Researchers at NYU School of Medicine have developed a handheld device that can detect subtle brain damage immediately after concussion.
The sophisticated yet simple-to-operate device, the researchers say, may prove especially useful on the battlefield or the football field, enabling brain damage to be detected almost immediately after mild head injuries. Such damage is often overlooked or misdiagnosed, even with an advanced imaging technique like computed tomography (CT), say the researchers.
The device, called BrainScope, is based on the studies of E. Roy John, Ph.D., Professor of Psychiatry and Director of the Brain Research Laboratories (BRL) at NYU School of Medicine. In the late 1970s, Dr. John discovered how to translate EEG tracings — recordings of the brain's electrical activity on an electroencephalograph — into numbers called quantitative EEGs, or QEEGs. A significant advance, QEEGs gave scientists an objective and standardized way to assess cognitive functions. Dr. John has devoted much of his career to the study of QEEGs and their clinical applications, in the process collecting and analyzing brainwave recordings from about 20,000 patients. Using this database, the world's largest, Dr. John established normal ranges for QEEGs across the life span and correlated deviations from these norms with a wide variety of neurological disorders, including concussions. This evidence provides the scientific basis for BrainScope.
BrainScope consists of an adhesive strip, containing six electrodes, which are connected to a mini-computer that resembles an oversized iPod. After a suspected head injury, a first responder affixes the electrode strip to the patient's forehead. The device automatically collects a sample of the patient's EEG and computes a large number of QEEG featureseach of which are compared to a databank of normal scores. Within minutes, BrainScope's color display indicates whether any of the patient's brain functions deviate from normal.
It is not uncommon for mild-to-moderate concussions to go unnoticed, because they cause no visible wound and symptoms like nausea quickly resolve. “The subtle brain dysfunction associated with such concussions is often invisible even to sophisticated imaging scanners, including CTs and MRIs,” says Dr. John.
“Moreover, such scans must be carried out in a hospital, and are typically performed hours or days after the initial injury, which delays treatment.”
“With a BrainScope, one would see the effects of a concussion right away, providing unequivocal evidence of injury and timely guidance for medical intervention,” says Leslie Prichep, Ph.D., Professor of Psychiatry at NYU School of Medicine and a longtime collaborator of Dr. John's.
The device is intended to be used as a triage instrument in a variety of settings, including battlefields, sporting events, emergency rooms, and clinics. Dr. John is particularly concerned about reports of the high number of concussive brain injuries caused by improvised explosive devices in Iraq, and the possibility that there are many homeless combat veterans with undiagnosed brain injuries caused by these devices. “BrainScope could be used on the battlefield, improving the chance that soldiers with less obvious brain injuries will receive proper care,” he says.
According to the Centers for Disease Control and Prevention, approximately 300,000 sport-related concussions occur annually in the United States. However, many of these injuries are not properly evaluated or treated. A major reason is that some symptoms of a mild concussion, such as headache, dizziness, and nausea, often disappear within minutes, leading players, coaches, and medical personnel to believe that nothing is wrong, which may not be true. Thus, many players with concussion receive no treatment and are sent back into action before they have fully recovered, raising the risk of recurrent injury and significant neurologic and cognitive deficits. Repeated mild brain injuries that occur within a brief period — hours, days, or weeks — can be catastrophic or fatal, the CDC has reported.
After the death of former NFL defensive back Andre Waters who committed suicide last year after suffering numerous concussions, teams at all levels of sport have begun to pay more attention to brain injuries. In the future BrainScope could assist clinicians in determining an athlete's level of recovery and readiness for safe return to competition after concussion, says Dr. John.
BrainScope is currently in preclinical testing at three hospitals, Bellevue Hospital Center in New York City, Case-Western Reserve in Cleveland, and Washington University in St. Louis. In these tests, emergency room doctors are determining whether the device is useful in making rapid assessments of whether brain dysfunction is present. Clinical trials for evaluating patients with concussion are planned for this fall. The device is based on patents held by NYU and is being manufactured by BrainScope, Inc., a privately held company located in Chesterfield, Missouri.