Findings released on November 25, 2014 in the Journal of Neurotrauma indicate that the presence of a blood protein known as SNTF shortly after a sports-related concussion can predict the severity of post-concussion symptoms in professional athletes.
The authors of the study – Robert Simon, PhD, and Douglas H. Smith, MD, professor of neurosurgery and director of the Center for Brain Injury and Repair at the University of Pennsylvania – noted upon release of this study of SNTF in concussion patients that
“these observations lend further support to the growing awareness that concussion is not trivial, since it can induce permanent brain damage in some individuals.”Read More
Several recent developments demonstrate increasing recognition of the serious potential consequences of concussion, and commitment to minimize those consequences through appropriate treatment of concussion:
Physicians have an ethical obligation to become knowledgeable about concussion.
On June 9, 2014 the American Academy of Neurology, the largest professional association of neurologists, released a position paper stating that doctors have an ethical obligationto educate and protect athletes from sports concussion and clear them to play only when the athlete is medically ready, standing firm against objections from players, athletes and coaches. The statement declares that sports concussion “is a major issue in the world of health care” and requires more attention from physicians. Read More
Recent research has shown that traumatic brain injury, (TBI) including mild traumatic brain injury (mTBI), can damage and cause dysfunction in the pituitary gland, a pea-sized gland located in the center of the skull that releases several essential hormones affecting such functions as growth and metabolism (part of the neuroendocrine system). Researchers have found that a surprisingly high percentage of patients with persistent symptoms following a TBI show evidence of neuroendocrine dysfunction.
It turns out that the anatomy of this gland makes it particularly susceptible to the sheering injuries seen in TBI. The most common dysfunction found after TBI is deficiency in the Growth Hormone (GH), one of the key hormones released by the pituitary gland. The symptoms of GH deficiency overlap with many persistent TBI symptoms including fatigue, poor memory, depression, emotional lability, lack of concentration and attention difficulties. Read More
In a study published November 18, 2013 in Frontiers in Neurology, researchers from Penn and Baylor report that they have identified a blood biomarker – SNTF – that if found on the day of injury predicts with substantial accuracy both cognitive impairment persisting more than 3 months and the existence of abnormal brain imaging finding in the corpus callosum and uncinate fasciculus of the brain (using diffusion tensor imaging (DTI). Read More
There has been much debate over what happens to the brain following a concussion, much of it recently focused on concussions in sports. One side of the debate maintains that concussions, also referred to as “mild traumatic brain injuries,” involve only a very short term disruption of brain function with no damage to the brain. As discussed in previous posts, this view has been discounted by a growing body of research involving advanced imaging technologies as well as post-mortem pathological studies showing that in a minority of cases concussions can cause lasting damage to the brain as well as persistent symptoms.
One of the causes of the failure of clinical trials to successfully treat TBI, the authors contend, is the common classification of TBIs as “mild, moderate or severe.” These classifications do not incorporate newer insights and findings from diagnostic tools such as imaging and biomarkers and therefore do not promote “mechanistic targeting” for clinical trials. The authors support the transition to a more nuanced approach, a precise disease classification model that is based on the precise pathoanatomical and molecular features of the injury. Read More
Defense attorneys often cite “meta-analytic” reviews of neurological studies to make the argument that “mild” traumatic brain injuries (mTBIs) cause no lasting effect beyond three months post-injury. A “meta-analysis” involves a statistical study of multiple studies published in the literature.
Meta-analyses in mTBI are often used to show that persistent symptoms are “neurotic” rather than “organic”
Fortunately, it is generally agreed that the majority of people who suffer mTBIs, sometimes referred to as “concussions”, report full recovery from symptoms within three months of the injury – in fact many recover much faster. A great deal of research over the past few years has focused on the minority of people who do not fully recover within three months, described as having a “persistent post-concussion symptoms (PCS).” These patients are sometimes referred to as the “miserable minority.” The “meta-analyses” are often cited as demonstrating that changes in performance after three months have “limited statistical and clinical significance;” in other words, that persistent symptoms must be psychological or “neurotic” rather than “organic” or neurologic. Read More
Two recent peer reviewed papers support the position statement adopted by the Brain Injury Association in 2009 that “Brain Injury” be treated not as static event from which patients gradually recover over time, but as the beginning of a disease process that that can cause symptoms that change over time, in some cases getting worse instead of better, and that can impact multiple organ systems.
The good news is that most people do, in fact, recover. For those who do not, however, the disease model is more consistent with the evolving research. As McCrea, Iverson, McAllister, et. al. noted in their 2009 Integrated Review of Recovery after Mild Traumatic Brain Injury, brain injury science has advanced more in the last few years than in the previous 50, causing us to change the paradigms we have used to understand both the injury and its consequences. Read More
In July, 2013 the Defense Centers of Excellence, serving the United States Department of Defense, issued important new guidelines for neuroimaging following “mild” traumatic brain injury. The guidelines begin with the well-accepted understanding that neuroimaging is not typically included in the diagnosis of mild traumatic brain injury(“mTBI”) because only 10-15% of people who sustain trauma resulting in mTBI will have an acute brain lesion on CT (computed tomography) scans. “The lack of positive imaging findings,” the guidelines emphasize, “does not invalidate a diagnosis of mTBI.”
What is significant about the guidelines is that they recommend imaging in mTBI cases where the victim has “new, persistent or worsening symptoms” 90 days or more following the injury (described as the “chronic stage.”) Read More
Concussion, or mild traumatic brain injury (TBI), typically produces no gross pathology, such as hemorrhage or abnormalities, that can be seen on conventional CT scans of the brain. It does cause rapid-onset neurophysiological and neurological dysfunction that in most patients resolves spontaneously over a fairly short period of time. Studies have shown, however, that approximately 15% of individuals with mild TBI develop persistent cognitive dysfunction and other symptoms. Researchers are starting to make progress on proving mild traumatic brain injury using the biomarkers that underlie such symptoms. Read More
