More than 3.8 million U.S. athletes annually experience a concussion and this injury is not exclusive to athletes. Concussions can occur at work, on the battlefield, or even the playground when children fall.
In addition to the short term damage to memory and balance, these concussions can also lead to long-term brain damage and death. For now, the only way to diagnose this condition is by observing the patient post-trauma. However, this approach is about to change.
According to an article in the Wall Street Journal, research by the National Institute of Health (NIH) published in the medical trade publication Neurology “raises hopes that a simple blood test for concussions will be as objective as diagnosing high cholesterol or a heart attack.” This research comes at a time of the year when the National Football League, which has received criticism from former players and head-injury specialists, is preparing for its annual championship – The Super Bowl.
In a recent interview, Dr. Michael Landers, a sports medicine specialist, and Dr. Scott Kutz, a neurosurgeon at Texas Health Spine & Orthopedic Center, shared their thoughts about this injury and how the new blood test might work.
What is a Concussion?
Dr. Scott Kutz is an expert in treating brain injuries such as concussions, and he offered an explanation of the condition.
“A concussion is a disturbance in the function of the brain that’s caused by a force or blow to the head,” he noted. “It can result in a variety of symptoms which may or may not involve memory problems or loss of consciousness. A concussion may not present significant problems at the time immediately after the trauma, but we are now discovering it can cause more problems in the near and distant future.
“Concussions can lead to migraine headaches and depression. After repeated concussions, real neurological changes can occur to the brain, resulting in its permanent alteration. Concussions have also been associated with Chronic Traumatic Encephalopathy (CTE), which can cause the patient’s behavior to become more erratic, and dramatically impact their moods, sometimes resulting in depression, and even suicide.”
Dr. Landers added, “If the concussion is not diagnosed quickly, the person who has received the blow to the head will likely continue with his or her activity and that secondary trauma – even though it may not be as severe as the first – can have serious ramifications such as paralysis or death.”
Observational Signs of a Concussion
At the present time, most diagnoses of concussion are the result of a physician, athletic trainer or emergency medical technician observing the injured party. Dr. Kutz explained these observational “signs” of a concussion.
“As a part of a diagnostic evaluation, there are a number of factors that are considered,” he said. “First, we want to determine if the patient has lost consciousness and if so, how long were they unconscious. Secondly, we look for symptoms that are associated with post-concussion syndrome. These include: headache or pressure in the head, neck pain, ability to balance, vision, hearing, cognitive function and possible confusion.”
Dr. Kutz continued, “There are now some standardized tests which help us quantify the severity of the concussion.”
A Blood Test for Concussions
Researchers at the NIH found that the blood protein tau could be an important new clinical bio-marker to better identify athletes who need more recovery time before safely returning to play after a sports related concussion. The study was published online in a January 2017 issue of Neurology.
Tau is also connected to the development of Alzheimer’s and Parkinson’s diseases, and is a marker of neuronal injury following severe traumatic brain injuries.
In the study, led by Dr. Jessica Gill, NIH Lasker Clinical Research Scholar and chief of the NINR Division of Intramural Research’s Brain Injury Unit, researchers evaluated changes in tau following a sports related concussion in male and female collegiate athletes to determine if higher levels of tau relate to longer recovery durations.
Dr. Landers noted that “there are pros and cons about this new test.”
“This test is based on tracking proteins that are normally found in the nervous system and, due to the trauma, are secreted into the blood stream,” he said. “Unfortunately, one in ten people do not have this protein and this will make it difficult for a blood test to definitively determine the existence of a concussion. This is a highly specific test and if this is the only test used, we could miss up to 20 percent of the concussions.”
Dr. Kutz, on the other hand, is excited about the prospects to this new diagnostic tool.
“This is a wonderful development,” he said. “It’s what we in the medical community have been searching for. Up until now, we could certainly undertake observational assessment such as CT scans and MRI tests, but these often fail to show the extent of the damage and they can be very subjective to both the patient and the observer.
“Having a quantifiable, objective tool to assess whether someone has had a brain injury and whether they are still affected by the brain injury is critical to our understanding of when it is safe to allow the patient to resume their normal activities.”
Young Athletes Have Unique Challenges with Concussions
Not all patients who have experienced a concussion recover as quickly as others.
“I’ve noticed that patients 13 years old and younger take longer to recover from a concussion,” Dr. Landers noted. “This may be due to the fact that they have more neural development yet to occur.
“Plus, the head-to-body ratio in younger players also impacts the severity of concussions. If a young football player weighs 100 pounds, his head with a helmet will be about 10 pounds. This means that about 1/10 of his mass is in the head region. When this is combined with a weaker neck found in youngsters, a ‘whiplash’ can occur.
“Parents and coaches must always remind these young athletes to be honest with their trainer, in spite of their enthusiasm to get back in the game,” he concluded.
If you suspect a concussion has occurred with yourself or family member, contact Texas Health Spine & Orthopedic Center at 888-608-4762 or email Jaclyn.McDaniel@thcds.com to set an appointment with Dr. Landers.
*Physicians who are members of the referral program practice independently and are not employees or agents of THSOC.