William P. Meehan III, M.D. guests on “5 questions with CJSM”
September 14, 2013
Readers of the blog will remember in August I was able to interview Dr. Jason Mihalik, University of North Carolina, about his work while using the ‘5 questions with CJSM’ format. I’m happy to say I have another willing victim for this format.
I have known William P. Meehan III, M.D. for several years; we both did our sports medicine training in Boston under the illustrious doctors Lyle Micheli, M.D. and Pierre d’Hemecourt, M.D., authors whose names will be familiar to readers of the journal as they have both been published in CJSM numerous times.
Bill, as I know him, is likewise establishing his own enviable track record in the clinical management and study of sport-related concussions. I have mentioned some of the work he has done in a recent blog post, and so in the spirit of brevity let’s get right to the interview.
Five Questions with CJSM
WM: Thanks so much for inviting me to be part of your blog, Jim. You do great work here at the Clinical Journal Sports Medicine I appreciate your including me.
1) CJSM: Thanks for those kind words Bill, and congratulations on your receipt of the first AMSSM-ACSM Foundation’s Clinical Research Grant for your project titled “A Randomized, Double-Blind, Placebo-Controlled Trial of Transcranial Light Emitting Diode Therapy for the Treatment of Chronic Concussive Brain Injury.” Can you tell us what potential you see for LED therapy in this arena
WM: The idea of using light emitting diodes (LEDs) to treat concussive brain injury was brought to my attention by Margaret Naeser, PhD, who works at the VA Boston Healthcare System and Boston University School of Medicine. Dr. Naeser approached me one day after a lecture and suggested that perhaps LED therapy could help people suffering from concussive brain injury. To be honest, I was a bit skeptical at first. But she was passionate and convincing about it. After reading some of the previous medical and scientific literature about light therapy, my mentor in the laboratory, Michael Whalen, MD at Massachusetts General Hospital conducted some experiments on mice that had suffered a traumatic brain injury. The results were promising. So the three of us, together with Rebekah Mannix, MD, MPH, Alex Taylor, PsyD, and Ross Zafonte, DO set out to conduct the study.
As you know, the current hypothesis of concussion is that a rapid rotational acceleration of the brain leads to changes in the ionic gradients across the axonal membrane. Those ionic gradients are restored to homeostasis by the action of the sodium-potassium pump. The sodium-potassium pump operates on adenosine triphosphate (ATP). It turns out that light in the red and near infrared spectrum when applied to cells in culture increases the activity of cytochrome C oxidase. This results in further ATP synthesis. Thus, some very astute researchers hypothesized that shining light in the red/near infrared spectrum on the brain would result in an increase in ATP production and perhaps decrease the healing times after certain brain injuries, including traumatic brain injury.
Dr. Whalen was nice enough to conduct an experiment in his laboratory using mice that had sustained brain injuries when we first heard about this. Those experiments showed that treatment with laser in the red/near infrared spectrum resulted in better outcomes on measures of cognitive functioning, specifically the Morris water maze. After considering all of the evidence I followed up with Dr. Naeser. She informed me that she had an ongoing trial of light emitting diode therapy for people suffering from chronic traumatic brain injury. She had also published a case series of two patients who sustained concussions during motor vehicle collisions, athletic participation, and military service, who showed improvements of their cognitive functions after LED therapy. So we decided to conduct a randomized, double-blinded, placebo-controlled trial of LED as treatment for concussion. Thus far, we have recruited half of our estimated sample size of 48 patients.
2) CJSM: Congratulations as well for becoming Director for the Micheli Center. If you had to compose a 140 character tweet to tell the world about the work you expect to accomplish there, what would it say?
WM: Thank you. I was delighted to become director of the Micheli Center for Sports Injury Prevention. We believe we are the first center in the world where athletes can come and learn which injuries they are at highest risk of sustaining, and what steps they can take to reduce the risk of those injuries. The full Injury Prevention Evaluation takes about 3-3.5 hours. It starts by collecting historical information, such as what sports the athletes play, what injuries the athletes have previously suffered, how many hours per week the athletes train, etc. Then the athletes move out to the assessment floor where we measure bony angles, flexibility at the joints, strength in various muscle groups, speed, power, agility, and many other factors that are associated with the risk of injury. The full evaluation includes over 300 data points, all based on the available medical and scientific evidence. At the end of the evaluation, athletes are given a list of the injuries for which they are at highest risk, and an individualized prescription that outlines the steps they can take to reduce their risk of sustaining those injuries.
Our goal is to encourage safe participation in athletics while simultaneously decreasing the risk of injuries sustained during sports.
Although I don’t have twitter account, if I had to put out a 140 character tweet to the world I would say, “Our goal is to reduce the risk of sustaining sports injuries while simultaneously encouraging athletic participation.”
(CJSM: 21 characters to spare with that tweet! Hey, Bill, with a name like yours, you can imitate RG3 and see if the twitter handle WM3 is available. You can make the Micheli Center go viral!)
3) CJSM: I wanted to note as well the fantastic achievement you and a group from Harvard realized in landing the $100 million grant from the NFL Players Union. What will your role be in this project, and where do you see the grant $ being used specifically in the field of concussion research?
WM: Thanks again. I was privileged to work with doctors Lee Nadler, Alvaro Pascual-Leone, and Ross Zafonte, and many others in submitting this application on behalf of Harvard Medical School. We were delighted to hear we had been awarded the grant. As you might imagine with a project of this size and scope, there is a substantial number of details that need to be worked out prior to initiation of the project. Ultimately, we hope to fully characterize the burden of injury and disease of National Football League players. We hope to further promising clinical and scientific research that directly relates to the medical problems suffered by NFL players. We hope to ultimately find better ways of diagnosing, treating, and preventing the illnesses and injuries suffered by NFL players and other athletes.
4) CJSM: Yet another item to note is your involvement in the release of the recent documentary, “The Smartest Team.” How did you get involved in that project, and what was the experience like being in front of the camera?
WM: The Smartest Team was a project initiated and completed by momsteam.com and its founder Brooke de Lench. She simply asked if I would answer some questions for the documentary. I am almost always willing to do that type of thing. They made the interview pretty casual and easy on me. I simply showed up and answered some questions that are commonly asked about concussion. I thoroughly enjoyed being part of it.
5) CJSM: Finally, if you had to name what you consider to be the top three advances in concussion diagnosis and management over the last decade, what would they be?
WM: Although each of these was realized slightly longer than a decade ago, proving that neurocognitive functioning and postural stability are affected by concussion was a major advance. Prior to those discoveries, there were many people who felt that athletes and non-athletes complaining of symptoms after concussion were simply malingering and/or suffering from psychological problems. The development of objective measurements of postural stability and neurocognitive functioning before and after injury allowed us to add evidence to the subjective symptoms that injured patients noted. This gave legitimacy to what previously had, at time, been brushed aside.
In addition, the preliminary data suggesting that concussions can be prevented I think is another promising advance. Specifically, an abstract presented by one of my colleagues, Dr. Dawn Comstock, at a recent conference suggesting that athletes who have a greater strength in the cervical spinal musculature were at decreased risk of concussion compared to athletes with weaker cervical musculature. This evidence suggests that by strengthening the muscles of the cervical spine an athlete might be able to decrease the risk of concussion. That is a major advance towards reducing the risk of these injuries
Once again I really appreciate you making me a part of this. I have been delighted to watch your work at The Clinical Journal of Sports Medicine.
Bill Meehan: truly a gentleman and a scholar. I can assure you we will be hearing a lot more from WM3 at CJSM, other sports medicine journals, here on the blog pages….and maybe on twitter? Ashton Kutcher beware.