Tag: traumatic brain injury

Good Outcomes for Severe Brain Injury Still Possible

Photo by Anna Shvets from Pexels

A new study adds to the growing body of evidence that decisions regarding moderate-to-severe traumatic brain injury (TBI) should not be made too soon after the injury, as a good prognosis can still emerge.

Researchers followed 484 patients with moderate-to-severe TBI and found that among the patients in a vegetative state, one quarter “regained orientation” — awareness of who, when and where they were —  within 12 months of their injury.

“Withdrawal of life-sustaining treatment based on early prediction of poor outcome accounts for most deaths in patients hospitalised with severe TBI,” said senior author Geoffrey Manley, MD, PhD,  noting that 64 of the 92 fatalities in the study occurred within two weeks of injury. Dr Manley is professor and vice chair of neurological surgery at UCSF and chief of neurosurgery at Zuckerberg San Francisco General Hospital.

“TBI is a life-changing event that can produce significant, lasting disability, and there are cases when it is very clear early on that a patient will not recover,” he said. “But results from this study show a significant proportion of our participants experienced major improvements in life functioning, with many regaining independence between two weeks and 12 months after injury.”

The patients in the study were enrolled by the brain injury research initiative TRACK-TBI, of which Dr Manley is the principal investigator. All patients were 17 and older and had presented to hospitals with level 1 trauma centers within 24 hours of injury. Their exams met criteria for either moderate TBI or severe TBI. The causes were falls, assault and primarily crashes involving a motor vehicle.

The patients, whose average ages were 35 in the severe TBI group (78 percent males) and 38 in the moderate TBI group (80 percent males), were assessed using the Glasgow Outcomes Scale Extended (GOSE), which ranges from 1 for death to 8 for “upper good recovery” and resumption of normal life. Impairment was also categorised with the Disability Rating Scale (DRS).

At two weeks post-injury, 93 percent of the severe TBI group and 79 percent of the moderate TBI group had moderate-to-severe disability, according to the DRS, and 80 percent had GOSE scores from 2 to 3, meaning they required assistance in basic everyday functioning.

But by 12 months, half of the severe TBI group and three-quarters of the moderate TBI group had GOSE scores of at least 4, indicating they could function independently at home for at least eight hours per day. Moreover, 19 percent of the severe TBI group had no disability, according to the DRS, and a further 14 percent had only mild injury, the researchers noted.

Most surprising were the findings for the 62 surviving patients who had been in a vegetative state. By the 12-month mark all patients had recovered consciousness and 1 in 4 had regained orientation. All but one survivor in this group recovered at least basic communication ability.

“These patients made the cut for favorable outcome,” said co-first author, Joseph Giacino, PhD, of Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Harvard Medical School. “Their GOSE scores were 4 or higher, which meant they could be at home unsupervised for at least eight hours a day, since they were able to take care of basic needs, such as eating and toileting.”

In prior work, a significant percentage of patients with grave impairments had been shown to achieve favorable functionality after many months or years. This study coincided with the recommendation in 2018 from the American Academy of Neurology that in the first 28 days after injury, clinicians should refrain from telling families that a patient’s prognosis is beyond hope.

“While a substantial proportion of patients die or suffer lasting disability, our study adds to growing evidence that severe acute impairment does not portend uniformly poor long-term outcome,” said Manley, who is also affiliated with the UCSF Weill Institute for Neurosciences. “Even those patients in a vegetative state – an outcome viewed as dire – may improve, since this is a dynamic condition that evolves over the first year.”

Source: University of California, San Francisco

Journal information:JAMA Neurology (2021). DOI: 10.1001/jamaneurol.2021.2043

CT Scans Improve Outcomes for Concussion Patients

Photo by MART PRODUCTION from Pexels

A study found that CT scans for concussion patients provide crucial information on their risk for long-term impairment and their potential to make a complete recovery, and points to the need for more follow-up.

In the UC San Francisco-led study, researchers examined CT scans of 1935 patients, aged 17 and over, whose neurological exams met criteria for concussion, or mild traumatic brain injury (TBI). Outcomes for moderate and severe TBI have been linked to CT imaging features, but this may be the first time this link has been identified in patients with concussion. This contradicts previous research which had found no prognostic significance of specific types of CT abnormalities.

