NEW YORK, Jan. 29, 2015 /PRNewswire-USNewswire/ -- New
research out of NYU Langone Medical Center could move the medical
community one step closer toward effectively detecting concussion
and quantifying its severity.
Neuroscientists and concussion experts from NYU Langone and
elsewhere, in a study publishing online January 29 in Journal of Neurotrauma, present a
unique, simple and objective diagnostic tool for concussion that
can be utilized in the emergency room or, one day, on the sidelines
at sporting events. The study utilized a novel eye-tracking device
to effectively measure the severity of concussion or brain injury
in patients presenting to emergency departments following head
trauma.
"Concussion is a condition that has been plagued by the lack of
an objective diagnostic tool which, in turn, has helped drive
confusion and fears among those affected and their families," says
lead investigator Uzma Samadani, MD,
PhD, assistant professor in the Departments of Neurosurgery,
Psychiatry, Neuroscience and Physiology at NYU Langone. "Our new
eye-tracking methodology may be the missing piece to help better
diagnose concussion severity, enable testing of diagnostics and
therapeutics, and help assess recovery, such as when a patient can
safely return to work following a head injury."
The eyes have served as a window into the brain, with
disconjugate eye movements -- eyes rotating in opposite directions
- considered a principal marker for head trauma as early as 3,500
years ago. Current estimates by optometrists suggest that up to 90
percent of patients with concussions or blast injuries exhibit
dysfunction in their eye movements.
Unfortunately, the "state-of-the-art" tool to detect eye
conjugacy is asking a patient to follow along with a physician's
finger, according to Dr. Samadani, who also serves as co-director
of the Steven & Alexandra Cohen Veterans Center for the Study
of Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone.
The eye-tracking technology used in this study was originally
developed by Dr. Samadani and colleagues at the Cohen Veterans
Center to assess eye movement in veterans of the long Middle East conflicts suspected of suffering
from traumatic brain injury (TBI), concussion or other forms of
brain injury.
In this new study, researchers compared 64 healthy control
subjects to 75 patients who had experienced trauma that brought
them to the emergency department at Bellevue Hospital Center in
New York City, with whom the NYU
School of Medicine has an affiliation agreement. They tracked and
compared the movements of patients' pupils for over 200 seconds
while watching a music video. All participants were between 18 and
60 years of age.
The study showed that 13 trauma patients who had hit their heads
and had CT scans showing new brain damage, as well as 39 trauma
patients who had hit their heads and had normal CT scans, had
significantly less ability to coordinate their eye movements than
normal, uninjured control subjects. Twenty-three trauma subjects
who had bodily or extremity injuries but did not require head CT
scans had similar abilities to coordinate eye movements as normal
uninjured controls.
Among patients who had hit their heads and had normal CT scans,
most were slightly worse at 1-2 weeks after the injury, and
subsequently recovered about one month after the injury. Among all
trauma patients, the severity of concussive symptoms correlated
with severity of disconjugacy.
Those offering support for Dr. Samadani's research include
Richard G. Ellenbogen, MD, The
Theodore S. Roberts Endowed Chair and professor and chairman of the
Department of Neurological Surgery at University of Washington Medicine and co-chair of
the Head, Neck and Spine Committee of the National Football League.
Dr. Ellenbogen was not involved in the study.
"Traumatic brain injury is one of the most common causes of
neurologic morbidity in the world today," Dr. Ellenbogen says.
"Sports concussion, on the mild end of the spectrum of TBI, has
captured the fascination of both the public and media. Since
concussion affects all ages, both genders and occurs in all sports,
being able to make the diagnosis quickly and accurately is
essential. The challenge physicians have in identifying concussion
is that the diagnosis is often based on self-reported symptoms.
"Dr. Samadani and her colleagues have come up with a novel and
objective manner of assessing patients with a suspected TBI," he
adds. "The beauty to their method is that it is non-invasive,
reproducible and easy to perform on the sidelines or in the field.
