) dependent on age and consistent with the limited research available – could be presented. tNAA is shown to be a sensitive marker of age during the age of 14 to 16, indicating ongoing brain development. Further research of the brain metabolite levels during crucial developmental phases is necessary to establish baseline levels of the metabolites during development. This would be an important first step to further investigate possible changes brought on by repetitive subconcussive head impacts (and concussion). Using the data at hand, differences in metabolite levels between soccer players and controls were not detectable. A larger data set with longer observation period, more sensitive methods to count headers (and possible other collisions and concussions to evaluate “realistic risks”) and more knowledge about baseline metabolite levels at different ages might further help to understand and see the effects of repetitive subconcussive head impact (and biological compensatory and repair mechanisms). This could provide a basis for guiding and protecting children from detrimental outcomes in their future.
Magnetic Resonance Spectroscopy, Repetitive Subconcussive Head Impact
Heinen, Felicitas
2024
English
Universitätsbibliothek der Ludwig-Maximilians-Universität München
Heinen, Felicitas (2024): Repetitive subconcussive head impact – Magnetic Resonance Spectroscopy in young athletes. Dissertation, LMU München: Faculty of Medicine
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Abstract

While sports around the world and its beneficial effects on body and mind and overall health are commonly acknowledged, many sports have faced an increased focus on player’s safety and health over the last few years. Researchers around the world are looking more closely at sports with potential detrimental effects on the body, brain and long-term-trajectories. The United States National Institute of Health (NIH) just recently publicly concluded that repetitive traumatic brain injuries can cause chronic traumatic encephalopathy (CTE) despite the resisting position of many official sport governing bodies of contact sports1. Soccer, being one of the most played sports, globally and nationally, has also been more closely looked at. Soccer players are not only at risk of unintentional tackles and collisions but face the challenge of heading the ball as intended part of games and practice. Many soccer players start practicing headers at a young age and continue to perform headers throughout their career. While there is some research hinting at increased risk for soccer players and other athletes of contact sports of developing neurodegeneration of the brain, it is important to understand the changes when they begin to be detectable and possibly reversible. The brain, as a remarkable sensitive, yet robust organ, is the main focus of this thesis. As part of a larger study called RepImpact, its main objective was the study of the effect of headers at a young age (14-16 years old); looking at the brain itself, its structure, pathways and its metabolites, but also at motor and balance skills, cognitive performance as well as blood and saliva markers. In order to detect early effects and minimal changes of repetitive subconcussive head impacts such as headers, Magnetic Resonance Spectroscopy (MRS) as a sequencing part of Magnetic Resonance Imaging (MRI) was used to detect changes in brain metabolites. This dissertation focused on brain metabolites of young soccer players and controls from Germany and possible changes before, during and after season, as well as in comparison to controls. Typical developmental changes of the brain – as seen through changes in metabolite levels of total N-acetylaspartate (tNAA) dependent on age and consistent with the limited research available – could be presented. tNAA is shown to be a sensitive marker of age during the age of 14 to 16, indicating ongoing brain development. Further research of the brain metabolite levels during crucial developmental phases is necessary to establish baseline levels of the metabolites during development. This would be an important first step to further investigate possible changes brought on by repetitive subconcussive head impacts (and concussion). Using the data at hand, differences in metabolite levels between soccer players and controls were not detectable. A larger data set with longer observation period, more sensitive methods to count headers (and possible other collisions and concussions to evaluate “realistic risks”) and more knowledge about baseline metabolite levels at different ages might further help to understand and see the effects of repetitive subconcussive head impact (and biological compensatory and repair mechanisms). This could provide a basis for guiding and protecting children from detrimental outcomes in their future.