“Radiologists who routinely read trauma scans know intuitively that patterns of intracranial injury on CT are not random,” said first author Esther Yuh, MD, PhD, of the UCSF Department of Radiology and Biomedical Imaging. “We showed there are patterns of injury, that some of these are associated with worse outcome than others, and that they provide a window into mechanisms of injury that is reproducible across large studies.”

The study was published online in JAMA Neurology.

“Although concussions are referred to as mild traumatic brain injuries, there is nothing mild about some concussions,” explained senior author Geoffrey Manley, MD, PhD, professor and vice chair of neurological surgery at UCSF and chief of neurosurgery at Zuckerberg San Francisco General Hospital. “Patients with concussion may suffer from prolonged headache, poor sleep and impaired concentration, and they are at higher risk of self-medicating with drugs and alcohol. Concussion can also contribute to depression and anxiety, and increase the risk for suicide. We need to view concussion not as an event but as a disease requiring physician follow-up after a patient is discharged from the hospital.”

The participants were enrolled by the brain injury research initiative TRACK-TBI, of which Manley is the principal investigator. To enrich the number of so-called complicated concussions, the researchers drew exclusively from patients who had been seen at hospitals with level 1 trauma centres. This meant 37 percent of study participants had a positive CT, significantly more than the 9 percent of positive CTs from patients in US emergency departments.

The most common patterns of injury, affecting more than half of CT-positive patients, were combinations of subarachnoid haemorrhage (SAH), subdural haematoma (SDH), and/or contusion, which may be caused by injuries such as falls from standing. About 7 percent had intraventricular haemorrhage (IVH) or petechial haemorrhage, caused by head rotation as in some sporting, scooter and automobile accidents; and 5 percent had epidural haematoma (EDH), often seen in sports injuries such as being hit with a baseball.

Average age of the patients was 41 and 66 percent were male. They were followed-up at two weeks, and at three-, six- and 12 months following injury. Patients in the SAH/SDH/contusion group failed to make a complete recovery at 12 months post-injury and had a range of outcome impairments, from mild to more severe.

Patients in the IVH/petechial haemorrhage group tended toward more severe impairments, in the lower-moderate disability range, a level potentially affecting multiple areas of function, such as employment, social and leisure activities, up to 12 months post-injury. Patients with EDH fared significantly better and demonstrated complete recovery by their six-month assessment.

Results from CENTER-TBI, a parallel brain injury research group that had enrolled 2594 participants at European trauma centres. validated the findings. “The confirmation of the findings in an independent cohort confirms the fidelity of our results,” said Manley, adding that patients with EDH were one exception, with incomplete recovery lingering for months longer than those patients followed by TRACK-TBI. However, more severe outcomes were not seen at any point in either study.

The researchers noted that even among concussion patients with positive CT scans, only 39 percent get follow-up care, which should be routine. They also cautioned that their findings are not a call for increased CT use, which has radiation dose concerns and is restricted to known or suspected concussions.

Indeed, a recently approved rapid hand-held blood test may reduce the amount of CT scans. Manley found this test was more sensitive than CT in detecting concussion. The blood test measures biomarkers associated with TBI, which were nearly 52 times higher in MRI-identified concussion patients than in healthy participants.

In addition to challenging the belief that CT features in concussion are not relevant, the researchers are also challenging the idea that concussion is “what the patient brings to the injury,” said Manley, who is also affiliated with the UCSF Weill Institute for Neurosciences. “In moderate and severe TBI, it is anecdotally taught that outcome is determined by ‘what the injury brings to the patient,’ while concussion is determined by baseline characteristics like age, sex and years of education. While the study confirms the importance of these characteristics, we show that in some concussion cases, poor outcomes are also attributed to ‘what the injury brings to the patient.'”

Source: University of California, San Francisco

Journal information: Yuh EL et al., Pathological computed tomography features associated with adverse outcomes after mild traumatic brain injury, JAMA Neurology, July 19, 2021.

