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A Journey to the Center of the Brain: New York Neurologist Wants to Understand What Happens When We Get Hit in the Head

Hilary Monaco has earned the black belt in Taekwondo, and she can take a few punches. When her sparring partner landed a hard kick to her head during practice last fall, she didn’t think much of it.

Two weeks later, she advanced to the final round of a big tournament and received another hit to the head. But this time, her body served her a severe warning. “The next day I couldn’t stand up, I was dizzy, and couldn’t focus or look at a computer screen without getting a splitting headache,” Monaco says. Her friends rushed her to the emergency room where she was diagnosed with a concussion.

Hilary Monaco, up and above right, during Taekwondo practice. Image Credit: Hilary Monaco.

Monaco, who is 25 years old and a graduate student of computational biology at the Memorial Sloan Kettering Cancer Center and Cornell University in New York, naturally worried about her brain and also about her ability to remain active in her favorite sport. She sought out Dr. Teena Shetty, a neurologist at Manhattan’s Hospital for Special Surgery, and a neuro-trauma consultant for the New York Mets and the New York Giants.

Shetty has been on a mission to learn more about traumatic brain injuries, diagnose and treat them faster, and reduce their long-term consequences. She says that concussions are notoriously difficult to diagnose objectively even with the latest medical equipment like magnetic resonance imaging (MRI). Her research is driven by a real need, she says. “There is a lot of awareness of concussions, but we still don’t have an optimal tool to see them.”

In 2013, Shetty launched a unique research program at her hospital looking for telltale biomarkers in the brain, including microbleeds and changes in water movement in the brain. They could help doctors get better at diagnosing concussions, selecting the right therapy, and improving treatment outcomes for patients.

Shetty is still seeking to enroll more people into the program.  “I would like to have as much data as possible to work with,” she says.  She is looking for patients between the ages of 15 and 50, who had an acute concussion less than 10 days ago.

The project is sponsored by the Head Health Initiative, a $60 million partnership between GE and the NFL. It has two goals: Help doctors find links between physical symptoms and changes in the brain that can be detected by medical technology like MRI. GE also plans to use the findings to build better MRI machines.

“The routine MRI was designed to look at soft tissue, blood vessels and structural anatomy,” Shetty says. “By comparing what we see on the images of the whole brain with the symptoms we gather during the actual neurological examination in the office, we’re starting to see correlations.”

Dr. Teena Shetty is a neuro-trauma consultant for the New York Mets and the New York Giants. Image credit: Teena Shetty.

Shetty and her team started by gathering a lot of clinical data from patients like Monaco. They get screened and examined four times: within 72 hours of injury and then after 10 days, one month and three months. “We want to see how their brain is changing, healing and responding to treatment,” Shetty says. “There are a great deal of hypotheses on what is happening in the brain and few answers.”

Shetty is using a GE-designed MRI machine to study her patients. She is looking for a set of biomarkers that include microbleeds caused by sheared neurons, changes in the size of different brain regions, metabolic changes inside brain cells, and also their ability to pass on signals. “Contrary to an ordinary bruise, the force of the impact isn’t localized,” says Ajit Shankaranarayana, who oversees the development of neurological applications for MRI at GE Healthcare. “It will travel through the entire brain. That’s why the symptoms can show up in different parts of the organ.”

Shankaranarayana says that his team is using Dr. Shetty’s results to develop a sensitive whole-body scanner that could peer deep into the brain. It could be equipped with a new suite of imaging software allowing doctors to measure the critical biomarkers. “The guts of the typical MRI machine will have to change,” he says. “There is a big need for this technology.”

The Centers for Disease Control estimates that 1.7 million people sustain a traumatic brain injury in the U.S every year, leading to 52,000 deaths.

Like other patients in the study, Monaco went through the screening and treatment course. Dr. Shetty monitored her symptoms and guided her through recovery. “The first thing she told me was to stop thinking,” Monaco recalls. “If you have a broken leg, don’t walk, she said. If you have a broken brain, you give it a rest.”

The odd thing is that doctors still haven’t figured out the best way to make their patients refrain from thinking. “My treatment regimen was very strict,” Monaco says. “But it does not have to be so in the future and this research can help.”

For the first few weeks she abstained from watching TV, reading, listening to music, and using her computer and apps on her smartphone. “We are all so connected, but not reading was actually the hardest thing,” she says.

Today, Monaco is back on the Taekwondo circuit. “Seeing Dr. Shetty was a real education,” she says. “I talked to her and realized that the first time I got hit, I had a concussion too.”

The Head Health research program now also includes the University of California – San Francisco (UCSF) and the Houston Methodist hospital. GE’s goal is to build the tools for its research partners and enable the science that will eventually drive better medical care, says  Amy Gallenberg, who runs the Head Health Initiative’s research work at GE. “The Head Health Initiative provides a great platform to further this cause not only for athletes but for our military populations as well,” she says. “We need to understand the brain better.”

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