Steady-State Visual-Evoked Potentials as a Biomarker for Concussion: A Pilot Study

Daryl H C Fong; Adrian Cohen; Philip Boughton; Paul Raftos; Joseph E Herrera; Neil G Simon; David Putrino

doi:10.3389/fnins.2020.00171

Steady-State Visual-Evoked Potentials as a Biomarker for Concussion: A Pilot Study

Front Neurosci. 2020 Mar 10:14:171. doi: 10.3389/fnins.2020.00171. eCollection 2020.

Authors

Daryl H C Fong¹, Adrian Cohen², Philip Boughton¹, Paul Raftos³, Joseph E Herrera⁴, Neil G Simon⁵, David Putrino⁴

Affiliations

¹ School of Aerospace, Mechanical and Mechatronic Engineering, Faculty of Engineering and Information Technologies, The University of Sydney, Sydney, NSW, Australia.
² Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
³ Randwick District Rugby Union Football Club, Sydney, NSW, Australia.
⁴ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, NY, United States.
⁵ Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.

Abstract

A variety of assessment tools are currently available to help clinicians assess Sports Related Concussion (SRC). Currently, the most widely available tools are neither objective nor portable, and are therefore not ideal for assessment at the site and time of a suspected injury. A portable system was developed to deliver a measurement of the steady-state visual-evoked potential (SSVEP). This system involved a smartphone housed in a Google Cardboard frame, which delivered a 15-Hz flicker visual stimulus while an electroencephalography (EEG) headset recorded EEG signals. Sixty-five rugby union players were tested during their regular season and were stratified into healthy, concussed, and recovered groups based on clinical examination. Their SSVEP response was quantified into a signal-to-noise ratio (SNR). The SNRs of players in each study group were summarized. Additionally, the SNRs of individual players who had baseline, post-injury, and post-recovery readings were analyzed. Sixty-five participants completed a baseline evaluation to measure their SSVEP. Twelve of these participants sustained a medically diagnosed concussion and completed SSVEP re-testing within 72 h. Eight concussed players received follow-up SSVEP testing after recovery. Concussed participants had a lower SNR [2.20 (2.04-2.38)] when compared to their baseline [4.54 (3.79-5.10)]. When clinically recovered, participant SNR was not significantly different to their baseline [4.82 (4.13-5.18)]. The baseline SNRs of the players who experienced a concussion during the season were not different to those of players who did not experience a concussion [4.80 (4.07-5.68)]. This is the first study to identify differences in SSVEP responses in male amateur rugby union players with and without concussion. It is also the first SSVEP demonstration for concussion evaluation at point-of-care. SSVEPs are significantly attenuated in the presence of concussion in these male athletes. Individuals returned to their baseline SSVEP following clinical recovery from the concussive injury. The use of SSVEPs has the potential to be a supplemental aid for the assessment and management of concussion.

Keywords: SSVEP; concussion; electroencephalography; football; sport.