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Blasting away at concussions

Local researchers hot on trail of reliable way to detect brain trauma

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A team of Winnipeg researchers is the first in the world to blast the brain with controlled levels of carbon dioxide and oxygen in a quest to develop a definitive test to diagnose concussions.

The cutting-edge work appears in the current edition of Plos One, a peer-reviewed, online medical journal published by the Public Library of Science (PLOS).

"These are preliminary findings, so by no means is this a home run. But we definitely think that we've got a man or two on base," says Dr. Michael Ellis, one of the study's authors.


Winnipeg's Pan Am Clinic hired Ellis last summer to treat child and adolescent concussion patients and to conduct concussion research. He will also head Pan Am's new concussion clinic, set to open in the fall at the MTS Iceplex.

Concussions are traumatic brain injuries that change brain function. Experts believe their effects -- visual disturbances, headaches, vomiting and confusion -- are usually temporary. In a few cases, concussions can cause permanent changes to the brain and even death.

There are no reliable tests to diagnose concussions. Rather, doctors rely on the Zurich Guidelines when diagnosing and treating concussed patients. Critics say the concussion symptoms outlined in the guidelines are too vague.

Dr. Alan Mutch, a neuroanesthetist and lead author of the PLOS study, says he hopes his team's findings will eventually unravel the mystery surrounding concussions and lead to a reliable diagnostic tool.

"We're excited about the preliminary results we have," says Mutch, noting that other researchers have hypothesized that concussions are caused by a lack of cerebral blood flow that results from a head injury.

Nevertheless, his research is still novel.

"We're the only the group in the world that's ever published using this technology in concussion," he says.

In the published results, 12 concussion patients and five control subjects were analyzed. Mutch says the study is ongoing and more research will be published in time.

Most of the concussion patients demonstrated a lack of cerebral blood flow compared with non-concussed subjects.

The technology used in the study involved what Mutch calls an MRI brain stress test.

It uses a powerful magnetic resonance imaging machine that Health Sciences Centre's Kleysen Institute of Advanced Medicine unveiled in 2013.

Mutch also used a computer-controlled "gas blender" that allowed study patients to breathe in carbon dioxide and oxygen through a tightly secured face mask.

"That breathing circuit allows us to change the gas concentrations in a very controlled manner," he says, noting that patients have two sensors attached to their heads.

"It shines infrared light through your forehead. It's completely painless. It's like if you're in a tent and you shine a flashlight through your hand when you're camping, and you can see the colour in your fingers come out.

"The whole brain lights up with carbon dioxide," he says.

"What it shows us is almost like a map of the brain's blood flow in response to this carbon dioxide stimulus."

Mutch learned how to use the technology during a six-month training stint in Toronto and eight months of training at the University of Cambridge in England.

Mutch says his research team was fortunate to gain access to the sophisticated MRI at HSC's Kleysen Institute, considering the clinical demands placed on it.

"This is quite an unusual situation. It's a real kudo to the powers that be at the Health Sciences Centre and the research foundation that's allowing this to be conducted."

Ellis, who treats up to 50 concussion patients in a week, says a need for more concussion knowledge is "urgent."


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Republished from the Winnipeg Free Press print edition August 11, 2014 D1

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