Kadner: Concussion blood test a game changer?
By Phil Kadner email@example.com May 29, 2014 8:16PM
President Barack Obama applauds Victoria Bellucci on Thursday at the White House Healthy Kids & Safe Sports Concussion Summit in Washington, D.C. | AP photo
Updated: July 1, 2014 6:35AM
A new blood test that reportedly can spot concussions in athletes could be “Nobel Prize-type stuff,” according to a neurologist at Christ Medical Center in Oak Lawn.
Swedish researchers, in a report published in the medical journal JAMA Neurology, claim to have found a way to test blood for a protein released from the brain during concussions.
Doctors have known for years that the tau protein can be detected in spinal fluid and at elevated levels in the brains of patients suffering from brain damage.
Tapping spinal fluid to test the level of tau was considered impractical, particularly among athletes who frequently suffer concussions. Detecting elevated levels of tau in the brain required a biopsy, most frequently done in autopsies.
“This discovery of a blood test that can detect increased levels of tau is considered a big deal because it can determine immediately if someone has suffered a concussion,” said Melvin Wichter, chairman of neurology and co-director of the Neurosciences Institute at Christ Medical Center. “It can then allow us to monitor a concussion victim’s progress in response to treatment.
“But the much bigger picture, the Nobel Prize-stuff, are applications in the detection and treatment of Alzheimer’s, dementia and CTE, chronic traumatic encephalopathy, which we’ve all read about regarding former professional football players such as Jim McMahon.
“In my practice, I don’t treat professional football players. But I see 10 cases of dementia a week, 10 Alzheimer’s cases, a number of cases of severe brain injury caused by things like automobile accidents.
“I just think the ramifications of this, if it can be repeated in other tests, are very, very big. I mean huge. And I’ve trying not to go over the top on the hyperbole.”
The researchers in Sweden, in an attempt to find a biomarker for concussions, gathered blood samples and tracked injuries to 288 professional hockey players in the Swedish Hockey League.
Among those, 35 experienced concussion-like symptoms, 28 of them were included in the study, and the researchers conducted blood tests one, 12, 35 and 144 hours after their injury.
The highest levels of the tau protein were reported in the first hour after the concussion and declined over the next several hours but still were elevated days later.
“The study sample, 28 hockey players, is very small, so more studies are going to have to be done before this blood test becomes accepted practice,” said Wichter, who declined to speculate how long that might take.
I asked him what the key to the breakthrough was, and he said tau proteins in the blood stream are measured in picograms, which are 1 trillionth of a gram. The researchers used special equipment that could measure substances that small in the blood.
“The thing you have to realize is that there is really no way right now to objectively determine if someone has suffered a concussion,” Wichter said. “Typically, if I’ve been in an accident, a police officer will ask me how I feel, and if I say I’m dizzy, can’t see right, feel sick to my stomach, he may suspect I have a concussion.
“Those are the sort of questions all of us typically ask patients, but the methodology is all subjective. If this blood test works, we will finally have an objective way of determining if someone has suffered from a concussion, and that is very important.”
But Wichter emphasized that the potential for monitoring treatments of people suffering from brain injuries or ailments may be even more important.
“With this blood test, I could monitor the effectiveness of my treatment of an Alzheimer’s patient or someone suffering from CTE,” he said. “I have no objective standard to measure that right now, except to ask the patient how he’s feeling and a number of questions to determine if there’s been any progress, or no regression, which can mean the treatment is working.
“This blood test, which measures the levels of tau, would tell us if the treatment is actually working because if it is there would be decreased levels of the tau protein in the blood.
“Now, that wasn’t part of this study, it’s just how I see the implications of the importance of this down the road. I am very enthusiastic about the potential here for improved medical care.”
To the patient, the blood test would seem like any other.
The researchers are working for a private company, and their discovery would be patented, meaning the cost potentially could be quite high. And that potential for a financial windfall likely will have other researchers scrutinizing the data closely.
The impact on sports could be dramatic, Wichter speculated.
“It could have a major impact on how we play sports,” he said. “An athlete who sustains a possible concussion would have a simple blood test done. If the result shows an elevated level of tau, he or she stays out of the game” until tau levels return to normal.
For some athletes, those symptoms might vanish in a few days or weeks, but for others the tau level could remain elevated much longer.
“It could mean the end of some careers,” Wichter said.
Many concussions in sports go undiagnosed because the symptoms are so mild or athletes fail to report them.
But if a blood test could be used and it was determined that many more athletes are suffering from brain injuries than previously thought, “it could change how the more violent contact sports like football, hockey, boxing and the martial arts are played,” Wichter said. “High schools, colleges and even professional sports organizations could determine that head injuries are too great a liability.
“But the far more important thing here is that this study is ultimately not about football quarterbacks or hockey players but treating ordinary people suffering from CTE and Alzheimer’s. As you can tell, as a neurologist, I am very enthusiastic about the possibilities.”