Study finds important gaps, new research priorities in pediatric concussion

Young boy resting in his bed with a sleeping dog.

“We were hoping to assemble neuroimaging data around concussion in kids to inform our research – instead we were surprised to find big gaps,” said Dr. Julia Schmidt, a post-doctoral fellow with Drs. Lara Boyd and Jill Zwicker. “Despite the prevalence and urgency of concussion, there were very few studies that looked at brain differences post-injury in children specifically.”

A systematic review, published this month in the journal Pediatrics, found that pediatric concussion is common but poorly understood, and points to new opportunities for research.

Concussion affects children differently than adults. Children may be more vulnerable to a concussive injury with the potential to disturb the brain’s maturation process; symptoms of brain injury can affect a child’s day-to-day life, impacting their learning and social development. It can also take children longer to recover.

“In our review, one method of imaging showed opposite findings to what we see in adults,” says Dr. Schmidt. “There are hundreds of neuroimaging studies investigating concussion in adults. However, the search in our review of childhood concussion only found 22 studies. Interestingly, around 20 per cent of those came from the labs of Dr. Boyd and Dr. Naznin Virji-Babul at UBC.”

“We can see that understanding mild traumatic brain injury specifically in children needs to be a priority,” says Dr. Schmidt, who works closely with researchers at the Djavad Mowafaghian Centre for Brain Health and with Dr. Shelina Babul at the BC Injury Research and Prevention Unit at BC Children’s Hospital Research Institute.

“There were very few studies that investigated how the concussed brain in children develops over time, compared to healthy controls.”

Dr. Schmidt now sees that understanding how a child’s brain is altered after concussion, both short-  and longer-term is a research priority, and has begun looking at non-invasive transcranial magnetic stimulation (TMS) to provide more information.

“Investigating neurophysiology using TMS hadn’t been pursued in children with concussion until recently,” explains Dr. Schmidt. “We know from our systematic review and other mechanistic research that the corpus callosum – the part of the brain that communicates between the brain’s hemispheres – is particularly vulnerable to concussive injury. We’re now uncovering more information about disruption in inter-hemispheric communication after concussion in children.”

“Despite our surprise at the knowledge gaps in pediatric concussion research, it does give us a clear sense of where we need to go next,” says Dr. Schmidt. “We’re hoping that if we can establish some biomarkers in brain injury in kids, we can start to provide more individualized, kid-focused treatment after concussion.”

The study was conducted with support from the Michael Smith Foundation for Health Research and the Vancouver Coastal Health Research Institute.