Latest Research on Concussions; Rather No Concussions = Changes

7 Mar

Certainly the research is flying in; mostly the investigations are now looking at either ways to detect the injury or objective ways to determine recovery.  There are a bunch of other designs and angles out there but the most important are the above.  Although it would be great if we had an objective way of determining concussion, it is really not the pressing issue (with solid education and conservative approach to injury – sit them out).

As I have stated over and over, the BIGGEST issue we face with concussions is the mismanagement of concussion from the beginning; therefore the need to identify when it is safe to return is more paramount in my opinion.

The newest research is out from the Cleveland Clinic, it looked at 67 college football players, more specifically it looked at their blood, report from WKYC;

In a study of 67 college football players, researchers found that the more hits to the head a player absorbed, the higher the levels of a particular brain protein that’s known to leak into the bloodstream after a head injury.

Even though none of the football players in the study suffered a concussion during the season, four of them showed signs of an autoimmune response that has been associated with brain disorders.

There we go again, telling and showing people that the hits that don’t elicit a concussive response are also a culprit in the brain injury crisis we are facing.  Coaches, particularly in soccer and football, will tell us that we are wrong and that it is either unproven or not a possibility because of how “safe” they practice or the equipment they have.

Back to the research, the group looked for the S100B protein that should only be in the brain;

Typically, S100B is found only in the brain; finding S100B in the blood indicates damage to the blood-brain barrier. While the exact function of S100B is not known, it is used in many countries to diagnose mild traumatic brain injury when other typical signs or symptoms are absent.

Studies in Janigro’s lab revealed that once in the bloodstream, S100B is seen by the immune system as a foreign invader, triggering an autoimmune response that releases auto-antibodies against S100B. Those antibodies then seep back into the brain through the damaged blood-brain barrier, attacking brain tissue and leading to long-term brain damage.

They also did some PET scans to confirm brain damage in an objective manner and it was confirmed.

Concussions can be difficult to diagnose, relying on player symptoms, cognitive tests or CT scans or MRIs that cost thousands of dollars. The S100B blood test offers an objective measure of whether a player has endured head trauma, as the researchers found that elevated S100B levels directly correlate to the number and severity of head hits.

Body contact or simply playing in a football game did not affect S100B levels in the players. A blood test will be much less expensive (about $40) and could be performed anywhere, such as locker rooms or doctors’ offices. More importantly, though, the blood test could offer a yes-or-no determination of whether an athlete requires medical intervention as a result of in-game collisions.

This article can be found in an online journal PLOS ONE, the research was sponsored by the National Institute of Neurological Disorders and Stroke (NINDS).

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21 Responses to “Latest Research on Concussions; Rather No Concussions = Changes”

  1. Glenn Beckmann March 7, 2013 at 08:36 #

    You also have to remember this is the same group of scientists who published an article stating that leather helmets performed just as well as modern helmets.

    You’ll pardon me if I don’t take everything they “conclude” at face value.

    It’s rather interesting to watch everyone in the medical and scientific communities point accusatory fingers at other groups’ research but don’t view information from their brothers in arms with the same critical eye.

  2. mriphysician March 7, 2013 at 08:37 #

    Of course you are right. I think helmets need to be improved also but people who do neuroscience understand that head trauma is cumulative.

  3. mriphysician March 7, 2013 at 08:40 #

    I tried to comment that they used diffusion tensor imaging as a gold standard to see if brain damage had occurred. Its nice to say that a blood test is conclusive but often they are not so doing the DTI studies over time (which has been done in studies) but not generally in real ordinary patient players is something we need to do and to standardize the way we process the DTI studies as well.

    Each group does it a different way.

  4. joe bloggs March 7, 2013 at 10:12 #

    These are preliminary results.

    1) S100B is not specific and increases with exertion;

    2) DTI suffers from serious inter-rater reliability problems;

    3) It is not clear they have observed an auto-immune response (not my field so hopefully someone more knowledgeable can add thoughts);

    4) I would like to learn more about the permeability of the BBB finding (it may be the most interesting observation in the study);

    5) I have no doubt damage is cumulative but is it clinical. In a sense, we can start to measure such small changes that a it does not really affect the patient; and

    6) We are going to need to adjust the definition of concussion because of point 5. For decades, it was no bid deal. Now, the pendulum is swing to measure factors the may not be entirely clinically meaningful.

