Concussions: Looking back, looking ahead (Part 1 of 2)

Fall means football for most high schools and colleges. But amidst the tackles and touchdowns, concussions are serious injuries that often go unrecognized and undertreated. In the past, players who were “dinged” or got “their bell rung” were simply resuscitated with smelling salts and then sent back into the game. But we now know that concussions are a type of traumatic brain injury (TBI) that can permanently impair brain function, even if someone doesn’t lose consciousness.

Up to 19 percent of football players suffer a mild traumatic brain injury during the playing season, and concussions are common injuries in many other sports and activities, as well. The severity of a concussion isn’t always directly related to the force of the hit. Someone can walk away unscathed from a severe pummeling, yet
 a mild bump or blow that jostles the brain can cause serious damage.

Neurosurgeon Garni Barkhoudarian, MD, and his colleagues at the Pacific Brain Tumor Center and Pituitary Disorders Program at Providence Saint John’s Health Center in Santa Monica, have studied the collateral brain damage that occurs after decades of playing football. In the past decade, medical science has scrambled to understand the debilitating, long-term consequences of concussions, which have already been linked to chronic traumatic encephalopathy, a degenerative brain disorder. What these scientists discovered adds to our knowledge about these injuries and may also pave the way toward devising more effective treatments, which have thus far proved elusive.

They looked at the effects of concussions on a group of 68 retired NFL players in hopes of identifying pituitary hormone dysfunction after repeated head trauma. The players’ average age was 47, and they had an average of three reported concussions over the course of their careers. Based on a lengthy questionnaire that evaluated their mental competency, they reported experiencing a poor quality of life.

“We picked a population of patients who had been exposed to clinical and subclinical concussions ever since they were children,” says Dr. Barkhoudarian.

In the study, which was published recently in the Journal of Neurotrauma, researchers analyzed participants’ hormone levels and found that about one out of four of them (23.5 percent) had serious deficiencies in key hormones governed by the pituitary gland, including growth hormone and testosterone. The tiny, pea-sized gland at the base of the brain is called “the master gland,” says Dr. Barkhoudarian, “because it governs other glands and controls many bodily functions.”

Study subjects with these hormone deficiencies had diminished mental competency scores compared to those without. Reduction in levels of these hormones can cause an array of difficulties. Men with low levels of growth hormone often have high levels of fat and cholesterol in their bloodstream, which increases the risks of heart disease and diabetes, and they tend to become overweight, lose muscle mass, get depressed and have decreased energy, according to Dr. Barkhoudarian.

Similarly, deficiencies in testosterone can contribute to erectile dysfunction as well as cause weight gain, fatigue, anemia and depression. “The treatment for this is relatively straightforward. These hormones can be supplemented with daily or monthly ad- ministration,” says Dr. Barkhoudarian. “We do patients a disservice if we miss that.”

Continue on to Part 2 of our series Concussions: Looking Back, Looking Ahead where we explore the latest developments in concussion management and testing.

Source: Brain Safety Zone. Innovative facilities, such as the Concussion Management Clinic, help head-injury patients heal; by Linda Marsa. Providence Health and Services, Fall 2015
https://california.providence.org/publications/2015/09/prov-health-fall-2015/