Treating Brain Injuries with Sex-specific Interventions

New research has identified a sex-specific window of opportunity to treat traumatic brain injuries (TBIs), which scientists are exploiting in a project to create a sex-targeted drug delivery for TBI.

The study, a collaboration of The University of Texas Health Science Center at Houston (UTHealth) and Arizona State University will be used to help design nanoparticle delivery systems targeting both sexes for treatment of TBI.

“Under normal circumstances, most drugs, even when encapsulated within nanoparticles, do not reach the brain at an effective concentration due to the presence of the blood-brain barrier. However, after a TBI this barrier is compromised, allowing us a window of opportunity to deliver those drugs to the brain where they can have a better chance of exerting a therapeutic effect,” said Rachael Sirianni, PhD, associate professor of neurosurgery at McGovern Medical School at UTHealth. Dr Sirianni’s collaborator and co-lead investigator on this grant, Sarah Stabenfeldt, PhD, was the first to demonstrate that the window of opportunity created in the blood-brain barrier differed between men and women, and it was this key finding that led them to apply for funding.

TBI results from blows to the head, and in the most severe form of TBI, the entirety of the brain is affected by a diffuse type of injury and swelling. The body responds with an acute response to the injury, followed by a chronic phase as it tries to heal.

“In this second phase, a variety of abnormal processes create additional injury that go well beyond the original physical damage to the brain,” Dr Sirianni said.

Normally, the blood vessels maintain a very carefully controlled blood-brain barrier to prevent the entry of harmful substances. However, during this second phase of healing following a TBI, those blood vessels are compromised, possibly allowing substances to seep in.

One of the numerous differences between female and male patients is varying levels and cycles of sex hormones such as oestrogen, progesterone, and testosterone. While these levels already differ in healthy people, additional hormone disruption for both sexes can result from a brain injury.

Dr Sirianni explained that this work is extremely important as presently TBIs have no effective treatment options. Current treatments for TBI vary widely based on injury severity and range from daily cognitive therapy sessions to radical surgery such as bilateral decompressive craniectomies. 

“The goal of this research is to develop different nanoparticle delivery systems that can target the unique physiological state of males versus females following a TBI. Through this research, we hope to develop an optimum distribution system for these drugs to be delivered to the brain and can hopefully find an effective treatment plan for TBIs,” Sirianni said.

Drugs that previously perceived as unsafe or ineffective when given systemically can instead be targeted directly to the injury microenvironment through nanoparticle delivery systems.

“With these nanoparticle systems, we’re looking at how we can revisit a drug that showed promise in preclinical studies or clinical trials but then failed,” Stabenfeldt said.

Source: The University of Texas Health Science Center at Houston

White Matter Changes Uncovered in Repeated Brain Injury

Photo by MART PRODUCTION from Pexels

A new study has uncovered insights into white matter changes that occur during chronic traumatic encephalopathy (CTE), a progressive brain disease associated with repetitive head impacts. This discovery may help in identifying new targets for therapies.

CTE been diagnosed after death in the brains of American football players and other contact sport athletes as well as members of the armed services. The disease has been identified as causing impulsivity, explosivity, depression, memory impairment and executive dysfunction.

Though much prior research focused on repetitive head trauma leading to the development of abnormal tau, this study focused on white matter changes, particularly the oligodendrocytes which myelinate nerve sheaths. The results have been published online [PDF] in the journal Acta Neuropathologica.

“Research to date has focused on the deposition of abnormal tau in the gray matter in CTE. This study shows that the white matter undergoes important alterations as well.  There is loss of oligodendrocytes and alteration of oligodendrocyte subtypes in CTE that might provide new targets for prevention and therapies,” explained corresponding author Ann McKee, MD, chief of neuropathology at VA Boston Healthcare, director of the BU CTE Center.

Dr McKee and her team isolated cellular nuclei from the postmortem dorsolateral frontal white matter in eight cases of CTE and eight matched controls. They conducted single-nucleus RNA-seq (snRNA-seq) with these nuclei, revealing transcriptomic, cell-type-specific differences between the CTE and control cases. In doing so, they discovered that the white matter in CTE had fewer oligodendrocytes and the oligodendroglial subtypes were altered compared to control tissue.