    As more studies are published, it will begin to get very tricky. We already have a CTE panic based on less than rigorous scientific reports and this could start another cycle that will confound getting to the bottom of the issue.

  5. Glenn Beckmann March 7, 2013 at 11:18 #

    A rather basic question that I sincerely hope you all can help answer for me. There is much talk/information about the cumulative effect of low velocity impacts to the head/brain over the career of a football player.

    Is that a simple Yes/No situation? In other words, if you take 200 low velocity impacts to the head over the course of a season, does your brain recover in the offseason? Which would, if true, essentially, reset the “hit counter” to zero for that player the next season?

    The predominantly ignored part of the Purdue study showing the decrease in cognitive performance by high school football players during a season (but who did not receive a diagnosed concussion) shows that all of those affected players returned to their normal baseline levels by the start of the next season. So, from a simplistic viewpoint, the brain (or parts of it) recovered and repaired itself.

    So, does this affect some portion of the cumulative effect theory over the career of a player?

    • jbloggs March 7, 2013 at 13:35 #

      It is anything but a simple question. Getting hit in the head a lot is bad for you. Getting hit once hard enough or at a particular angle is very bad for you.

      How old is the subject? Prepubescent children are likely to suffer much more severe issues from repeated head trauma. Cantu has covered this. While a few dinosaurs like Derman and Guskiewicz think a young child can sustain lots of hits in exchange for developing football skills these fellows and their associates have shown no evidence. Let’s face it, they are well paid consultant to the the NFL or NCAA paid to keep the issue confused. The evidence will almost certainly show younger children should not have their heads battered.

      We don’t know much about high school other than Purdue. Damage is done but the subjects seem to have achieved functional recovery. One should not take this as these subjects do not suffer learning disabilities or will not suffer long-term neurological pathologies. Purdue suggested a functional recovery in a short time window. College will likely play out similarly to high school.

      Minor league professional (D-1/BCS) and NFL is where it will become very interesting. These players have had long exposures under intense conditions. In many cases, players have been subjected to poor medical treatment. On the other hand, these players instinctively know how to protect themselves load their necks and change angles of attack. These data are very complicated and will take years to sort out. Longer play with poor medical treatment will show negative results. The degree of damage will have not only a care component but also a genetic component.

      In the near term, rules, coaching, restrictions on contact, training and medical care will be much more central to dealing with the issue rather than equipment (equipment needs to be in good condition and properly fitted – but you knew that).

  6. Jake Benford March 7, 2013 at 19:49 #

    This is another interesting study that gives us results that we do not know how to use. The study out of Purdue was the first study that objectively showed impairment from multiple sub concussive blows. While these athletes’ scores returned to baseline, we do not know if this equates to complete healing. We also do not know if these athletes remain at higher risk for subsequent injury and if so for how long. This recent study demonstrates that multiple sub concussive blows likely result in a transient disruption in the blood brain barrier. Because we do not know the function of S 100 B in the brain, we cannot conclusively correlate its release with long-term injury. We can also not draw any direct correlation to production of auto antibodies to this protein. All of this research is very important and interesting but not clinically useful at this time. It is going to take several large well-developed long-term studies that follow cognitive impairment over time and correlate them to these biomarkers and the patient’s history of injuries to the head.

    • A Concerned Mom March 8, 2013 at 10:08 #

      I’m just a mom, but suspect there’s enough evidence for everyone to focus on putting in place rules to limit contact for youth sports. I lean towards the limitations advanced in Cantu’s book, roughly summarized as: no tackle, checking or heading under 14, and the implementation of hit counts to ensure no youth athlete is sustaining over what would be recognized as a reasonable number of impacts based on current research (such as Perdue’s).

      I’m open to other ideas (there are people much more qualified than I am to make these decisions). If people are more comfortable with an incremental approach, say no tackle/heading under 10 or 12 and then simple contact restrictions, such as full contact practice only allowed 1X or 2X’s per week, then I think we would still be taking a step in the right direction. Also, I believe requiring youth leagues to get training and support from an organization such as USA Football would be another step in the right direction. Personally, I prefer flag for under 12/14, but again access to education, training and other support would be a major step in the right direction – oh, and I recognize one of USA Football’s roles is to protect the game – and would suggest that parents always verify claims with other sources and take a show me it works approach.

