The National Institute of Neurological Disorders and Stroke has awarded a $10 million grant to a consortium of academic institutions focused on identifying the best diagnostic techniques for predicting recovery and long-term consequences of concussion among children. Researchers at the USC Mark and Mary Stevens Neuroimaging and Informatics Institute (USC Stevens INI) at the Keck School of Medicine of USC will oversee the collection and analysis of imaging data for the project from seven sites across the United States for the next five years.
"It can be extremely debilitating for young people to deal with the adverse consequences of concussion, but right now, we don't know what their prognosis will be when they first get injured," said Paul M. Thompson, PhD, associate director of USC Stevens INI and the lead USC researcher on the project. "The objective of the study is to demystify that, ultimately paving the way for earlier and better interventions."
The study, known as Concussion Assessment, Research and Education for Kids, or CARE4Kids, will enable researchers and to use advanced brain imaging and blood tests to explore biological markers - changes in blood pressure, heart rate and pupil reactivity - that could predict which youngsters will develop persistent symptoms after concussion. The CARE4Kids study will enroll more than 1,300 children nationwide.
The challenge at hand
More than three million Americans are diagnosed with concussions each year. About 30 percent of them continue to experience symptoms three months after injury, and adolescents face an even higher risk of delayed recovery, known as persistent post-concussion syndrome. Common symptoms include chronic migraine headaches, learning and memory problems, exercise intolerance, sleep disturbances, anxiety and depressed mood.
The study will employ state-of-the-art imaging methods capable of detecting subtle changes and signs of recovery in the brain.
"This is a real area of strength for USC because we have some of the inventors of the most advanced brain scanning methods," said Thompson, a professor of ophthalmology, neurology, psychiatry and the behavioral sciences, radiology and engineering at the Keck School. "One of them, in wide use around the world, is a technique called arterial spin labeling, or ASL, which tracks blood flow in the brain with incredible precision without requiring the patient to perform tasks."
Finding a fix
The study has two major stages. The first part will evaluate children with concussion to identify a set of biomarkers predictive of persistent post-concussion symptoms. In the second stage, designed to validate the findings, researchers will study a new group of children diagnosed with concussion to confirm that these biomarkers accurately predict who will experience prolonged symptoms. The goal is to develop a diagnostic protocol that can be used in general clinical practice by doctors and other health professionals caring for pediatric patients who've experienced a concussion.
Institutions currently recruiting patients for the study include UCLA Mattel Children's Hospital, Children's National Hospital, Seattle Children's, the University of Washington, University of Rochester, University of Texas Southwestern Medical Center and Wake Forest School of Medicine. Indiana University, the National Institute of Nursing Research, University of Arkansas and the data coordinating center at the University of Utah are also involved in the project.
USC researchers will leverage their expertise to coach enrolling sites on data collection, including for some of the more advanced types of imaging technology such as ASL and quantitative susceptibility mapping (QSM), which is capable of picking up micro hemorrhages in the brain. In addition to Thompson, members of the USC team include Danny Wang, PhD, director of imaging technology innovation and developer of the ASL technology; Kay Jann, PhD, assistant professor of research neurology; and Arthur Toga, PhD, director of the USC Stevens INI.