Since previous studies have largely focused on the CTE-specific tau lesion located in the cortex in the brain, these findings are particularly informative as they explain a number of features of the disease. “In comparison, the cellular death process occurring in white matter oligodendrocytes in CTE appears to be separate from the accumulation of hyperphosphorylated tau,” she said. “We know that the behavioural and mood changes that occur in CTE are not explained by tau deposition. This study suggests that white matter alterations are also important features of the disease, and future studies will determine whether these white matter changes play a role in the production of behavioral or mood symptoms in CTE, such as explosivity, violence, impulsivity, and depression.”

Source: Boston University School of Medicine

Journal information: Chancellor, K. B., et al. (2021) Altered oligodendroglia and astroglia in chronic traumatic Encephalopathy. Acta Neuropathologica. doi.org/10.1007/s00401-021-02322-2.

Head Injuries Widespread Among Female Prisoners

Photo by RODNAE Productions from Pexels

New research has found that 78% of women prisoners in Scotland have a history of significant head injury – most of which occurred in the context of years of domestic abuse.

The University of Glasgow-led study also found 66% of women prisoners had suffered repeat head injuries for many years. The majority of the study participants were from the most deprived 20% of the population. One US study of male prisoners found 63.7% of at least one traumatic brain injury, and 32.5% had experienced multiple such injuries.

Of those with a history of head injury, the most common cause (89%) of repeat head injury was domestic violence. Only five women had experienced a single incident of moderate-severe head injury. Of those with a history of significant head injury, a first head injury before the age of 15 was reported by 69% of women.

For the study, researchers interviewed around a quarter of women in Scottish prisons, 109 women in total, between 2018 and 2019. They were assessed for a history of head injury, including its causes, a history of abuse, as well as for disability and mental and physical health conditions.

Of the 78% with a history of significant head injury, 40% also had an associated disability. Previous research has reported that many women in prison have a history of head injury, but none looked at disability.

Those with a history of significant head injury were three times more likely to have violent criminal behaviour, and also spent three times longer in prison.

Nearly all participants (95%) reported a history of abuse, with over half reporting sexual abuse in childhood and 46% reporting sexual abuse in adulthood. Physical abuse in childhood was reported by 39%, while 81% of participants reported physical abuse in adulthood.

Alcohol or drug misuse history was common, with substantially higher rates in the group who reported significant head injuries. Almost all, 92%, complained of mental health difficulties, with anxiety and depression the most commonly reported. Although the participants had 12 years of education on average, schooling was often disrupted by exclusion or truanting and many required special schooling or support.

Professor Tom McMillan, Professor of Clinical Neuropsychology at the University of Glasgow and lead author of the study, said: “It is already recognised that women in prison are vulnerable because of histories of abuse and substance misuse. However, this research shows that a history of significant head injury is also a vulnerability and needs to be included when considering mental health needs and in developing criminal justice policy given the relationships with associated disabilities, abuse and violent crime’’.

“Our findings suggest that interventions to reduce mental health morbidity, and assessment and management of risk of violent offending should include history of significant head injury. There is a need to recognise these vulnerabilities at an early stage, including at the first contact with the criminal justice system, to assess these women and provide long term support.”

Common persistent effects of significant head injury include impairments in information processing and emotional changes associated with impulsivity, irritability and egocentricity. These effects can impair judgement and self-control, increase the risk of offending. Significant head injury can also impair the maturation of the developing brain if occurring before adulthood.

The characteristics of significant head injury in women in prison differ from women with significant head injury in the general population. Domestic violence was the most common cause of these injuries in women in prison, whereas  in the general population falls are most common. In addition head injury occurred repeatedly in around two-thirds of women in prison with significant head injury, whereas single incident head injury from an accident is more common in the general population.