      My greatest fear is that if we do too little (and it’s important to remember that some states don’t even have concussion laws on the books, and in many cases those laws don’t extend to the youngest participants), those long-term studies of today’s youth athletes may end up discovering just how many hits to the head it takes for certain kids (who may be vulnerable due to genetics or other factors) to destroy their brains. I’ve seen what neurodegenerative diseases can do to someone’s life, and wouldn’t wish that on anyone.

      Sports and other activities can be great for kids, and I’m not motivated in the least to attack any particular sport or activity (or equipment manufacturer – perhaps kids could wear helmets for flag in case of accidental contact). Just think it’s time to have some serious conversations about what should be done based on what we now know and suspect. We don’t have the full picture yet, but again I suspect we know enough to take more aggressive actions to protect our youngest athletes (they’re really just kids who happen to participate in sports).

      There’s much skepticism out there (fueled by obfuscation at times), and if we wait for people to start believing that concussive and sub-concussive impacts are a problem, or if we wait for the results of long-term studies, I fear today’s youth athletes will pay an unnecessary price (we already know that what we were doing results in problems). Additionally, if we don’t take steps to reduce contact, think more cautious parents could end up keeping their kids away from youth sports. I know I don’t want to sign my kids up for a study to follow any cognitive impairment caused by sports participation on a long-term basis – I would rather avoid such impairment.

      • Matt Chaney March 8, 2013 at 10:48 #

        Excellent discussion, and, right on, Concerned Mom: What exactly anyone needs to know about high-risk tackle football, at this point for example, is beyond me. But we delude ourselves, and deny, delay imperative questions, keeping the cultural fantasy another season, especially the modern chapter of silly-money kids football. Hey, I agree with many a hypothesis floating about, and wish there were funding for practical vetting and application, in theoretical risk preventions of football including injury research, NP testing and drug analysis. But foremost we face stark limitations of reality, particularly for impacting any health menace of Phat Lord Football in this country, encompassing some 4 million participants, the vast majority juveniles. (Sure, i.e., I think genetic predisposition to brain trauma and disease is a real and fascinating variable, but, sorry, the thesis is largely irrelevant for time being, along with most ‘long-term’ study proposals currently in play. Ha, I don’t need to know my pertinent genotype to know I severely injured my brain playing modern football in bullet-head helmets, and the cycle continues for countless young guys today, 30 years later.) Football has stalled on real reform through ‘expert’ brain-farting, among tactics, since the Victorian Era. [Teddy Roosevelt, Woodrow Wilson, the NCAA didn't change squat about brutal football, way back when by the way, among stupid myths we regurgitate as history.] We’ll never change anything fundamentally about tackle football in America without first downsizing this circus in enormous fashion. The game can do or die by this fact.

      • Educator Mom March 8, 2013 at 21:38 #

        Well I am a mom and a teacher. “The predominantly ignored part of the Purdue study showing the decrease in cognitive performance by high school football players during a season (but who did not receive a diagnosed concussion) shows that all of those affected players returned to their normal baseline levels by the start of the next season.” So if we are to take that study as accurate and factual, then is the portion of a student athlete’s academic career that occurs during football season unimportant? And even if they return to their normal baseline levels, how much of the school year goes by before that occurs? How much of a decrease in a student athlete’s cognitive performance is acceptable to us as a culture? Our students need the adults to help them find ways to be active, play sports, AND be safe. They only have one brain and unlike an ACL injury, so far our medical community hasn’t found a way to repair that one brain.

      • joe bloggs March 9, 2013 at 09:20 #

        BOOM – Educator Mom

        Well Played.

        The Football Machine thinks schools are marketing platforms for the losers and training centers for the genetic freaks. For the former, as long as they as the loser can obtain of level of education sufficient to pay the cable bill all is good, and for the latter who cares. He is a genetic freak and the union will make sure he can get his share of PEDs to keep him functional until his brain and body gives out. He can look good and die early of brain damage (sorry die slowly of brain damage but we will deny him disability because now he is a loser).

        Go TEAM.

  7. brokenbrilliant March 7, 2013 at 20:09 #

    I would also suggest that another significant issue is fear that seems to pervade the issue outside the ranks of those who study/discuss it on a regular basis. Even if you have the best diagnostics and follow-up care possible, if there is still public ignorance and bias around the issue (i.e., concussion = brain injury = brain damage = mental incapacity/a host of other issues)… and that ignorance and bias continues to pervade the medical profession as well as the general public… we will continue to have an inconsistent response to it. And a diagnosis, while essential to have and address, could wind up with potentially catastrophic results for the individual impacted. Fear and ignorance and lack of balanced response can certainly impact outcomes, as stress (due to internal and external factors) compounds the issues in a host of different ways.

