HCB News: How has fMRI contributed to the care of concussion patients?

WG: Well, I think for the first time we have a tool that we can evaluate whether someone is… whether the functioning of the brain is normal or not. We don’t really have the longitudinal data to say how concussions should be treated. Lots of people that make claims about nutritional supplements, about different types of programs to put concussion patients through, and how quickly they should return to play or not. But, for the first time, we can actually watch the brain and see if it’s functioning normally or not. I think the jury is still out about how it actually alters the treatment of these patients. But we can’t really decide that issue until we have the data to show that the patient is injured or not. And it makes eminent sense that the brain, which works as the distributive super computer, if you’ve scrambled the wires – if you’ve damaged some of the inner connections of the brain, that in such a state it would not be wise to subject the brain to repeated injury. Because we’ve certainly seen major issues of Chronic Traumatic Encephalopathy and athletes that undergo repeated brain injury.


HCB News: Every few weeks it seems like there is a fascinating new Functional MRI study being announced that provides insight into the brain’s physical response to common stimuli such as playing music or experiencing social anxiety. In your opinion, how do these studies relate to modern medicine and the clinical care of patients?

WG: I think there’s been a tremendous disconnect. There have been thousands of papers written about Functional MRI. But if you go to most medical centers, most universities around the country, there’s almost none of it being performed in a real clinical way other than as I’ve said for preoperative localization. And our goal is to try to bring some of these tools more into the main stream to provide standardized testing of a number of brain functions. And, you know, I think that the other problem that we have with many of these studies in the literature is they are often poorly controlled. So, you know, the same thing that causes stimulation in one area of the brain, another researcher… It’s sort of like somebody will say: “Well this guy’s addicted to pornography. Ok, it lights this area of the brain up”. The same area is lit up by ten other things. So it’s pretty nonspecific and I think that those types of studies are very interesting in helping us to understand how the brain works and some of the limitations of fMRI, but I don’t think that they’ve contributed much to the clinical usage of MRI.

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