Source: University of Glasgow

Journal information: Tom M McMillan et al. Associations between significant head injury and persisting disability and violent crime in women in prison in Scotland, UK: a cross-sectional study, The Lancet Psychiatry (2021). DOI: 10.1016/S2215-0366(21)00082-1

Girls at Almost Double The Risk of Concussion in American Football

In high school American football, girls are at nearly double the risk of concussion compared to boys, according to a new study. Girls are also less likely to be removed from play and take longer to recover from the injury than their male counterparts.

Researchers at the University of Pennsylvania and Michigan State University along with Prof Willie Stewart, Honorary Professor at the University of Glasgow reviewed three years of injury data for a population of around 40 000 female high school American footballers in the Michigan High School Athletic Association, comparing them to a similar number of their male counterparts.

They found that, as seen in previous studies, the risk of sports related concussion among female footballers was 1.88 times higher than among males. The researchers also identified several sex-associated differences in sports concussion mechanism and management. This provides new insight into this kind of injury in this demographic. 

Male footballers tended to be injured in collisions with another player and were 1.5 times more likely than females to be removed from play on the day of injury. Female footballers were most often injured from impacts involving equipment, such as the ball or a goalpost, and also took on two days longer on average to recover from injury and return to play. A recent study however showed no differences for concussion recovery time among male and female college athletes, but there could be differences depending on the type of sport.

These sex-associated differences among teenage athletes in mechanism of injury and in management and outcomes of concussion raise the question of whether sports should consider the adoption of sex specific approaches to both participation and concussion management.

Lead author Dr Abigail Bretzin, postdoctoral fellow and certified athletic trainer at the University of Pennsylvania, said: “This is the first study to look in this detail at sex-associated differences in concussion management and outcomes in teenage footballers. Our findings add to research showing that female athletes are at increased concussion risk compared to male athletes, and highlight the importance of sex-specific research in this field.”

Senior author Prof Stewart, said: “Given we know the importance of immediate removal from play for any athlete with suspected concussion, it is notable that “if in doubt, sit them out” appears more likely to happen for boys than girls. This, together with the finding that mechanism of injury appears different between boys and girls, suggests that there might be value in sex-specific approaches to concussion education and management in this age group.”

Source: Medical Xpress

Journal information: Abigail C. Bretzin et al. Association of Sex With Adolescent Soccer Concussion Incidence and Characteristics, JAMA Network Open (2021). DOI: 10.1001/jamanetworkopen.2021.8191

Brain Glue Heals Neural Damage from Brain Injuries

In a new study, researchers at the University of Georgia’s (UGA) Regenerative Biosciences Center have shown that the “brain glue” they developed protects against loss of brain tissue after a severe injury, and may also help in functional neural repair.

Significant traumatic brain injury (TBI) commonly results in extensive tissue loss and long-term disability, with no clinical treatments available to prevent this.

The new finding is the first to provide visual and functional evidence of the repair of brain neural circuits involved in reach-to-grasp movement in brain glue-implanted animals following severe TBI.

“Our work provides a holistic view of what’s going on in the recovery of the damaged region while the animal is accomplishing a specific reach-and-grasp task,” said lead investigator Lohitash Karumbaiah, an associate professor in the University of Georgia’s College of Agricultural and Environmental Sciences.

The brain glue developed by Prof Karumbaiah was designed to mimic the meshwork of sugars supporting brain cells. The hydrogel contains key structures that bind to two protective protein factors that can enhance the survival and regrowth of brain cells after severe TBI: basic fibroblast growth factor and brain-derived neurotrophic factor.

In previous research, Prof Karumbaiah and his team demonstrated that the brain glue conferred significant protection to brain tissue from severe TBI damage. In order to tap the neuroprotective capability of the original, they changed the delivery surface of protective factors to help accelerate the regeneration and functional activity of brain cells.

“Animal subjects that were implanted with the brain glue actually showed repair of severely damaged tissue of the brain,” said Karumbaiah. “The animals also elicited a quicker recovery time compared to subjects without these materials.”

The team used a tissue-cleaning method to make the brain less opaque, allowing them to 3-D image the cells’ response in the reach-to-grasp circuit, which is similar in rats and humans.

