The study, published in the Journal of Neurology, was led by a team at Queensland University of Technology’s Genomics Research Centre, including Bridget Maher, Neven Maksemous, Heidi Sutherland, and Lyn Griffiths. The researchers performed whole exome sequencing on 93 unrelated individuals who had each sustained one or more concussions, drawing participants from four distinct groups: patients referred for familial hemiplegic migraine gene testing who had reacted severely to trivial head trauma, hospital-diagnosed concussion patients, community and sporting recruits, and 35 Australian Defence Force veterans recruited through the Gallipoli Medical Research Foundation biobank. Their symptoms ranged from full recovery to persistent migraine, vertigo, fatigue, and cognitive difficulties lasting more than a year.

The scientific rationale behind the work rests on what neuroscientists call the neurometabolic cascade of concussion. When biomechanical force deforms brain cells, membranes become leaky. Potassium ions flood out of neurons while sodium and calcium pour in, and excitatory neurotransmitters such as glutamate are released in quantity. Voltage-gated ion channels amplify this depolarisation, and the brain must then burn enormous amounts of ATP to pump ions back across membranes and restore ionic balance. This metabolic strain triggers hyperglycolysis, oxidative stress, and calcium-mediated mitochondrial disruption, leaving neurons energy-depleted for roughly two weeks — a window that matches the typical recovery period for most concussions and may explain why symptoms persist longer in some people.

The team’s hypothesis was sharpened by a curious clinical observation: familial hemiplegic migraine, a rare autosomal dominant disorder caused by pathogenic variants in ion channel and synaptic genes, sometimes produces catastrophic reactions to minor head trauma. Patients with familial hemiplegic migraine type 1, driven by mutations in the calcium channel gene CACNA1A, can develop seizures, cerebral oedema, coma, or even death after trivial head impacts — a phenotype that eerily resembles second-impact syndrome. Mouse models carrying human CACNA1A mutations show enhanced glutamatergic transmission and an imbalance between excitatory and inhibitory signalling that facilitates cortical spreading depression and worsens outcomes after experimental brain injury. If rare variants in these pathways could turn a small bump into a neurological emergency, the researchers reasoned, subtler variants might tip the scales toward ordinary concussion susceptibility.

To test this, the team applied a rigorous sequential filtering pipeline to their exome data, restricting analysis to three tiers of genes: the known familial hemiplegic migraine genes CACNA1A, ATP1A2, and SCN1A; a panel of 353 ion channel and transporter genes; and 220 genes involved in neurotransmission. Variants had to be protein-altering, rare (with a minor allele frequency below 0.02 in population databases), predicted damaging by at least two of four computational tools — SIFT, PolyPhen, MutationTaster, and CADD — and pass visual inspection in a genome browser. The result: 62 rare missense variants across 24 genes in 59 of the 93 participants, meaning 63 percent carried at least one candidate variant, and 26 individuals carried two or more.

The most dramatic finding came from a burden analysis. Among 16 ion channel-related genes, the researchers counted 43 different rare, amino-acid-changing variants, with 51 predicted damaging alleles in the concussion group. The overall prevalence of these alleles was 0.64 percent — roughly five times higher than the 0.12 percent observed in the gnomAD non-Finnish European reference population. A Fisher’s exact test confirmed the enrichment was highly significant, with an odds ratio of 5.44 and a P value below 0.0001. In other words, people with concussion history were far more likely than the general population to carry rare variants predicted to perturb the function of neuronal ion channels.

Several individual genes stood out. The sodium channel gene SCN9A, which encodes NaV1.7 — a channel central to pain signalling — harboured six different variants across seven participants, four of which had previously been linked to pain disorders such as erythromelalgia and small fibre neuropathy. One variant, p.Ile228Met, has been experimentally shown to impair slow inactivation and increase the excitability of sensory neurons. The SCN8A variant p.Arg1026Cys appeared in four unrelated participants, and SCN8A encodes NaV1.6, a channel notably lost from axons in animal and human studies of traumatic brain injury. On the calcium side, variants cropped up in CACNA1A, CACNA1B, CACNA1C, CACNA1D, CACNA1E, CACNA1I, and CACNB2, including a CACNA1I variant shown by the same group to reduce calcium channel current density. Six participants carried rare variants in ATP7B, the copper-transporting ATPase gene whose pathogenic mutations cause Wilson disease — a frequency far exceeding the estimated population rate of about one heterozygous carrier per ninety people.

Neurotransmission genes added another layer of intrigue. Ten participants carried variants in SNCAIP, which encodes synphilin-1, a synaptic protein tied to energy homeostasis and to the alpha-synuclein pathology of Parkinson’s disease. This connection resonates with large epidemiological studies showing that concussion raises later-life Parkinson’s risk by roughly 50 to 57 percent. Variants also appeared in CHAT, which encodes the enzyme that synthesises acetylcholine; in KIF17, SV2C, SYT9, and UNC13B, all involved in synaptic vesicle traffic and transmitter release; and in potassium channel genes KCNJ10 and KCNT2, whose dysfunction is linked to epilepsy and impaired regulation of extracellular potassium. Follow-up genotyping in an independent cohort of 280 migraine cases and 280 matched controls confirmed that the channel variants were genuinely rare in the general population and not simply markers of migraine, one of concussion’s most common symptoms.

The authors are careful about interpretation. With a cohort of only 93 people, heterogeneous recruitment, and no formal genome-wide association design, the findings must be regarded as discovery-stage rather than definitive; replication in larger, ancestrally matched cohorts and functional assays of individual variants remain essential. None of the variants appear pathogenic in a classical single-gene fashion — concussions still required head trauma to occur. Instead, the picture emerging is one of subclinical vulnerability: heterozygous variants that an ordinary brain might tolerate, but that impair the delicate process of restoring ionic and excitatory balance after the metabolic storm of a concussion. Some variants may only matter under the energy-limited conditions of the post-injury brain, or in combination with a second variant or a second impact.

The implications, if confirmed, are considerable. Genetic testing is not yet suitable for routine clinical use in concussion care, as the latest international consensus statement on concussion in sport emphasises, but this study offers a mechanistically grounded set of candidate genes and variants that could eventually feed into risk assessment, return-to-play decisions, and prognosis. More broadly, the work reframes concussion not merely as an accident of biomechanics but as an interaction between force and the genome — one in which the wiring of our ion channels and synapses helps determine who bounces back and who does not. As sequencing becomes cheaper and cohorts grow, the dream of predicting, and perhaps one day protecting, the brains most at risk moves a step closer to reality.

Subject of Research: Genetic susceptibility to concussion through rare variants in ion channel and neurotransmission genes

Article Title: Investigating genetic susceptibility to concussion through rare variants in ion channel and neurotransmission genes

Article References: Maher, B. H., Maksemous, N., Sutherland, H. G., Smith, R. A., Dabash, O., Greenhow, A., Nasralla, F. A., Nyholt, D. R., van den Maagdenberg, A. M. J. M., Lea, R. A., & Griffiths, L. R. (2026). Investigating genetic susceptibility to concussion through rare variants in ion channel and neurotransmission genes. Journal of Neurology, 273(10), Article 591. https://doi.org/10.1007/s00415-026-14139-8

Image Credits: AI Generated

DOI: 10.1007/s00415-026-14139-8

Keywords: concussion, mild traumatic brain injury, ion channels, rare variants, whole exome sequencing, SCN9A, CACNA1A, neurotransmission, post-concussion syndrome, familial hemiplegic migraine, genetic susceptibility, Journal of Neurology