Altered brain microstructure in association with repetitive subconcussive head impacts and the potential protective effect of jugular vein compression: a longitudinal study of female soccer athletes

Myer, Gregory D.; Foss, Kim D. Barber; Thomas, Staci; Galloway, Ryan; DiCesare, Christopher A.; Dudley, Jonathan; Gadd, Brooke; Leach, James; Smith, David W.; Gubanich, Paul; Meehan, William P.; Altaye, Mekibib; Lavin, Philip T.; Yuan, Weihong

doi:10.1136/bjsports-2018-099571

Cited by 44 publications

(42 citation statements)

References 65 publications

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“…Diffusion Tensor Imaging (DTI) is an MRI modality capable of detecting changes to the white matter microstructure following Traumatic Brain Injuries (TBIs) (13). There is now evidence to suggest that subconcussive head injury is associated with aberrations in brain tissue microstrutcture (8,(14)(15)(16). Radial Diffusivity (RD) is a DTI marker which reflects myelination wherein high RD is associated with myelin loss following injury and low RD is associated with myelination (17).…”

Section: Introductionmentioning

confidence: 99%

BDNF Val66Met Positive Players Demonstrate Diffusion Tensor Imaging Consistent With Impaired Myelination Associated With High Levels of Soccer Heading: Indication of a Potential Gene-Environment Interaction Mechanism

et al. 2019

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The purpose of this study was to examine the potential effect modifying role of the BDNF Val 66 Met polymorphism on the association of soccer heading with white matter microstructure. We studied 312 players enrolled in the ongoing Einstein Soccer Study, a longitudinal study of amateur soccer player in New York City and surrounding areas. At enrollment and 2 years later, total heading in the prior 12 months (12-mo.) was estimated using an established self-report instrument and diffusion tensor imaging (DTI) was performed. Generalized Estimating Equations (GEE) logistic regression models were employed to test effect modification by the BDNF Val 66 Met polymorphism on the association between 12-mo. heading exposure and DTI. We identified a significant interaction of 12-mo heading * BDNF Val 66 Met genotype on the presence of low Radial Diffusivity, a DTI marker associated with myelination. Only Met (+) players demonstrated significantly reduced odds of low RD [OR (95 % CI): −2.36 (−3.53, −1.19)] associated with the highest vs. lowest quartile of 12-mo heading exposure. BDNF Val 66 Met (+) soccer players with long-term exposure to high levels of heading exhibit less low Radial Diffusivity, suggesting impaired re-myelination may be a substrate of the previously reported association between heading and poor functional outcomes in soccer players.

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Section: Introductionmentioning

confidence: 99%

BDNF Val66Met Positive Players Demonstrate Diffusion Tensor Imaging Consistent With Impaired Myelination Associated With High Levels of Soccer Heading: Indication of a Potential Gene-Environment Interaction Mechanism

et al. 2019

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“…Using diffusion tensor imaging (DTI), Myer et al described the ability of a specialized neck collar to dampen the effects of subconcussive impact on white matter integrity through bilateral jugular vein compression, diverting blood flow to vertebral veins and promoting venous engorgement. The authors reported pre- to postseason changes in mean diffusivity, axial diffusivity and radial diffusivity in a noncollar group versus collar group, finding significant correlation between head impact exposure and DTI changes over the season in the noncollar group [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…In female high school soccer athletes, Myer et al . found microstructural changes in the white matter tracts on DTI in athletes who did not wear the collar device in comparison to athletes who wore the device [ 46 ]. Correlation of these imaging changes with neurocognitive outcomes is unclear.…”

Section: Resultsmentioning

confidence: 99%

Concussion in soccer: a comprehensive review of the literature

et al. 2020

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Sports-related concussion has been examined extensively in collision sports such as football and hockey. However, historically, lower-risk contact sports such as soccer have only more recently garnered increased attention. Here, we review articles examining the epidemiology, injury mechanisms, sex differences, as well as the neurochemical, neurostructural and neurocognitive changes associated with soccer-related concussion. From 436 titles and abstracts, 121 full texts were reviewed with a total of 64 articles identified for inclusion. Concussion rates are higher during competitions and in female athletes with purposeful heading rarely resulting in concussion. Given a lack of high-level studies examining sports-related concussion in soccer, clinicians and scientists must focus research efforts on large-scale data gathering and development of improved technologies to better detect and understand concussion.

