Thanks to Will Smith’s new movie, Concussion, chronic traumatic encephalopathy (CTE) is in the news. The movie chronicles the efforts of pathologist Bennett Omalu (played by Smith) to convince the NFL that big hits and permanent brain damage just might be connected. Omalu coined the name chronic traumatic encephalopathy after years over research.

Over the years there have been many football players found to have CTE, which unfortunately can be diagnosed only during autopsy. However, last week the federal government announced that they were earmarking nearly $16 million to find ways to diagnose CTE in living patients, with the hope that early diagnosis might make identification and treatment of the problem possible. Boston University researchers are part of the group receiving those federal dollars.

According to Robert Stern, professor of neurosurgery, neurology, and neurobiology and anatomy at the BU School of Medicine, CTE is a progressive disease starting earlier in life, related in some way to exposure to repetitive hits to the head. CTE gets worse as the person ages and the disease spreads throughout the brain, destroying brain cells.

Stern said CTE symptoms include changes in mood, such as apathy and depression; behavior changes such as aggression, rage and other impulse control problems; and problems with thinking, affecting planning and organization abilities. He says that, if the disease continues, eventually the person’s cognitive abilities will get bad enough that their daily life is impacted, which is referred to as dementia.

Although repeated blows to the head are a necessary factor in developing CTE, Stern says it is a mystery why some players develop CTE and others do not. Understanding more about the disease is necessary in order to figure out how common it is and why some people do not get it.

The movie is sparking a lot of discussion about concussions and NFL changes over the last decade intended to make the sport safer. Initially not receptive to Omalu’s theories, the league has now implemented nearly 40 rule changes, strict concussion protocols, and better sideline medical care, leading to a 34 percent decrease in NFL concussions since the 2012 season. The NFL is also funding research and developing better protective equipment.

Concussion is increasing awareness of chronic traumatic encephalopathy and the dangers of head hits. Many Americans may be getting their first lessons about the danger of permanent brain damage from head hits from the movie.

For the first time, scientists have made a connection in humans between autistic behavior symptoms and a neurotransmitter in the brain. According to the breakthrough study’s lead author, Caroline Robertson of MIT’s McGovern Institute for Brain Research, a neurotransmitter known as GABA is responsible for curbing “runaway excitation” in the brain.

In other words, GABA inhibits brain cells from firing in response to signals received from outside. Scientists now think that a lack of the neurotransmitter may cause overexcited neurons to be hypersensitive to sensory input, which is seen in people with autism.

People with autism find it difficult to tune out distracting sights, sounds and sensations, making them feel overwhelmed as sensory input comes flooding in all at once. Robertson says that GABA helps to filter out signals from the external world that are not relevant at the time.

The connection between reduced GABA activity and autism-like behavior had previously been found in animals, but the hypothesis has only recently been tested on humans. In the study, adults were asked to switch back and forth between images, a task requiring brain inhibition. Those with autism were significantly less able to focus on one image while suppressing the other, switching back and forth only half as much as the group without autism.

Researchers from Harvard and MIT measured GABA activity in the participants’ brains while they completed the assigned task, and found that those without autism were better able to suppress one image if they had higher GABA levels. In the autistic group, the GABA levels had no relationship to the ability. Robertson says it is not as simple as saying that particular neurotransmitter is missing in the autistic brain, but rather that it is not doing its job. Researchers are not sure of the cause for the dysfunction, and say a lot more work will be necessary.

The breakthrough does not mean that autism symptoms could be improved by simply increasing GABA, but the findings are promising. Physicians may soon be able to use GABA activity as an early screening mechanism for autism, and may also open the possibilities of treatment and perhaps even prevention of the condition. Robertson cautions that it will not be as simple as curing autism with GABA-enhancing drugs.

Photo by Nancy J Price, Creative Commons License

Treatment of simple appendicitis cases with antibiotics is a reasonable alternative to surgery, according to a new study published in JAMA Surgery, which found that three out of four children were successfully treated without being operated on.

Research co-authors, Dr. Katherine Deans and Dr. Peter Minneci, from a children’s hospital in Ohio, found that many patients with acute appendicitis who were placed on drugs overnight felt fine the next day. Their observations prompted a study on 102 patients between the ages of 7 and 17 who had uncomplicated cases of acute appendicitis. The parents of the patients were given a choice between surgery and antibiotics. Thirty-seven opted to try the antibiotic treatment.

Only two out of the 37 were readmitted within the next 30 days for appendicitis surgery. Seventy-five percent did not require surgery as long as one year later. However, the researchers caution that without surgery there is a risk of the condition returning.

The new treatment, which reduces cost, recovery time, and time lost from school and work, requires IV antibiotics for at least 24 hours in the hospital, then 10 days of oral antibiotics at home. The children that avoided surgery needed an average of 13 fewer days of rest.

Minneci also said that the two treatment options are similar in terms of safety, with no significant difference in complications.

About 11 percent of all pediatric emergency room visits are due to appendicitis, and 70,000 children per year undergo appendectomies in the U.S. Nearly 25 percent of those cases are children whose pain has not lasted longer than 48 hours and whose appendix has not burst, making many of them appropriate candidates for the antibiotic treatment.

The researchers caution that patients with appendicitis still need to see a surgeon to determine whether antibiotics treatment is appropriate. Dr. Russel Jennings, A Boston Children’s Hospital surgeon, said that “it’s important you don’t change the quality of care.”

Jennings, who was not involved in the new study, said the antibiotic treatment for adults with appendicitis is probably already available in large medical centers, and perhaps for some of the large centers that treat children.