An Israeli brain-imaging system is being used in the treatment of concussions in American professional and college football players for the first time this fall, improving on methods used up to now.
The NFL and the NCAA football seasons began in the past month, on the heels of the US Food and Drug Administration’s approval of the BNA Analysis System in August. Several labs that specialize in sports medicine are already using the system, created by an Israeli start-up called ElMindA, to diagnose and monitor concussions in athletes, including NFL and NCAA football players.
The BNA system is able to “see” concussions, which are invisible to existing imaging technologies, like MRI or CT scans. Based on EEG readings from a futuristic-looking “helmet,” the system creates an image of the brain that can be used to identify any connectivity problems in the organ’s electrical network. The same information can also be expressed as a neurocognitive score. Concussions are mild traumatic brain injuries caused by the brain banging against the skull
Concussed brains produce unique images and scores. For competitive football players, who are often eager to get back on the field, knowing how long to wait for the brain to heal can help prevent them from compounding the injury, though much about the cumulative effects of repeated brain trauma, even milder than concussions, remains to be discovered.
“Our BNA system directly and objectively measures brain activity,” said Prof. Amir Geva, ElMindA’s chief technology officer, who founded in the company in 2006 based on patented computer engineering research he did at Ben-Gurion University of the Negev. “When it comes to concussions in football, BNA gives doctors more information than ever about when it’s safe to return to play.”
Turning concussion diagnosis on its head
Growing public concern in the United States about concussions in sports, and particularly in football, has hit both the NFL and NCAA hard in recent years. Congress has taken the NFL to task over its handling of concussions in a series of Congressional hearings since 2009, and both leagues are offering to settle multi-million dollar concussion-related lawsuits by athletes.
In the two weeks of NFL football that has been played so far this season, seven concussions or head injuries have been reported. In the month-old NCAA football season, the number is 19. Some of these athletes have been diagnosed with BNA.
‘The BNA technology for me is a game changing technology, because it is for the first time a tool that we have access to that measures the networks of the brain in an electrical way’
The biggest challenge in treating concussions is figuring out when they start and end, since they heal unpredictably with time. Batteries of neurocognitive tests, like the widely used imPACT test, allow doctors to evaluate concussions by measuring aspects of cognition, like working memory, attention, and distractibility. But cognitive changes can have many causes. MRI and CT brain are useful only for ruling out more serious brain injuries.
ElMindA’s BNA system is the first technology that allows doctors to measure the direct impact of a concussion on the brain. To get a BNA scan, a patient sits down at a special workstation and dons a helmet-like net of 64 electrodes. The patient then performs the usual well-established neurocognitive tests.
The difference is that instead of a doctor measuring the patient’s performance on the tests, the system records the brain’s electrical activity along the scalp. A computer at the workstation sends the information to “the cloud,” where ElMinda’s software analyzes it based on amplitude, frequency, location, timing, and synchrony.
The results of the analysis can be viewed on the workstation’s computer screen and by doctors anywhere in the world, as a 2-D or 3-D image of the brain and as a set of neurocognitive scores. To check for impairments, the information can be compared to previous BNA scans of the patient or to ElMindA’s database of more than 7,000 brain scans, which is growing all the time.
Dr. Jeffrey Kutcher, a neurologist at the University of Michigan and a team doctor for its storied football team, says the BNA system has transformed his treatment of sports concussions. In addition to his work with athletes at his university, Kutcher sees NCAA and NFL football players from around the country.
“The BNA technology for me is a game-changing technology, because it is for the first time a tool that we have access to that measures the networks of the brain in an electrical way. We can actually see and get a feel that this is how the brain is working,” Kutcher said. “What I can tell you as a neurologist is any tool that will allow me to make a better judgment as to whether the injury is over, allows me to make the best possible medical decision for my patients, and this tool allows me to do that with a greater level of confidence.”
Beyond the gridiron
Concussions are not an issue in football alone. The Centers for Disease Control estimates there are 1.6 million to 3.8 million sports and recreation-related concussions in the United States every year. Playing sports with a concussion can worsen the injury and possibly cause long-term brain damage.
The NCAA lawsuit includes athletes from other sports, and the NHL and FIFA are facing lawsuits of their own. All 50 US states have passed concussion-related legislation since 2009, and US President Barack Obama even held a summit on the youth concussions in May. Coincidentally or not, the president was shown ElMindA’s BNA system when he visited Israel a year earlier.
Only a handful of clinics in the world are treating patients with BNA systems at the moment, and doctors are still trying to figure out how best to use the technology. In addition to the system at the University of Michigan, Athletico, a physical therapy company that treats athletes from all of Chicago’s professional sports teams, has five systems, and the University of Pittsburgh has one.
Some 20 other systems are being used for research in North America, Europe, and Israel. ElMindA, headquartered on the bottom two floors of a low-slung building on a quiet street in Herzliya, is partnering on research with the likes of Harvard Medical School and the University of Pittsburgh Medical Center. In addition to concussions, the company is looking into drug optimization, pain management, early detection of neurodegenerative diseases, and diagnosis and treatment of attention deficit hyperactive disorder and mood disorders.
“Our platform is a very generic platform to non-invasively look at the brain, to manage your brain health,” said Ronen Gadot, ElMindA’s CEO. “We are looking into many applications.”
ElMindA is also part of an Israeli government funded research consortium that includes four other Israeli companies and about a dozen academic institutions. The consortium’s goal is to “close the loop” between brain imaging and the kind of brain stimulation companies like Brainsway do. The focus is on ADHD, Parkinson’s disease, and depression.