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“…Relation to previous investigations. A variety of previous investigations into the effects of sports participation, repetitive head impacts and white matter tissue properties of athletes have used the diffusion tensor (DTI) model (Bahrami et al, 2016;Basser et al, 1994;Bazarian et al, 2014;Burzynska et al, 2016;Chang et al, 2015;Chun et al, 2015;Churchill et al, 2017aChurchill et al, , 2017bDavenport et al, 2016aDavenport et al, , 2016bDavenport et al, , 2014Deng et al, 2018;Duru and Balcioglu, 2018;Gajawelli et al, 2013;Hänggi et al, 2015Hänggi et al, , 2010Jäncke et al, 2009;Koerte et al, 2012;Kuzminski et al, 2018;Lao et al, 2015;Marchi et al, 2013;Mayinger et al, 2018;McAllister et al, 2014;Merchant-Borna et al, 2016;Myer et al, 2018Myer et al, , 2016aMyer et al, , 2016bPark et al, 2015;Saghafi et al, 2018;Schlaffke et al, 2014;Schranz et al, 2018;Sollmann et al, 2018;Stamm et al, 2015;Yuan et al, 2018) . The studies investigating the effects of elite sports participation commonly report lower fractional anisotropy (FA) and higher mean diffusivity (MD) between athletes and non-athletes.…”

Section: Discussionmentioning

confidence: 99%

Advanced mapping of the human white matter microstructure better separates elite sports participation

Caron¹,

Bullock²,

Kitchell³

et al. 2020

Preprint

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Collision-sport athletes, especially football players, are exposed to a higher number of repetitive head impacts. Little is known, however, regarding the effects of long-term exposure to repetitive head impacts on brain tissue structure and the locations (i.e. superficial or deep tissue structures) affected. On top of this, little is known about the effects of highly competitive athletics on brain tissue structure. We investigated this relationship, including the baseline effect of collegiate athletic participation, by mapping measures of microstructure to cortical and subcortical white matter parcels and major white matter tracts of varsity IU football players, cross-country runners, and non-athlete students using advanced microstructural mapping techniques and machine-learning. We tested a series of hypotheses on the differences between the subject groups. To do so, we implemented an innovative approach to statistical hypothesis testing combining advanced white matter tissue properties and machine-learning classifiers. We used cross-validation to select the best subject group model and best machine-learning classifier. Wide-spread differences in brain tissue microstructure across cortical, subcortical, and major white matter structures were documented. The tissue properties of the major white matter tracts were found to best predict collision-sport participation and sports participation in general, however, cortical and subcortical white matter parcels were also found to predict collision-sports participation. The biggest differences in brain tissue microstructure is between the athletes (football and cross country combined) and the non-athletes students. The rewards and risks of playing competitive sports at the highest collegiate level may account for the differences in brain microstructure. This was the first investigation into the effects of repetitive head impacts to use an open-source data processing platform brainlife.io. The data and code for these analyses are available via brainlife.io.

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Altered brain microstructure in association with repetitive subconcussive head impacts and the potential protective effect of jugular vein compression: a longitudinal study of female soccer athletes

Cited by 44 publications

References 65 publications

BDNF Val66Met Positive Players Demonstrate Diffusion Tensor Imaging Consistent With Impaired Myelination Associated With High Levels of Soccer Heading: Indication of a Potential Gene-Environment Interaction Mechanism

BDNF Val66Met Positive Players Demonstrate Diffusion Tensor Imaging Consistent With Impaired Myelination Associated With High Levels of Soccer Heading: Indication of a Potential Gene-Environment Interaction Mechanism

Concussion in soccer: a comprehensive review of the literature

Advanced mapping of the human white matter microstructure better separates elite sports participation

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