Sports-related concussions

CENTRAL RESEARCH

Sports-related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. An estimated 3.8 million cases of concussion-related concussions are due to sports and recreational activities each year. In contact sports such as boxing, American football, ice hockey and rugby, this type of injury is common.

This issue has inspired films based on true stories such as Concussion (directed by Peter Landesman) and has now put the NFL’s concussion protocol under heavy scrutiny after quarterback Tua Tagovailoa’s second head and neck injury (Fig. 1) during the Miami Dolphins loss to the Cincinnati Bengals. As a result, the protocol update considers that it is forbidden for a player to return to the game if he is diagnosed with ataxia, an abnormality of balance/stability, motor coordination, or dysfunctional speech, very common in people who have a head injury.

Figure 1. Fencing posture of Tua Tagovailoa after suffering his second injury, associated with head trauma.

Courtesy: https://www.razon.com.mx/deportes/nfl-video-escalofriante-jugador-miami-conmociona-pleno-partido-500328

Increased concussions can lead to subtle behavioral changes, early onset of memory disorders, dementia, or trigger chronic traumatic encephalopathy (Omalu, et al., 2005), which can only be confirmed after post-mortem evaluation. The current diagnosis of CRS begins with subjective clinical evaluations considering symptoms or neuropsychological tests, for example, using the Glasgow Coma Scale (GSC), although some of the lesions are not easily detectable even with routine brain scans such as computed tomography (CT) of the head. Multifaceted and complex presentation of lesions can lead to ill-advised clinical reports and judgments.

There is currently great interest in identifying objective biomarkers that support the diagnosis of CRS. Some of the blood biomarkers that have been used to detect CRS are the ubiquitin carboxyterminal hydrolase L1 protein (UCH-L1) and the glial fibrillar acid protein (GFAP), which are synthesized and secreted from neurological cells to brain injury; these two proteins can be easily evaluated using the Banyan BTI (Brain Trauma Indicator) indicator approved by the FDA’s Advanced Devices Program that allows a Detection within a few hours after suffering a head injury. Other biomarkers that perform similar functions are calcium-binding B protein S100 (S100B) or total tau protein (p-tau), although many of them do not show minor concussions, which do not produce structural changes in the brain (Costandi, 2018).

Other alternatives for detecting CRS have been the creation of patches, helmets, or portable devices such as BrainScope, however, specialists in sports medicine indicate that more effective CRS detection systems are still required and warn that children and adolescents are more likely to suffer concussions and may take longer to recover than adults.

Writing by Claudia Mejía Morales, PhD

Research and Development Analyst at Drox Health Science. Ph.D in Biosystematics, Ecology and Management of Natural and Agricultural Resources, with orientation in Biotic Products; Master in Environmental Sciences, with orientation in Environmental Technology.

Sources:

1. Omalu, B. I., DeKosky, S. T., Minster, R. L., Kamboh, M. I., Hamilton, R. L., & Wecht, C. H. (2005). Chronic traumatic encephalopathy in a National Football League player. Neurosurgery, 57(1), 128-134.

2. Costandi, Mo. 2018. FDA Okays First Concussion Blood Test but Some Experts Are Wary. https://www.scientificamerican.com/article/fda-okays-first-concussion-blood-test-but-some-experts-are-wary/