Mayo Clinic Looking into Autonomic Response to Concussion

Neurologists at Mayo Clinic in Arizona have taken a promising step toward identifying a test that helps support the diagnosis of concussion. Their research has shown that autonomic reflex testing, which measures involuntary changes in heart rate and blood pressure, consistently appear to demonstrate significant changes in those with concussion.

Appearing on their website, the information researchers are delving into is a new angle on  concussions.  It is widely known that traumatic brain injured (TBI) patients have autonomic system (ANS) deficits/abnormalities.  However the group from Arizona thought an investigation into concussed patients was worth the effort.  Low and behold their findings are a promising first step in possible assessment and management of the concussion.

One interesting note, was this notion on dizziness;

“Contrary to popular belief, the symptoms of ‘dizziness’ that patients feel just after a concussion may, in some cases, be symptoms of autonomic system impairment rather than a vestibular or inner ear disturbance,” says Bert Vargas, M.D., a Mayo neurologist.

No one is telling you to take blood pressures with assessment (ergo baselines), yet, but with this information could come not only objective testing but biomarkers associated with ANS changes;

“This study shows a possible electrophysiological biomarker that indicates that a concussion has occurred — we are hopeful that with more research this will be confirmed and that this may also be a biomarker for recovery,” he says.

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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; Continue reading

Will Biomarkers be the Next Step?

The current imaging techniques available to the doctors and clinicians do not allow for a diagnosis of concussion or related degenerative issues of the brain.  There has been information about promising breakthroughs, Dr. Bennet Omalu’s interview, however there may be a way to compare and even diagnose if dialed in correctly.

The only issue is that this type of information gathering is invasive, but it does indeed show promise as various companies have been working on a process to gather information.  Thanks to the website Sports Medicine Research: In the Lab & In the Field I was able to read a paper concerning such biomarkers in boxers;

No difference were found between boxers and controls within their medical and social history. Only 1 boxer had current concussion signs and symptoms listed on the questionnaire. Both, boxers and control groups had no symptoms of concussion on their neurological exam, MRI, or neuropsychological examination. Boxers had significantly elevated concentrations of GFAP and NFL at both acute and long-term tests compared to controls. T-tau and S-100b were also significantly elevated in boxers compared to control but only during the acute test period.

Repetitive head trauma in boxing may be associated with increased risk of chronic traumatic brain injury. Analysis of biomarkers can assist in understanding the pathology associated, at a molecular level, with concussions. Furthermore, some biomarkers may be sensitive enough to detect subclinical brain responses to repetitive head impacts and could possibly be used to predict the risk of the patient having a prolong recovery or long-term effects. In this role, biomarkers may be able to prevent-long term effects if they can be eventually used to improve return to play guidelines.

You can read how the study was framed and run in the link above, however I feel this may be the important part.  The two prominent biomarkers above are Continue reading