“Because of the tissue-clearing method, we were able to obtain a deeper view of the complex circuitry and recovery supported by brain glue,” said Prof Karumbaiah. “Using these methods along with conventional electrophysiological recordings, we were able to validate that brain glue supported the regeneration of functional neurons in the lesion cavity.”

“Doing the behavioral studies, the animal work and the molecular work sometimes takes a village,” said Karumbaiah. “This research involved a whole cross-section of RBC undergraduate and graduate students, as well as faculty members from both UGA and Duke University.”

Source: Medical Xpress

Journal information: Charles-Francois V. Latchoumane et al. Engineered glycomaterial implants orchestrate large-scale functional repair of brain tissue chronically after severe traumatic brain injury, Science Advances (2021). DOI: 10.1126/sciadv.abe0207

New Test Picks up Concussion Biomarkers in Saliva

A new test has been found to effectively pick up concussion biomarkers in the saliva of rugby players.

This paves the way for a non-invasive, easy-to-use pitch-side test to rapidly detect concussions for early treatment. Concussion is a serious problem in contact sports, with players such as college American Football athletes consistently underestimating its risk. Missing a concussion can have a range of consequences, from delayed recovery to more serious (albeit rare) injuries such as traumatic brain swelling.

Detecting concussions requires an assessment by a clinician of the signs and symptoms of the injury. However, recent advances in DNA sequencing technology have made it possible to use small non-coding RNAs (sncRNAs) as biomarkers in rapid tests. sncRNAs regulate the expression of different cellular proteins associated with various diseases, such as cancer and Alzheimer’s disease.

t is thought that since saliva can receive cellular signals directly from the cranial nerves in the mouth and throat, biomarkers from a brain injury would quickly show up.

A panel of 14 sncRNAs differentiated concussed players from those where traumatic brain injury had been suspected but ruled out, and from the comparison group, both straight after the game and 36–48 hours later.

Over two seasons, samples were collected before the rugby season began from 1028 players from the two elite professional tiers, and during standardised ‘gold standard’ head injury assessments at three time points—during the game, afterwards, and 36–48 hours later from 156 of these players .

The researchers also took saliva samples from a comparison group of 102 uninjured players, as well as 66 with muscle or joint injuries, and so had not had head injury assessments.

However, the researchers stressed that the observational study nature and design of this study cannot show that the biomarker test is any better than a gold standard clinical test for concussion.

“In community sport, [sncRNAs] may provide a non-invasive diagnostic test that is comparable in accuracy to the level of assessment available in a professional sport setting,” while the test could be added to current head injury evaluation protocols at the elite level,” they add.

And as the biology of concussion is still not fully understood, sncRNAs might help to shed light on the response to injury as this evolves over time, they suggest.

“The detection of signatures of concussion at early time points in saliva (a non-invasively sampled biofluid) presents both at the pitch side, and in primary care and emergency medicine departments, an opportunity to develop a new and objective diagnostic tool for this common clinical presentation,” they conclude.

As an addendum to their findings, they added: “A patented salivary concussion test is in the process of being commercialized as an over-the-counter test for elite male athletes.

“Meanwhile our research team aims to collect further samples from players in two elite men’s rugby competitions to provide additional data to expand the test and develop its use. This will guide the prognosis and safe return to play after concussion and further establish how the test will work alongside the head injury assessment process.”

The researchers plan to add more participants to the SCRUM study, such as female athletes and community players.
Source: Medical Xpress

Journal information: Valentina Di Pietro et al. Unique diagnostic signatures of concussion in the saliva of male athletes: the Study of Concussion in Rugby Union through MicroRNAs (SCRUM), British Journal of Sports Medicine (2021). DOI: 10.1136/bjsports-2020-103274

Plasma microRNAs as Biomarkers for Mild Brain Injury

Plasma microRNA could serve as biomarkers for the detection and diagnosis of mild traumatic brain injury, a recent study from the University of Eastern Finland (UEF) has found.

Mild traumatic brain injury is extremely difficult to detect as it is almost invisible to most imaging techniques, and visible signs in daily life may be masked by compensation for increased task difficulty.

