After concussion, biomarkers in the blood may help predict recovery time
July 3, 2019
Science Daily/American Academy of Neurology
A study of high school and college football players suggests that biomarkers in the blood may have potential use in identifying which players are more likely to need a longer recovery time after concussion, according to a study published in the July 3, 2019, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"With so many people sustaining concussions and a sizeable number of them having prolonged symptoms and recovery, any tools we can develop to help determine who would be at greater risk of problems would be very beneficial, so these results are a crucial first step," said study author Timothy B. Meier, PhD, of the Medical College of Wisconsin in Milwaukee and a member of the American Academy of Neurology.
The study involved 41 high school and college football players who experienced a concussion during the season. None of the players lost consciousness with their concussions. The players were matched with 43 football players of the same level, age and position who did not have a concussion during that season.
All of the participants had blood tests at the beginning of the season. Those who had concussions had blood tests within six hours after the injury, then again 24 to 48 hours later and also eight, 15 and 45 days later. Those who did not have concussions had tests at similar times for comparison.
The tests looked at levels of seven biomarkers for inflammation that have been related to more severe brain injury. Of the seven biomarkers, two were elevated for those with concussion at six hours after the injury compared to the athletes with no concussion. The biomarkers interleukin 6 and interleukin 1 receptor antagonist were both elevated at six hours after concussion.
For interleukin 6, levels at the beginning of the study were 0.44 picograms per milliliter (pg/mL) for those who later had concussions and 0.40 pg/mL for those who did not have concussions. At six hours after the injury, those with concussions had levels of 1.01 pg/mL, compared to levels of 0.39 at a similar time for those without concussions.
"These results demonstrate a meaningful increase in the levels of interleukin 6 for athletes who sustained a concussion compared to athletes who did not," said Meier.
Athletes with higher levels of interleukin 6 six hours after the injury were also more likely to take longer to recover from their symptoms. Overall, the athletes with concussions had symptoms for an average of 8.9 days. Eight of the 17 athletes with concussion and high interleukin 6 levels at six hours after injury, compared to their levels at the beginning of the season, still had concussion symptoms eight days after the injury.
"Eventually, these results may help us better understand the relationship between injury and inflammation and potentially lead to new treatments," Meier said.
https://www.sciencedaily.com/releases/2019/07/190703171853.htm
Concussion rates are nearly double what we thought -- and summer is prime injury time
July 2, 2019
Science Daily/University Health Network
A new study has uncovered concussion rates that are nearly double what has previously been recorded, showcasing the need for increased education about concussion and access to more specialized, best-in-practice concussion care.
With concussions seeming more common than ever before, researchers at Toronto Rehabilitation Institute -- University Health Network, set out to answer the question, Are we looking at a true epidemic, or just better recognition?
By embarking on the largest-scale study on concussions ever undertaken in Canada, the researchers discovered that 150,000 of Ontarians (1.2% of province's population) are diagnosed with a concussion each year. That's almost twice as high as previously recorded, and may represent a closer estimate of the true picture of concussion in Ontario.
Their findings were published the Journal of Head Trauma Rehabilitation.
"Past research has looked at the incidence of concussion by examining a particular population; cause of injury; or use a single reporting source, such as records from the Emergency Department. This can under-represent estimates of the real incidence of concussion," says lead author, Laura Langer.
"Our study revealed concussion rates that are almost double what has been previously reported, and highlights the critical importance of looking at everyone who sought medical attention for their concussion."
These more accurate estimates support the importance ongoing awareness around concussion symptoms and management, and the need for more specialized concussion clinics near populations that need them the most.
Video: https://www.youtube.com/watch?v=aJcCd8QINvU&feature=youtu.be
Concussions in Ontario -- who is at risk?
By leveraging the ICES Data Repository -- a province-wide archive that integrates multiple clinical and administrative health databases -- the team captured an unprecedented, comprehensive, view of concussion rates in Ontario between 2008 and 2016.