    Ultimately, I really believe the price we pay is deeply personal — in un-measurable ways that reach far beyond the inner workings of our brains — and the cost is high, when we don’t step up and deal with concussion/TBI proactively.

  8. Glenn Beckmann March 11, 2013 at 07:46 #

    Well, at least I received two cognizant, well reasoned answers before the Phat Lord Hyperbole stuck its nose in again. Amazing. Simply amazing.

    • Matt Chaney March 11, 2013 at 10:00 #

      You’re such a smart a**, Helmet Seller, with nothing but HYPERBOLE to say. Does your Daddy Football and Helmet Industry know you pop off with such stupidity on regular basis? In public? Course, that rhetoric is par for the course, your type. I much you get paid for a three-sentence burp like yours here?

    • Matt Chaney March 11, 2013 at 10:07 #

      And keep selling football helmets by the millions to small kids, Mr. Beckmann, with your lame disclaimer attached. Keep feeling good about yourselves as a group, Daddy Football and Helmet Industry, and kidding yourselves how serious, fact-laden criticisms amount to hyperbole–regarding which, incidentally, you employ constantly. BS is all you got, in fact.

      • Glenn Beckmann March 12, 2013 at 10:09 #

        Listen Matt, I asked a question – looking for an answer from some of the smart people who come here. I had my opinion about what I thought the answer to be but, in fact, was given a different viewpoint that I hadn’t thought of. That made me think about my opinion and decide that I wasn’t exactly right.

        Something you should try some time. You might not be such an asshole if you did.

      • Dustin Fink March 12, 2013 at 11:35 #

        Stop…

        Matt and Glenn you both people I honestly consider friends; why you ask? You both offer valuable insight into this cause… You both are not afraid to stick your neck out and speak your mind… You both are closer in agreement on this than you think…

        I am not saying you have to be beer drinking buds (although you both would enjoy each others company). We don’t need this… I want disagreement and discourse but turn it down a notch… An occasional “douchebag”, “idiot”, “smartass”, “jackass” is all fair game…

        Other than that have at it!

      • Glenn Beckmann March 12, 2013 at 10:10 #

        You always think the song is about you, don’t you?

      • Matt Chaney March 12, 2013 at 11:27 #

        Great response, you PR hack, typical nothingness. Can’t come with anything but punk insults, can you? And your ‘reply’ upstairs here wasn’t about me? Yeah, and your ideas for football change make as much sense as that lame claim–if you would ever spell out those same, old talking points for us, courtesy of Daddy Football’s feeding straight to you. So what you got to say of any substance, Smart Man? Just take a few of your well-paid minutes to NOTE MY HYPERBOLE. Moreover, what do YOU know that can be done about football brutality, especially in your bullet-head helmets? (No, I’m not saying the game goes back to leathers, ha; no, the game is what it is, in the here and now, and can’t turn back on armor tech.) And if all you have is more brat crap, fine, you’ll have the last word in this round between us. You’re so weak!

      • Dustin Fink March 12, 2013 at 11:34 #

        Stop…

        Matt and Glenn you both people I honestly consider friends; why you ask? You both offer valuable insight into this cause… You both are not afraid to stick your neck out and speak your mind… You both are closer in agreement on this than you think…

        I am not saying you have to be beer drinking buds (although you both would enjoy each others company). We don’t need this… I want disagreement and discourse but turn it down a notch… An occasional “douchebag”, “idiot”, “smartass”, “jackass” is all fair game…

        Other than that have at it!

  9. Matt Chaney March 12, 2013 at 12:03 #

    I hear you, Dustin, and pardon me, everyone, including Mr. Beckmann, for my tone. But I don’t suffer anyone’s foolishness regarding blood-sport football. I chose long ago to pay for my independent voice about football stupidity in this culture, in my study, fact-gathering, reporting and qualified opinion, and I will hammer someone upside the head in an instant for it. I respect Mr. Beckmann’s question above myself, on sub-concussive blows, and appreciate learning more on matter from the qualified replies. And I agree with his implication, that I’m starting to just repeat my points around here; I’ll take that to heart… Like I say, if Mr. Beckmann wants to reply here with something substantial–basically imparting his wisdom I’ve requested–I will respond and in accordance with your house request, Dustin. If it’s just more of his silliness, I’ll readily leave it alone.

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