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Contact:
Katherine Snedaker, MSW, PinkConcussions.com / 203-984-0860 PinkConcussions@gmail.com
Dr. Jimmy Sanderson, Clemson University / 864-656-3996 jsande6@clemson.edu
Norwalk, CT – Media attention and public interest in sports concussion injuries has been increasing at a rapid rate. As a result, it is important for researchers and concussion advocates to enhance research efforts on this very important topic. To provide some insight on female concussions, we launched a research study in October 2013, which focused on female athletes from all sports, and their past and present experiences with concussions. Via social media tweets & posts about the study, 652 women contacted us to participate. Of the 597 women who were eligible to participate and sent a link to the survey, 538 women completed the forty question online survey. This research study was also was designed to explore female verses male athletes' experiences with reporting concussions, another salient avenue in the concussions dialogue, as many athletes do not report concussions willingly or are mis-diagnosed.
Now we are recruiting for a NEW IBR approved study of male athletes and their experiences with concussions in conjunction with our recent efforts to recruit female athletes to discuss their concussion experiences.
This research aims to explore reasons why male/female athletes would report or not report concussions and examine potential gender differences that can inform the athletic, medical, and academic communities.
Current and former male athletes are eligible for this study which will be conducted by researchers from Clemson University with the advocacy group, Pink Concussions. For this study, male athletes, age 18 and over, who are willing to participate can sign up now at PinkConcussions.com or click here. Participants will be emailed a link to a twenty-minute online survey about their experiences with sports and non-sport concussions and reporting concussions.
The research also will investigate male/female athletes' willingness to have genetic testing that may show links to the repair and recovery of brain cells after concussion. After finishing the survey, participants in the study can opt for an additional study and consider submitting DNA collected by a cheek swab to be tested for variants at the Apolipoprotein E (APOE) gene. Testing for certain genes has previously documented an association between specific genetic factors and outcomes from injuries such as concussion.
Apolipoprotein E is a protein that is important in the repair and recovery of brain cells that have been damaged due to concussion. The clinical studies point to a relationship between certain genetic signatures and poorer overall concussion response. While additional evidence is needed to better understand the relationship between APOE status and concussion outcomes, the American Academy of Neurology introduced APOE testing into concussion management guidelines this year.
This research will be beneficial in shedding light on and male female athletes’ experiences with concussions and reporting concussions. We hope the results of this research will help further concussion research by focusing on the communicative element present in this issue, and the results of the study will be helpful for athletes, parents, administrators, physicians, and advocates.
Co-Researchers in this study are Dr. Jimmy Sanderson and Dr. Melinda Weathers in the Department of Communication Studies at Clemson University, along with Ms. Katherine Snedaker, MSW, of PinkConcussions.com.
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For more information about this study, help in recruiting athletes or to participate in the study, please fill the contact form at PinkConcussions.com or contact:
Dr. Jimmy Sanderson Clemson University jsande6@clemson.edu 864-656-3996Katherine Snedaker PinkConcussions.com PinkConcussions@gmail.com 203-984-0860
The recently published study, "Menstrual Phase as Predictor of Outcome After mTBI in Women" is so exciting because this study goes a step beyond confirming that women's concussions are different than men's. This research explored why in detail the differences occur within the subset of women themselves compared to men's experience of concussion. The authors of the study are Kathryn Wunderle, BA; Kathleen M. Hoeger, MD, MPH; Erin Wasserman, BA; Jeffrey J. Bazarian, MD, MPH, of The University of Rochester.
I will now offer my layman's view of this study; and as always, I encourage you to read the original study posted below. Please feel free to correct/comment on my thoughts and send me any questions you would like me to pass on to the research team who conducted the study. I will post questions and responses in my next blog.
Many of us who have experienced concussions or worked with women with mTBI have long felt there was a connection between concussion and a woman's cycle. In this study, researchers sought to prove the “Withdrawal Hypothesis,” which states that if a woman has a high level progesterone in her body at the time of an injury, she will experience sudden drop in progesterone. And that it is this decrease or "drop" that will cause worse concussion outcomes than a woman who had low level of progesterone at the time of injury and did not experience this "drop."
So who has a low level of progesterone (thought to be beneficial at the time of a concussion)?
Who has a high level of progesterone?
Researchers in this study hypothesized that women who experience mTBI during part of their cycles when progesterone is high, would have worse outcomes than women injured during time in their cycles when their progesterone is low.
Does anyone has level of progesterone which is resistant to this "drop?"
Remember in the case of this study, low progesterone levels at the time of concussion were predicted to be beneficial as they did not "drop" because they were low at the start. High levels which were subject to the "drop" were thought to predict poor outcomes.
The final results of this study support the researchers' prediction that women in their cycle where "progesterone is highest, had worse post-concussion symptoms" than women whose progesterone is initially low. Similarly, women who were taking synthetic progestin as birth control seemed to mirror the women who were in the low progesterone phases.
The authors of the study warn that their findings must be "considered preliminary." Yet, they believe if their conclusions are "confirmed by others, it has important implications for both treatment and prognosis."
My mind races with the possibilities...
As with every finding in the concussion field, more research needs to be done. But this study supports the hypothesis that the acute withdrawal of progesterone after mTBI may be the missing link (or one of the missing links) to why differences are seen in men and women's concussions. And in my opinion, this is a huge news for the concussion world - for men and women alike.
PDF of The Menstrual Phase as Predictor of Outcome After mTBI in Women Study
Objective: To determine whether menstrual cycle phase in women at the time of mild traumatic brain injury (mTBI) predicts 1-month outcomes.
Setting: Six emergency departments; 5 in Upstate New York, and 1 in Pennsylvania.
Participants: One hundred forty-four female participants (age, 16-60) who presented to participating emergency departments within 4 hours of mTBI.
Design: Nested cohort study with neurologic and quality-of-life outcome assessment, 1 month after enrollment. Female subjects aged 16 to 60 enrolled in the parent cohort study, with 1- month neurological determination data available, were classified into menstrual cycle groups by serum progesterone concentration and self-reported contraceptive use. Main Measures: Rivermead Post Concussion Questionnaire and EuroQoL/EQ5D.
Results: Women injured during the luteal phase of their menstrual cycle, when progesterone concentration is high, had significantly lower EuroQoL General Health Ratings and Index Scores than women injured during the follicular phase of their cycle or women taking oral contraceptives. Multivariate analysis confirmed a significant independent effect of menstrual cycle phase on EuroQoL Index Score and the Rivermead Post Concussion Questionnaire Somatic Subscore.
Conclusion: Menstrual cycle phase and progesterone concentration at the time of mTBI affect 1-month quality-of-life and neurologic outcomes. This association has important implications for treatment and prognosis after mTBI. Key words: brain concussion, brain injuries, follicular phase, luteal phase, menstrual cycle, postconcussion syndrome, progesterone, quality of life
PDF of The Menstrual Phase as Predictor of Outcome After mTBI in Women Study
Thank you to the authors - Kathryn Wunderle, BA; Kathleen M. Hoeger, MD, MPH; Erin Wasserman, BA; Jeffrey J. Bazarian, MD, MPH - and Leslie Orr of University of Rochester Medical Center - for allowing us to post this study.
Please direct questions to pricesned@gmail.com if you would like to take part in our exchange with the authors of the study.
