Georgetown Hosts Research Summit on Concussions in Females

Posted in GUMC Stories

FEB. 19, 2016–When physicians, researchers and scientists gather at Georgetown University February 27-28 for the International Summit on Female Concussion and TBI (traumatic brain injury), they will tackle what they say is an underappreciated medical issue: brain concussions in girls and women.

Much research on concussions has been focused on male athletes, such as football players and boxers. Sex differences that affect the risk of concussion and the outcome following one have had little study and even less national attention. However, the existing evidence suggests a significant problem. In 2012, the American Medical Society for Sports Medicine released a statement declaring that in sports that are played the same way, such as soccer and volleyball, female athletes sustain more concussions, have more severe symptoms and take longer to recover than their male counterparts.

Melissa Coyne, director of games administration at US Lacrosse in Baltimore, knows what a sports-related concussion can do. She’s had three, but the worst was her first concussion, which she experienced in 1995 as a 16-year-old high school basketball player.

“I was going to save a ball from going out of bounds, and I had turned my head and thrown the ball and hit the wall,” Coyne says.

She was completely knocked out. And she didn’t feel right for about the next six months. The concussion “had a big effect on just every day-to-day thing — like reading, taking tests, not being able to sleep well, having my mood and appetite change.

“I think I wasn’t quite sure if it was all related to concussion, though my doctor told me it was,” Coyne says. “I had really serious sensitivity to loud sound and bright light for a while. Things like that I don’t think I was expecting — I don’t really think I had the first clue about what a concussion really could do.”

Coyne had another concussion later in high school and her third occurred when she was an undergraduate at the University of North Carolina at Chapel Hill. Both of those concussions occurred while playing lacrosse and neither was as severe, but from the symptoms, she knew she was concussed. Coyne was out for a week after the second concussion and kept quiet about the third because she wanted to keep playing. “Even though I knew I had a concussion and wasn’t at 100 percent, I was going to play.”

“Double digit” concussions

As with many females who report a longer recovery after a concussion, Coyne’s experience illustrates the issues that participants in the Georgetown meeting will discuss. The first known scientific meeting to discuss concussions in girls and women, the conference will feature presentations and workshops with at least three dozen researchers. It will also host panels of sports reporters and female athletes who have had multiple concussions. The event is co-hosted by Georgetown University Medical Center and the non-profit advocacy group PINKconcussions.

Researchers at the conference aim to understand what is and isn’t known in the clinical presentation and outcomes of concussions in girls and women, not only through athletics, but as a result of domestic violence, military combat and accidents. Their goal is to develop a white paper on what gender-specific clinical practices and safety protocols should be researched as well as possible new strategies to treat females with concussions.

“The concussion research conducted to date on sex differences shows females on average have different injury rates, symptoms and rates of recovery than men,” says Katherine Snedaker, a Connecticut clinical social worker who founded PINKconcussions, the world’s first organization to focus on females with concussions from sports, abuse, accidents and military service. “Yet the medical community does not yet have any sex-specific guidelines, protocols or resources for females with concussions.”

Snedaker says that because females may need longer time to recover from concussions than their male counterparts, they should be educated about this possibility to set their expectations. They should also receive medical and social support if needed for a longer recovery. 

While Snedaker says she has had a “double digit” number of concussions — from field hockey, car accidents and other accidents that each resulted in 6-8 weeks of headaches — she became interested in the issue of concussion recovery after her son was concussed when he was in the sixth grade and suffered from post concussion syndrome for two years. 

Her son’s experience led Snedaker to initiate a city-wide concussion plan which enacted concussion guidelines for all youth sports in her hometown of Norwalk, Conn. It also tracks concussions across all 11,000 school children. The data collected by  Snedaker and the school nurses as a result demonstrates a higher rate of concussions in girls. “While we have found that fewer girls play sports compared to boys, for the last year and a half of collection, the girl athletes have been concussed at twice the rate as the boys,” she says.

Snedaker says the Georgetown summit will “be an educational event for those who attend,” and she hopes the researchers will develop “recommendations on what gender-specific clinical practices and safety protocols should be researched and/or implemented to best treat females with concussions.”

Studying concussion in female mice

“We want the smartest people in this country and Canada on this subject to talk about their data, their ideas, the need for research on the issue of concussion in women,” says David Milzman, MD, professor of emergency medicine at Georgetown University School of Medicine and director of brain trauma research in the department of emergency medicine at MedStar Washington Hospital Center.

“There is very little solid data now about sex in concussion presentation or outcomes. It is not clear there is a difference — and that is why we need to investigate it,” says Milzman, the scientific chair of the summit.

If differences do exist, it may be due to a number of reasons, he says, including fluctuations in the estrogen cycle and lower body mass and musculature supporting the neck and head.

Georgetown neuroscientist Mark Burns, PhD, says that one reason so little is known about female concussions is that, until recently, basic research has been limited to male animal models.  

“In the last few years, there has been a growing awareness of fundamental differences between males and females,” says Burns, who leads Georgetown’s Laboratory for Brain Injury and Dementia. “The basic view for many, many years was always, ‘We’re all the same except for our reproductive systems,’ and that’s turned out to be just plainly not true. That understanding has led the National Institutes of Health to push for basic research that uses both male and female animals.”

Burns, who is also helping to organize the conference, plans to present data on inflammatory differences in male versus female mice after brain trauma. “We can see already that there are differences in behavior, inflammatory responses in the brain and the amount of cell death that occurs.

“If and when we discover sex differences in concussions, we can use our male and female mice to go back and try to figure out the mechanisms of action,” Burns says.

“For me, the most exciting part of the summit is the prospect of sitting down with preclinical and clinical researchers, discussing gaps in knowledge and identifying a roadmap to direct scientific research and improve patient treatment.”

Renee Twombly
GUMC Communications