Here is what they found:
· About 150,000 Ontarians experience a concussion each year
· Children under 5 years old experience the highest rate of concussion among all Ontarians
· Adults over 65 -- especially women -- experience a higher rate of concussion than younger adults
· 26% all of concussions are diagnosed in the summer
· Rural communities experience a higher rate of concussion than non-rural communities
· Though most concussions are diagnosed in the Emergency Department, more and more patients with concussion symptoms are visiting their own doctors
Epidemic or better recognition?
According to the team, the high rate of reported concussions is likely influenced by a number of factors, including increased public awareness from athletes and the media, new mandatory reporting laws, and the release of numerous diagnostic and management guidelines for physicians and patients.
Future directions
Access to the ICES Data Repository presents a unique opportunity for Ontario to be a world leader in concussion care and research.
As patients increasingly look to their own doctors for a diagnosis, the researchers identify a need to continue raising awareness about causes and symptoms, and a growing obligation to educate doctors on concussion care.
Furthermore, since about 1 in 7 Ontarians with a concussion will experience persistent, post-concussive symptoms, it's critical to develop tools to identify who will face long-term problems, so we can individualize early treatments to prevent long-term complications.
The study was funded by, and conducted in collaboration with, Ontario Neurotrauma Foundation. Toronto Rehabilitation Institute is also financially supported by the Toronto Rehab Foundation.
This study made use of de-identified data from the ICES Data Repository, which is managed by ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues.
https://www.sciencedaily.com/releases/2019/07/190702152800.htm
Impact of concussions reduced in children with more years of sport experience
April 4, 2019
Science Daily/York University
More years in sports -- not less -- may help protect the brains of children who have had a concussion, against future concussions, a new study says.
Research from York University's Faculty of Health found that children who have played in a performance sport for at least seven years, and have a history of concussion, recover better from concussions than children who have fewer years in the sport. Their years in the sport may give them more skill-related motor "reserve" that helps them to get back to the level they were playing at previously.
"Our results suggest there's an advantage to staying with skilled activity to the point where your brain can maintain performance even when it's still being affected in subtle ways by a past injury," says senior author, Lauren Sergio, professor in the School of Kinesiology and Health Science and Centre for Vision Research at York University. "This performance may be protective and would reduce vulnerability to another concussion when playing with non-concussed peers."
Sergio and her former postdoctoral student and lead author, Marc Dalecki, now an assistant professor in the School of Kinesiology at Louisiana State University, along with co-author Alison Macpherson, professor in York's School of Kinesiology & Health Science, examined factors that may influence performance recovery after a concussion.
"The findings of this study are important because it demonstrates that athletes with more years of experience return to pre-concussion levels more quickly than inexperienced athletes," says Macpherson. "This can be one factor to help guide decisions about returning athletes to play."
Their study looked at 126 youth, aged eight to 17 years old, 64 with a history of concussion and 62 without, over a two-year period from 2013 to 2015. Participants, parents, team managers, and coaches were interviewed in order to obtain detailed information about the concussion history. All concussion history participants were defined as "asymptomatic" in accordance with current return-to-play protocol guidelines at the time of testing. Participants were asked to perform two visuomotor tasks over 20 trials that required sliding the index finger of the dominant hand along a dual-touch screen laptop, with touch screens in the vertical and horizontal planes.
In the first condition, they moved their hand on the vertical screen in the same direction as the target on the screen. In the second condition, participants had to slide their finger along the horizontal touch screen in the opposite direction of a presented target on the screen. In other words, in order to move the cursor to the left, they had to slide their finger to the right. This type of condition is similar to passing a hockey puck to a teammate on the left while skating to the right.
Researchers found youth with a concussion history with seven or more years of sport experience and higher levels of eye-limb coordination-related sport experience had quicker motor skill recovery times (around 12 months) compared to their peers with less than six years of sport experience (around 30 months or two seasons later). They found no differences in these results when factoring sex or age.
https://www.sciencedaily.com/releases/2019/04/190404104401.htm