Swedish Boxing Study

In April a Swedish study was released on boxing and biomarkers in the cerebrospinal fluid (CSF); findings were not only somewhat successful for possibly getting a biomarker test, it shed light on the controversial subconcussive blows and cumulative effects as well.

Sanna Neselius, Helena Brisby, Annette Theodorsson, Kaj Blennow, Henrik Zetterberg and Jan Marcusson did perform the largest study of active boxers known, what was less known until this one study is how long and what level the CSF biomarkers are in samples of each boxer.  The most curious part of the study is that only ONE of the boxers ever reported symptoms associated with concussion yet the results show increased levels of certain biomarkers in 80% of the boxers that would be indicative of “acute axonal and neuronal damage.”

The studied biomarkers were;

Biomarkers for brain damage include neurofilament light protein (NFL), a marker of subcortical myelinated axons [21], total tau (T-tau), a marker of cortical axons [22], [23], tau phosphorylated at threonine 181 (P-tau181), a marker of tangle pathology [24], heart-type fatty acid binding protein (H-FABP), a marker of grey matter neurons [25], glial fibrillary acidic protein (GFAP) [26] and S-100B as markers of astroglial cells [27], [28] and the 42 amino acid isoform of amyloid β (Aβ1–42), marker of plaque pathology [23].

Not only were the biomarkers collected in the acute time frame (within 6 days) but also after a period of 14 days, or resting the brain.  Interestingly enough even after the resting period boxers continued to have high levels of NFL and T-tau;

Increased CSF levels of T-tau, NFL, GFAP, and S-100B in >80% of the boxers demonstrate that both the acute and the cumulative effect of head trauma in Olympic boxing may induce CSF biomarker changes that suggest minor central nervous injuries. The lack of normalization of NFL and GFAP after the rest period in a subgroup of boxers may indicate ongoing degeneration. The recurrent head trauma in boxing may be associated with increased risk of chronic traumatic brain injury.

What this study tell us in layman’s terms is:

  • After boxing there are chemical changes at a level consistent with nerve damage in the brain even WITHOUT symptoms
  • After boxing and a 14 day rest period levels of chemical changes in the brain continue to be high enough to be consistent with some sort of damage
  • There may be more solid information for an objective type test for traumatic brain injury

Full Article HERE


6 thoughts on “Swedish Boxing Study

  1. joe bloggs July 23, 2012 / 11:30

    It appears to be some very sound research that suggests that sub-clinical injuries may have long-term damage.

    It would be nice to see a larger longer term study including other sports but spinal taps have risks of there own. Hopefully, tests can be developed that don’t require CSF to identify the biomarkers.

  2. Robert A. Arnone, D.C. July 24, 2012 / 07:43

    This study is wonderful as it further proves my concussion theory. I have proposed that it is indeed the head and neck dis-relationship which is the main mechanism of injury rather than the brain rattling inside of the skull in nearly all concussion cases.

    This study certainly explains how there can be no symptoms while displaying abnormal function. Pressure upon the brainstem from head-neck mis-alignment alters mental transmission up to the higher brain and results in abnormal function 100% of the time, whether symptoms are present or not.

    This is why all athletes who participate in contact sports need to be examined by a head-neck injury specialist during their entire career.

    Furthermore, our testing is completely safe and requires no spinal tap, we examine brainstem function and have a reliable method of doing so.

    Even more importantly, after thorough analysis and measurement, we then properly correct the head-neck mis-alignment which allows proper function to return and improvement.

    If the patient was having symptoms as a result of this then we see them improve at least some if not much or completely. If they were not having symptoms, then they are still functioning correctly which slows down or reverses the destruction.

  3. Jake Benford July 28, 2012 / 22:49

    A study like this is a good stepping stone, but it leaves many questions unanswered. Having a biomarker with this much sensitivity is a double edged sword. We do not know what the cut off is as to what level is significant. We also do not know what level of trauma the markers become measurable. Without this information, we can not determine if a sub-clinical level is relevent or not. We also do not know if the trauma from the spinal tap may have caused a biomarker leak. So, like I said, a good stepping stone that will hopefully lead to other studies that will tell us how to use this information.

    • joe bloggs July 29, 2012 / 20:22

      Dr. Benford,

      I am awaiting the results of more SB100 publications. The Banyan Biomarker (actually three) should be reported later this year although GAO reports that it is as accurate as a PSA in prostate exams meaning many many false positives.

      Clinical relevance will be the key to any of them as displaying a protein expression has little to do with functional performance. How much is enough to imply short-term or long-term damage. It will be years but that is where this will need to go.

  4. Jake Benford July 30, 2012 / 10:42

    I agree. A lot of research to be done. Hopefully the issue will remain on the front burner and it will get the attention and financial support to answer some of these questions. Let us know when these publications are available.

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