Blood biomarkers can satisfy the demand for timely, accurate, easily accessible and affordable tests for mild traumatic brain injury. They are minimally invasive and can provide molecular information about the injury on an ongoing basis.

MicroRNAs (miRNAs) are non-coding sections of RNA that play a key role in gene expression. The researchers sequenced DNA in blood plasma taken from animal models subjected to mild and severe traumatic brain injury. They selected the miRNAs which showed the greatest potential for use as biomarkers for further analysis with polymerase chain reaction (PCR). They wanted biomarkers that were both sensitive and specific to traumatic brain injury in an animal model.

Dr Noora Puhakka, A. Virtanen Institute for Molecular Sciences, UEF, said, “We have been developing a suitable analysis and measurement method especially for miRNAs that can be found in small amounts in plasma, and this method is based on digital droplet PCR.

“Humans and animals share many identical miRNAs, and this makes them excellent candidates for translational studies, where results achieved in animal models are sought to be applied in humans. However, it has proven challenging to reproduce results from different studies and different sets of data. This is why assessing the quality of measurement methods, and reproducibility, is an extremely important part of biomarker research.”
The study a pair of possible biomarker candidates to diagnose mild traumatic brain injury both in the animal model and in human patients.  

“We found two interesting biomarkers in the animal model, the plasma miRNAs miR-9a-3p and miR-136-3p, which we then decided to analyse in blood samples taken from patients with traumatic brain injury. Elevated levels of these biomarkers allowed us to identify some of the patients who had experienced a mild traumatic brain injury,” Dr Puhakka explained.

“Both of these miRNAs are more abundant in the brain than in other tissues, and their elevated levels in plasma could possibly be due to brain injury and the level of its seriousness. However, further research in larger patient cohorts is still needed.”

Source: News-Medical.Net

Journal information: Gupta, S. D., et al. (2021) Plasma miR-9-3p and miR-136-3p as Potential Novel Diagnostic Biomarkers for Experimental and Human Mild Traumatic Brain Injury. International Journal of Molecular Sciences. doi.org/10.3390/ijms22041563.

Young Athletes’ Recovery Helped by New Concussion Guidelines

A study has found that the adoption of new concussion guidelines, which emphasises a more active form of rest, reduced the duration of symptoms among athletes aged 11 to 18.

Concussions are the most common form of traumatic brain injury, often occurring either as a direct result of a blow to the head, or from forces experienced by the body that impart an acceleration to the head. Symptoms include mood changes, cognitive changes, sensory phenomena such as headaches or dizziness, and changes in sleep pattern.

The researchers compared medical records from 2016-18, which used the newer guidelines, to a set from 2011-13, which used the older guidelines.

Lead researcher John Neidecker, DO, and Sports Concussion Specialist, explained: “The most significant change in care involved a shift from strict rest or cocoon therapy to a return to low-intensity physical or cognitive activity after 24 to 48 hours. Our results show active rest dramatically improved recovery times among young athletes with first-time concussions.”

Active rest involves light activity that steadily increases under supervision, with minimal head movement.

“If diagnosis of a pre-existing condition has never been given, patients cannot be expected to report one during our concussion assessment,” said Dr. Neidecker. “This is especially true in the adolescent age group, as some may have a condition that they are not aware of yet. This makes screening for preexisting conditions more complex, yet even more essential for this age group.”

For example, intolerance to 3D movies could indicate an unrelated pre-existing condition. Information from parents about preinjury personality and behaviour could uncover anxiety.

“This more individualised, osteopathic approach in screening the athletes’ past medical history helped us identify health issues that may have been overlooked in the past,” said Dr Neidecker. This allows treatment to be more effectively tailored, he explained.

Knowledge about concussions has improved; in the 2011-13 dataset, the counselling given was more cautious and ominous, Dr Neidecker noted. Adequate communication and a positive outlook may have helped reduce reported symptoms, and may be essential for patients with anxiety. 

Source: News-Medical.Net


Journal information:
 Neidecker, J. M., et al. (2021) First-time sports-related concussion recovery revisited: management changes and impact on recovery. Journal of Osteopathic Medicine. doi.org/10.1515/jom-2020-0106.