Kelsey A. Rushing, Payton E. Butler, Grace Graves, Alex B. Rich, Maggie C. Steen, Ervin Watson, Kaitlyn G. Willis, Allyn Abadie, Eric P. Plaisance, FACSM, Cody E. Morris. University of Alabama at Birmingham, Birmingham, AL.

BACKGROUND: Sports-related concussions (SRC), a form of mild traumatic brain injury, occur as a result of collision or physical contact during participation in athletics, with most of these injuries occurring in adolescents. Following SRC, glucose disposal and utilization are decreased in affected areas of the brain. Current treatment strategies (rest, hydration, and over-the-counter medications) neglect to address metabolic changes that could have long-term consequences. Emerging evidence suggests that ketone metabolism is not impaired following SRC, leading to the hypothesis that exogenous ketones could represent an effective strategy to decrease cerebral inflammation and cognitive dysfunction. The purpose of this study was to determine if ketone supplementation within 7-14 days of SRC will attenuate associated perturbations in energy metabolism. METHODS: Five athletes (3 male and 2 female) aged 12-19 y who had suffered a SRC within 7-14 days were enrolled in a 4-week intervention, with measures occurring at enrollment (baseline), 7, 14, and 30 days. As part of standard of care, a licensed healthcare professional conducted the Sports Concussion Assessment Tool, Return-to-Sport, and Return-to-School assessments. Trained research personnel used the C3Logix Concussion Management System to evaluate cognitive function, balance, reaction time, and stability. The single-blind procedure involved participants being counterbalanced to one of two groups, to either receive the ketone supplement or a placebo control. A 2x4 (group x time) repeated-measures ANOVA was used to evaluate differences in the proposed outcomes. RESULTS: The current sample size is too small to draw definitive statistical conclusions. From August 2020 through April 2022 (20 months), 71 total patients were seen in the single-site clinic during the period studied. Of those 71, only 24 (34%) were considered eligible for the study due to defined inclusion/exclusion criteria. Of the eligible sample, six participants were initially enrolled (8% of total patients, 25% of eligible sample) and one participant dropped out. No outcome variables showed significant differences between groups (p > .05): Balance Error Scoring System, Memory and Processing, Simple Reaction Time, Choice Reaction Time, Neuromotor Function, Symptom Severity, Visual Acuity. CONCLUSION: The results of the current feasibility study show that additional studies with multiple sites are needed to recruit a sufficient sample size, including more acute cases, to fully investigate this hypothesis. Future studies should aim to recruit additional clinic sites to improve recruitment and retention of an adequate sample to fully investigate this hypothesis. Sponsor: Faculty Development Grant Program funded by the Faculty Senate of the University of Alabama at Birmingham.

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