Rethinking Concussion Assessment: Advances in Brain Network Activation

Technology called Brain Network Activation allows health care professionals to evaluate brain network function after traumatic brain injury and during recovery.

The natural evolution of science and technology has increased our understanding of the brain and shown us how this vital organ works on a functional and cellular level. Much progress has been made — our knowledge is vastly more advanced today than it was even a decade ago.

Yet in many ways, progress on how we handle concussions, as well as other brain injuries and neurological disorders, is still hindered by the limited knowledge we have of the functional networks of the brain and how these networks change over time. Standard methods of evaluating and treating brain injuries and disease such as MRI and EEG have long existed. Despite these technologies, the brain remains something that neurologists must treat without being able to directly visualize the underlying networks.

As practicing neurologists, this problem presents an opportunity for us to rethink how we analyze the brain when treating injuries such as concussion. Specifically, we need to embrace and utilize new technologies that can measure and monitor brain network health on an extended time-frame. The more we understand how the brain is operating over time, the greater our chances of leveraging this information with our knowledge of other neurological disorders. Not only must this shift in mindset occur among neurologists, but awareness must improve among patients themselves — attention to brain health should not be optional or initiated as the result of an injury or illness

Utilizing Brain Network Activation

When a patient is recovering from a concussion and feeling better, the neurologist must determine whether the injury has healed without direct knowledge of whether the injury itself is present. A non-invasive, non-surgical baseline diagnostic technology, such as Brain Network Activation (BNA), has the ability to measure brain networks over time and allow neurologists to be more confident as to whether these networks are intact and operating at normal function following an injury. It is a level of information that is currently inaccessible with other technologies, and critical in preventing patients from returning to risky activities while they are still vulnerable.

The brain, as we know, is quite plastic; it changes over time, so there are differences not only between individuals but within the same individual over a period of months or years. Ideally, routine practice should involve a benchmark evaluation in youth that is conducted every year to map their individual brain function. For example, if a young athlete participates in a season of sports, by monitoring the brain network’s health from one season to the next, the treating physician can get a sense of the bigger picture that can help with the clinical decision process should an injury occur. If we begin following our youth early on, we can use this information to follow brain network activity into a patient’s 30s, 40s, 50s, and beyond, and manage their brain health with increased clarity.

This approach goes beyond concussion and traumatic brain injury. Technologies like BNA provide a different type of output than MRI and EEG-based technologies in that it is a direct measurement of network function. Other technologies can measure physiological states or signatures that have to do with how the brain is functioning, but don’t describe the actual electrical activity used to perform a task. BNA represents a new frontier in that way.

By rethinking how we assess brain activity and incorporating these new objective technologies, we have the opportunity to potentially impact our understanding, tracking, and treatment of mood disorders, PTSD, stroke, Alzheimer’s, and ADHD.

In the near future, neurologists should have the ability to address an entire spectrum of disease and injury by differentiating between and measuring both brain function and structure. The science will continue to develop and research will help new, critical technologies gain acceptance in regular clinical practice.

Jeffrey S. Kutcher, MD, is the director of the Michigan Neurosport Program and is an associate professor of neurology at the University of Michigan Medical School. His research interests focus on the neurologic sequelae of sports injuries and the management of neurologic diseases in the athlete, particularly concussion, migraine headache, and sleep disorders.