Dr. Kevin Most: Concussions- Andrew Luck And New Blood Tests
With football starting thought this would be timely, the blood test noted at the bottom is pretty exciting and may be a way to accurately diagnose a concussion in real time
The brain is amazing and what we know about it can be thought of as being amazing as well. However we are finding out we need to understand more about the brain and how it works. We have yet to conquer Alzheimer’s, ALS and many more brain related health issues. We are making advancements however many feel we are too slow or need more work done on the brain.
As we start the football and soccer season the discussion of concussions always arises. Individuals and parents need to be aware of the signs of a concussion and the impact of a concussion on an individual. The long term effects of concussions are being highlighted regularly now as we hear of another NFL player who is suffering from CTE. We should realize that we are not hearing about the college athletes who don’t make it to the pro ranks who suffer from this in silence.
Andrew Luck retiring from football at the age of 29, is he the smart one? Would a parent be disappointed if their child left a dangerous occupation that has proven in many cases to take away a portion of the activity and shortened their lives, one would think not and in fact celebrate with them their choice. Personally I think the fans of the Colts who booed Andrew Luck as he walked off the field as word of his retirement was announced should be embarrassed. Cheering him for his prior activity and decision would have been more appropriate. Is he a smart guy, well with a degree in architecture from Stanford one would have a tough time saying no.
I am not saying Luck retired because of a history of concussions however Luck had suffered from a concussion in 2016. He was placed on concussion protocol, and one would expect that he probably suffered from more than one concussion during his pro career as well as college. In 86 games with the Colts he was sacked 174 times, this does not count the number of hits he received after throwing a pass or after being tackled following a run. I am not saying he retired because of the chance of CTE but I am sure his other injuries got his attention- lacerated kidney and shoulder surgery.
Stories like this allow us to take a moment and discuss concussions. What to look for , what to expect, how to treat and what is new in this world.
A concussion is simply an injury to the brain that results in temporary loss of normal brain function. It is caused by a blow to the head. I Many people assume that in order to have a concussions it must involve a loss of consciousness, but that is not true. In many cases, a person with a concussion never loses consciousness.
People with concussions often cannot remember what happened immediately before or after the injury and may act confused. A concussion can affect memory, judgment, reflexes, speech, balance and muscle coordination.
Even mild concussions should not be taken lightly. Experts emphasize that although some concussions are less serious than others, there is no such thing as a “minor concussion.” In most cases, a single concussion should not cause permanent damage. The importance of removing an individual from a situation where they may receive another concussion after one, cannot be minimized. A second concussion soon after the first one does not have to be very strong for its effects to be permanently disabling.
So how common are concussions? Unfortunately very common. Estimates vary, the Brain Injury Research Institute estimate that in the US alone we are approaching 4 million concussions each year, with the majority related to sports and recreation. We also see concussions with car accidents, slips and falls and in some occupational settings.
So what should we be looking for in individuals with concussions. There are 3 main features that we look for. Inability to maintain a coherent stream of thought, disturbance of awareness and increased distractibility, and the inability to carry out a sequence of movements or thoughts. These features are highlighted with the symptoms we see with individuals who have a concussion.
Symptoms of concussions include
• Prolonged headache
• Vision disturbances
• Nausea or vomiting
• Impaired balance
• Memory loss
• Ringing ears
• Difficulty concentrating
• Sensitivity to light
• Loss of smell or taste
So what do we do when we think someone has a concussion, first is remove them from the situation that gave them the concussion. We do that to prevent a second concussion. The step after that is to seek medical evaluation to make sure this is a concussion and not a more serious injury. After that rest is important and following up with a sports medicine doctor or a neurologist. Both of these physicians will follow a fairly standard protocol. This will include discussing what to do and what to avoid. Most individuals will be told to stay away from computers, TV’s and cell phone use beyond calls. Monitoring the symptoms and improvement will then allow the physician to allow light aerobic exercise, non-contact. The decision to return to contact sports should not be rushed or taken lightly. The athlete may want to return quickly but the long term effects of the concussion as well as the risk of a second concussion must be considered.
In Illinois, each school district must educate coaches, trainers and student athletes about concussions, what to look for and the risk of continued play following a concussion. We know the most important thing is to identify a student athlete who may have suffered a concussion and remove him from the field, but this is not as easy as it sounds. There are tools that can be used by a trainer or a non-medical individual to assess for a concussion. Some of the tools are built specifically for medical professionals to use. An example is the SCAT which has gone thru many changes as it is being perfected. It is now in its 5th rendition. This is a tool that can be used before the season starts, when the athlete is completely healthy, that score is used as a baseline and then compared against following an injury. The importance of knowing what is the individuals “normal” is important to diagnose as well as return to participation.
The increase in the number of studies on brain injuries is growing dramatically, from identification to impact of trauma to the head. This is being done in military, sports and occupational settings and we can expect a lot of information on TBI in the upcoming years.
A new study out last week is showing, that taking hits that don’t cause a concussion may still cause issues with our brain. This study was done at the University of Rochester. What they did was scan the brains of the football team before the season started, and they focused on one specific potion of the brain. The mid brain which controls our eyes and ears, they concluded that if this portion of the brain was damaged that other areas would as well. The players wore special helmets that tracked the intensity and head movement of each hit thru the year. Of the 40 studied, 2 had suffered concussions and they were removed from the study. The other 38 had not sustained a concussion but they had accumulated over 19,000 impacts to the helmets. At the end of the year they rescanned these athletes and looked at the midbrain again, they also looked at the players individually based on the number of impacts they had sustained. What they found was that most of the players had changes in the white matter of the midbrain, even though they did not sustain any concussions thru the year. They found that the midbrain was not as healthy at the end of the year then it was at the beginning of the year.
This study has obviously triggered many questions, like are those changes reversible, will those changes accelerate in future years, are these changes impacting the individual now ( no pre or post study was done on fine movement)
Each of these questions will be evaluated thru more studies.
This past week we heard of ground breaking news on a blood test that Abbott has developed that looks for a protein in the blood that would indicate a concussion had occurred. The test can be completed within 15 minutes and may in the future be the new gold standard for diagnosing a concussion in real time. The blood tests looks for a protein that is released when the brain has been injured. The study released last week in Lancet, was completed in 18 trauma centers in the US and included 450 patients. These patients were thought to have a concussion and had a normal CT scan, blood tests were done and follow up MRI (much more accurate test for concussions) as well. They found that the among the 90 individuals with the highest level of the protein, 64% actually had a TBI when the MRI was completed, they also found that the 90 individuals with the lowest amounts of the protein had only an 8% finding of a TBI. This blood test was done using a hand held portable device that gives the results in minutes. This technology is not yet commercially available in the United States but is being used now in other countries outside the US for many tests.
From a prevention point of view we have continued to see attempts to make equipment safer however no one has food a silver bullet to protect an individual from a concussion. There has been research on helmets, mouth guards and headbands, none of which have panned out in a prevention way. There continues to be equipment that will attempt to identify a player who has received a blow strong enough to cause a concussion. High tech mouth guards appear to be more accurate that helmet monitors as the impact on the mouth guard gives a more accurate picture of the movement of the head.
Prevent IM Mouth guard is one mouth guard that is doing many studies and collecting data on its mouth guard. They are working with the Department of Defense as well as many major universities. Expect to see more data soon on how well this equipment works.
The take home message is that all concussions are serious, identifying and treating the concussion is important for the long term outcomes, there is no silver bullet to prevent concussions and that testing to identifying concussions quickly and accurately may be here soon.