BCAA Supplementation for Concussion

Children's Hospital of Philadelphia42 enrolled

Overview

This study is a randomized, placebo-controlled, double-blinded, therapeutic exploratory clinical trial of branched chain amino acids (BCAA's) in the treatment of concussion. The aim of the study is to determine whether, compared to placebo treatment, administration of BCAA's, at one or more doses, after a concussion improves neurocognitive recovery at one or more time-periods post concussion.

Annually, between 100,000 to 140,000 children present to the emergency department for concussion in the United States.1 The Centers for Disease Control now estimates that 1.6 - 3.8 million sports related concussions occur each year in the United States. A large proportion of these patients have enduring cognitive and neurobehavioral problems. Concussion is a heterogeneous insult to the brain that precipitates a complex pathophysiological process that can result in a cascade of deleterious side effects. At present, there are no proven therapies to mitigate or prevent the neurocognitive and neurobehavioral consequences of concussions. The limbic hippocampus, a brain structure crucial for learning and memory, is often damaged in concussion. In preclinical studies in our laboratory, analysis of ipsilateral hippocampi isolated from mice after traumatic brain injury (TBI) demonstrated that only the concentrations of the three BCAA's (valine, isoleucine, and leucine) were significantly altered (reduced) after injury. When these brain-injured animals received dietary supplementation with BCAA's, the concentrations of these amino acids were restored in the injured hippocampus and the injured animals demonstrated significant cognitive improvement to levels comparable to those obtained in non-injured control animals. In light of these results and the increasing awareness and morbidity associated with concussion, we are proposing a pilot therapeutic exploratory clinical trial to determine the effects of BCAA's in reducing the neurocognitive side effects of concussion injury.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

Conditions

Brain Concussion

Interventions

Branched Chain Amino AcidsDRUG

The three BCAA's will be combined together and dissolved in a flavored solution.

Placebo solutionDRUG

The placebo solution will have similar taste, texture, consistency and appearance as the BCAA solution.

Eligibility

Sex: ALLMin age: 11 YearsMax age: 34 Years

Medical Language ↔ Plain English

Inclusion Criteria 1. Males and females, ages 11 - 34 years, of any race. 2. Subjects who had a concussion, as diagnosed by a qualified physician, within 72 hours prior to enrollment. 3. Ability to have daily email and internet access. 4. Females must have a negative urine pregnancy test and must use an acceptable method of contraception. 5. Subjects must, in the opinion of the referring physician, have the capacity to provide informed consent. 6. Informed consent by the subject, or for subjects \<18 years old both informed consent by a parent/guardian and child assent. Exclusion Criteria 1. Witnessed seizure at the time of injury or penetrating head injury. 2. Prior concussion or TBI within 90 days. 3. Concussion or TBI severe enough to require admission to an intensive care unit for observation or intervention. 4. Previous history of TBI or concussion requiring admission to the hospital, disabling stroke, epilepsy, brain tumor, neurodegenerative condition, or psychiatric disease. 5. Subjects taking neurological or psychoactive medications as a regular daily prescription medication. 6. Known history of maple syrup urine disease or known family history of maple syrup urine disease. 7. Any investigational drug use within 30 days prior to enrollment. 8. Allergy to Food, Drug, and Cosmetic (FD\&C) Red #40 (red dye 40) or Sucralose. 9. Lactating females. 10. Parents/guardians or subjects who, in the opinion of the investigators, may be non-compliant with study schedules or procedures.

Locations (1)

The Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States

Outcomes

Primary Outcomes

Reaction Time Difference Between Drug and Placebo Groups

Processing speed subtest of the Axon Sports Computerized Cognitive Assessment Tool. The values provided are the median of log reaction time to the processing speed subtest, where a lower score indicates a faster time and thus improved processing speed.

Time frame: Day 21

Secondary Outcomes

Clinical Symptoms

Evaluate whether BCAA supplementation reduces total symptom burden on a total symptom scale of 9 concussion symptoms rated each from 0-6, minimal value 0, maximum value 54, a higher score indicates a higher symptom burden and therefore a worse outcome

Time frame: Day 21

Return to Physical Activity Baseline

Determine whether BCAA supplementation more rapidly facilitates a return to physical baseline. The physical activity score is scaled on a 6 point Likert scale (0-5), where 0 represents no activity and 5 represents full activity, therefore a higher score represents a closer return to baseline activity by the end of the study period

Time frame: Day 21

Neurocognitive Recovery-- Attention

Determine whether administration of BCAAs improves the median log reaction time of the attention subtest of the neurocognitive testing battery. A lower median log reaction time represents improved attention

Time frame: Day 21

Compliance and Adherence to Treatment

Adherence to treatment among dosage groups, reported as the median percent drink consumed among the group across the study period, where 100% = all drink (2 doses per day x 21 days) consumed, and 0% represents no drink consumed

Time frame: Day 21

Tolerability of BCAA's Based on Adverse Events

Data from ClinicalTrials.gov

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