New concussion test keeps athletes safe

About 400,000 high school and college athletes suffer a concussion each year. It may not come as a surprise to hear that football players are the athletes who most at risk for concussions. What you may not know is that a player can get hit hard, not get a concussion and still put their brain at risk.

But a new test could help coaches decide within seconds whether a player needs to sit out or not – even if they don’t have a concussion.

Baldwin College senior Zach Barley has seen his fair share of hard hits over the years.
“Hundreds, thousands maybe – a lot!” said Barley.
He was once pulled from a game after suffering a concussion. But it doesn’t take a blow like that one to damage a player’s brain. Brain damage can also come from what is called a “sub-concussive” hit.

Cleveland Clinic and the University of Rochester teamed up to develop a blood test taken before, during and after a game to find out if those hits can damage the blood brain barrier. This barrier is the lining of each blood vessel in the brain which prevents harmful molecules from getting in. When a player is hit hard, that barrier is breached.

"The blood test is based on a molecule called S100B, which is present primarily in the brain and is normally not present in the blood,” said Dr. Damir Janigro, director in cerebrovascular research at the Lerner Research Institute. “When the barrier breaches, these molecules show up in the blood."

Then the immune system attacks.

"The body believes there is a pathogen, or bacteria, or a fungus, or some enemy to fight," said Janigro.

This can affecting brain tissue, similar to what happens with Alzheimer’s patients.

Right now, Barley’s brain is intact and he likes it that way.

“I'm not willing to risk my life over playing a game," he said.

This new test could mean he and other players won’t have to.

Before, doctors used MRI to see damage from a concussion or sub-concussion but it is not as sensitive as the blood test.

Researchers hope to continue developing the blood test and one day have it used on the sidelines of every game.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY

TOPIC: NEW CONCUSSION TEST KEEPS ATHLETES SAFE
REPORT: MB # 3641

BACKGROUND: A concussion is a traumatic brain injury that alters mental status and causes other symptoms. Many people assume that they do not have a concussion if they have not lost consciousness, but significant injury can occur without losing consciousness at all. When a concussion is suspected, a certified athletic trainer, a trained coach, or the team physician should immediately perform an initial "sideline" evaluation, which includes: symptoms list review, focused orientation exam that tests short-term memory recall like the event or play, focused neurological exam, assessment of athlete's ability to stay attentive to a complex task like reciting months backwards, and focused orientation exam that tests long term recall like their birth date. If a concussion is left undiagnosed, a concussion could place an athlete at risk of developing second impact syndrome. (Source: http://www.stopsportsinjuries.org/concussion.aspx)

SYMPTOMS: Concussion symptoms can include: balance problems, irritability, headache, difficulty communicating, dizziness, drowsiness, fatigue, feeling emotional, feeling mentally foggy, memory difficulties, nausea, nervousness, numbness or tingling, sadness, sensitivity to light or noise, sleeping more than usual or difficulty falling asleep, visual problems - blurry or double vision, and vomiting. (Source: http://www.stopsportsinjuries.org/concussion.aspx)

NEW TECHNOLOGY: Concussions are the leading cause of brain damage in sports, especially football. However, researchers at Cleveland Clinic and the University of Rochester found that football players suffer long-term brain changes even in the absence of concussion. In a study of 67 college football players, researchers discovered that the more hits to the head a player had, the higher the levels of a particular brain protein that is known to leak into the bloodstream after a head injury. None of the football players in the study had a concussion during the season, but four of them showed signs of an autoimmune response that has been associated with brain disorders. "Much attention is being paid to concussions among football players and the big hits that cause them, but this research shows that more common, 'sub-concussive' hits appear to cause damage too," Damir Janigro, PhD, Director of Cerebrovascular Research in Cleveland Clinic's Lerner Research Institute and study leader, was quoted as saying. The study used several methods to assess brain injury, like brain scans, blood tests, and tests to measure memory, motor control, reaction time, impulse control and balance, in addition to extensive review of game video to assess head hits among the players in the study. For the blood test, researchers drew blood from football players at Baldwin Wallace University, John Carroll University, and the University of Rochester before and after games, so that they could search for the S100B protein in the blood. Usually S100B is found in the brain, finding S100B in the blood means that there has been damage to the blood-brain barrier. Studies in Janigro's lab revealed that once in the bloodstream, S100B is seen by the immune system as a foreign invader, triggering an autoimmune response that releases auto-antibodies against S100B. Four players out of the 27 for whom pre-season S100B blood levels were measured, showed signs of an autoimmune response to S100B. Concussions can be difficult to diagnose, relying on player symptoms, cognitive tests or CT scans that cost thousands of dollars. The blood test offers an objective measure of whether a player has endured head trauma. A blood test will be much less expensive (about $40) and could be performed anywhere, such as locker rooms or doctors' offices. (Source: www.clevelandclinic.org)

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FOR MORE INFORMATION, PLEASE CONTACT:

Andrea Pacetti
Cleveland Clinic
(216) 316-3040
PACETTA@ccf.org


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