It provides a simple and elegant method of being able to assess the
functional deficits that occur with TBI, and thus help the
physician make a rapid and accurate diagnosis. By tracking eye
movements, they have been able to quantitatively assess the
function of the brain. Their new approach will hopefully identify
those patients who may be missed by basing the evaluation simply on
subjective complaints. This work adds an important dimension to our
ability to provide safe, rapid and accurate care to those who
suffer TBI in sports or with daily life activities."
This new study of non-military, civilian trauma patients
visiting the emergency department builds on recent research
conducted by Dr. Samadani, supported through the Cohen Veterans
Center, which found that the use of this novel eye-tracking
technology could reveal edema, or swelling, in the brain as a
potential biomarker for assessing brain function and monitoring
recovery in people with head injuries. That study, published
Dec. 16 in Journal of Neurosurgery,
looked exclusively at military veterans.
Dr. Samadani's future work aims to replicate eye-tracking's
diagnostic potential for head injuries on a larger scale in
Iraq and Afghanistan veterans with post-concussive
syndrome and post-blast military brain injury.
Estimates from the Centers for Disease Control and Prevention
state about 2.5 million U.S. emergency department visits were
associated with traumatic brain injury in 2010, with rates
increasing by about 70 percent over the previous decade. Currently
there is no tool seen as a gold standard for diagnosing
concussions, and imaging tests like CT-scans and MRIs are
ineffective in the absence of structural damage to the brain.
"Two patients who suffer a head injury and present with
virtually-identical CT-scans might have completely different
symptoms," Dr. Samadani points out. "That's where eye-tracking can
help objectively reveal when one patient may be much more affected
by a concussion than another."
Also lending third-party support for Dr. Samadani's research is
M. Sean Grady, MD, the Charles
Harrison Frazier Professor and Chairman of the Department of
Neurosurgery at the Perelman School of Medicine at the University of Pennsylvania. Dr. Grady also was not
involved in the research.
"The importance of this study is that it establishes a reliable
test and a 'biological' marker for detecting concussion," Dr. Grady
says. "Since concussion can occur without loss of consciousness,
this can be particularly important in sideline evaluations in
athletics or in military settings where individuals are highly
motivated to return to activity and may minimize their symptoms.
More work is needed to establish its sensitivity and specificity,
but it is very promising."
The study was conducted by members of five different departments
at NYU Langone: Emergency Medicine, Trauma Surgery, Neurosurgery,
Psychiatry and Ophthalmology. The full list of authors other than
Dr. Samadani includes Robert Ritlop,
M Eng, Marleen Reyes BA , Elena Nehrbass BS, Meng Li MS, Elizabeth
Lamm BA, Julia Schneider,
David Shimunov, Maria Sava, Radek Kolecki MS, Paige Burris, Lindsey
Altomare, Talha Mehmood MD,
Theodore Smith MD PhD, Jason H. Huang MD, Christopher McStay MD, S. Rob Todd MD, Meng Qian PhD, Douglas Kondziolka MD, Stephen Wall MD, and Paul Huang MD
Dr. Samadani's research and the work of statisticians
Meng Qian, PhD and Meng Li, MS, are supported by the Steven and
Alexandra Cohen Veterans Center for Post-Traumatic Stress and
Traumatic Brain Injury. This work also is sponsored by the NYU
Applied Research Support Fund. Dr. Samadani's work also is funded
by a VA Merit Award and by the National Space and Biomedical
Research Institute to evaluate eye tracking as a diagnostic tool
for elevated intracranial pressure.
Author Disclosure Statement
Dr. Samadani has submitted patents describing the technology
utilized in this paper. These patents are owned by NYU and the VA and licensed to Oculogica Inc., a
company co-founded by Dr. Samadani and co-investigator Robert Ritlop.
Media Inquiries:
Ryan Jaslow
212.404.3511 │ryan.jaslow@nyumc.org
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SOURCE NYU Langone Medical Center