Repetitive hits on the head that are below the threshold for causing a concussion may still result in changes in the brain’s white matter, a small study of soccer players suggested.
On average, elite male soccer players — who often use their heads to direct the ball — had a range of negative changes in white matter architecture compared with a group of competitive swimmers who were unlikely to have repetitive brain trauma, according to Inga Koerte, MD, of Harvard Medical Schools Psychiatry Neuroimaging Laboratory in Boston, and colleagues.
Those differences were observed even though none of the participants in either group had a history of concussion, Koerte and colleagues reported in a research letter in the Nov. 14 issue of the Journal of the American Medical Association.
Although it is possible that frequent heading of the ball could explain the impairments in the soccer players, “differences in head injury rates, sudden accelerations, or even lifestyle could contribute,” the authors wrote.
Previous studies have shown that repetitive traumatic brain injury can have negative long-term consequences — including impaired white matter integrity — but the effects of frequent subconcussive head impacts are less clear.
Koerte and colleagues explored the issue using high-resolution diffusion tensor imaging, which can detect changes in white matter architecture.
The study included 12 right-handed male soccer players from an elite-level soccer club in Germany. All had trained since childhood for a professional career. Their mean age was 19.7 and they had been playing for an average of more than 13 years.
The control group consisted of 11 competitive swimmers who were matched by age, handedness, and sex. Their mean age was 21.4 and they had trained for an average of more than 9 years.
None of the participants in either group had a history of concussion or any neuropsychiatric disorders.
All underwent diffusion tensor imaging to measure markers of mild traumatic brain injury (fractional anisotropy and mean diffusivity) and axonal and myelin pathology (axial and radial diffusivity).
After adjustment for age and years of training, the soccer players showed increased radial diffusivity “in the right orbitofrontal white matter, the genu and anterior portions of the corpus callosum, association fibers involving bilateral inferior fronto-occipital fasciculus, bilateral optic radiation, and bilateral anterior cingulum, right anterior, right superior, and bilateral posterior corona radiata, right anterior limb of the internal capsule, right external capsule, and right superior frontal gyrus” (P<0.05 for all).
A widespread increase in radial diffusivity also has been seen in patients with mild traumatic brain injury and suggests possible demyelination, according to the researchers.
Soccer players also had higher axial diffusivity in the corpus callosum, but there were no differences between the groups in fractional anisotropy or mean diffusivity.
A neuroradiologist found no abnormalities in structural images of the brain.
The researchers could not exclude the possibility that heading the soccer ball resulted in the changes in white matter architecture, but they said that the reason remains unclear.
As an alternate explanation, they noted that “soccer players showed increased axial diffusivity in the absence of increased radial diffusivity limited to the corpus callosum, possibly resulting from specialized training or neuroinflammation.”
The authors acknowledged that the study was limited by the small sample size, the use of a single cross-sectional evaluation, and the lack of information on functional outcomes.
The study was supported by the Else Kröner-Fresenius Stiftung and the Deutsche Akademischer Austauschdienst. It was also supported in part by the Intrust Post-traumatic Stress Disorder and Traumatic Brain Injury Clinical Consortium, which is funded by a Department of Defense Psychological Health/Traumatic Brain Injury Research Program grant, and by a grant from the National Institute of Neurological Disorders and Stroke.
Koerte reported receiving a fellowship from the German Academic Exchange Service and Else Kröner- Fresenius Stiftung; having a grant pending with the NIH; and receiving travel expenses and accommodations from the Society for Neuropediatrics in Germany. Her co-authors reported relationships with Springer Publishing, Bracco, Philips Radiology, Munich Medical International, Deutsches Zentrum fuer Neurodegenerative Erkrankungen, Friedrich-Baur Stiftung, Arbeitsgemeinschaft Botulinumtoxin, Deutsche Forschungsgemeinschaft, Omnibus Stiftung, Guerbet, Merck-Serono, the Radiological Society of North America, Philips, Siemens, Deutsche Roentgengesellschaft, Alfried-Krupp-Stiftung, Bayer-Schering, Thieme Medical Publishers, the European Society of Radiology, Asklepios Clinics, Eurobioimaging, the German National Cohort, Munich Cluster of Excellence M4 Imaging, BMBG German Centers for Lung Diseases and Cardiovascular Diseases, the NIH, the Department of Defense, the International Brain Injury Association, Demos Books, Elsevier, Intrust, the U.S. Department of Veteran Affairs, the National Alliance for Medical Imaging, the National Institute of Mental Health, National Alliance for Research in Schizophrenia and Depression, Fogarty International Center, National Health and Medical Research Council, Silvio Conte Centers for Basic Translational Mental Health Research, and the 9th World Congress on Brain Injury.
Source : Med Page Today