Every weekend thousands of kids participate in a multitude of sports ranging anywhere from basketball to field hockey. The outcome of the game is ambiguous, but the occurrence of a head injury is almost guaranteed. When a player gets hit in the head, coaches and parents alike look for obvious signs of a concussion- headache, concussion, dizziness, loss of consciousness, etc. Internal physiological assessment is not the current standard for a concussion diagnosis, but should it be? Are we missing out on crucial indications of brain injury by using physical symptoms as the only standard of diagnosis?
In her recent talk, Dr. Krizman revealed that there are detectable physiological changes-identifiable by frequency-following Response (FFR)- in the brain of an individual who has experienced concussions; thereby suggesting that there are manifestations of a concussion beyond physical symptoms. Dr. Krizman challenged contemporary understanding of concussions, suggesting that even concussions with low reports of physical symptoms may be highly detectable in the brain signature; are we allowing athletes to return to play even when they are still neurologically unsound? More seriously has modern concussion protocol put athletes at higher risk of a traumatic brain injury (TBI)?
Further research conducted by William T. O’Brien and colleagues have revealed venous blood levels of glial fibrillary acidic protein (GFAP) and neurofilament light (NfL)- as candidate biomarkers of concussions. Glial fibrillary acidic protein (GFAP) is a structural protein and component of glial cells. Following injury to the cell, GFAP leaks out and is detectable. Moreover, GFAP is a crucial indicator of astrocyte damage; high levels of GFAP reveal profound trauma to astrocytes. NfL- neurofibrillary light chain- is also a structural protein that resides in axons. It serves as the hallmark sign of axonal damage. William T. O’Brien and colleagues utilized these biological measures to observe athletes with sport related concussions (SRC) at 8 different points for up to 12 weeks.
William T. O’ Brien et.al, found that GFAP levels notably spike in number, 24 hours after a concussion. Some athletes revealed prolonged elevation of GFAP for up to four weeks. Thus, indicating that concussions result in almost an immediate injury to cells, more specifically astrocytes. NfL levels differed temporally as they displayed a delayed onset. NfL levels typically peak between weeks one and four post concussion. A small population of athletes experienced ongoing NfL elevation for up to 12 weeks. These athletes had to wait notably longer to return to play. The researchers further associated loss of consciousness (LOC) with measured NfL and GFAP levels. Moreover, they found that athletes who lost consciousness showed higher elevation of NfL and GFAP.
William T. O’ Brien et.al, identified heightened elevation of physiological biomarkers-GFAP and NfL- in concussed individuals. These biomarkers serve as an indication of traumatic injury to both astrocytes and axons. Their research reveals distinctive neurological changes that should undoubtedly be considered following sport related concussions (SRC).
While Dr. Krizman discussed unique brain signatures identified in an individual who has had concussions, using FRP, William T. O’Brien and colleagues have further found blood-based biological markers- GFAP and NfL- which persist far beyond physical symptoms recovery. Both areas of research indicate that cellular injury remains despite reported physical recovery. Thereby stimulating conversations regarding current concussion protocol and the most effective/safe route of ensuring full recovery for athletes.
References-
Kraus N, Thompson EC, Krizman J, Cook K, White-Schwoch T, LaBella CR. Auditory biological marker of concussion in children. Sci Rep. 2016 Dec 22;6:39009. doi: 10.1038/srep39009. PMID: 28005070; PMCID: PMC5178332.
O’Brien WT, Spitz G, Xie B, et al. Biomarkers of Neurobiologic Recovery in Adults With Sport-Related Concussion. JAMA Netw Open. 2024;7(6):e2415983. doi:10.1001/jamanetworkopen.2024.15983
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