Head injuries have been part of contact sports since the inception of contact sports. I imagine the average gladiator became wobbly after a few trips to the Coliseum.
Yet the NFL head injury settlement of $765 million caught many by surprise, and seemed almost sacrilege to the average fan.
The Afghanistan and Iraq wars gave us another lesson in head injuries. Previous wars had taught doctors the care of high velocity wounds (gunshots, shrapnel). These wars were different, an out-gunned, out-manned and out-trained enemy had to make do and improvise.They invented the improvised explosive device (IED). This created a fundamental change in war injuries. Previously, injuries were primarily explosively driven projectiles. But IEDs were often explosions that lacked projectiles or our armor stopped the projectile. So the result was a pure concussive injury.
Concussions were the focus during a day-long White House summit in late May. President Obama was among the many speakers at the event, which was attended by researchers, parents, coaches, professional athletes and sportscasters.
The hope is the White House gathering will shine a spotlight on the need for more research on how to identify, respond and prevent brain injuries in children while still promoting the value of team sports.
Concussions have been more than a little difficult to diagnose, treat and give patients good prognostic information. Our most powerful tools to diagnose head injuries – MRIs and CTs – come back looking normal, even in a serious concussion. The problem is, it’s a cellular injury, an injury that is below the resolution of every imaging test we currently employ.
With concussions we are almost at the level of 18th century practitioner (leaches, anyone?). We rub our chins thoughtfully and give sage advice based on someone’s guess at how many minutes the patient was knocked out, or how they looked when they woke up:
We tell patients to “take it easy and try hard to avoid another concussion.” Sometimes it works out, and sometimes everybody is tragically surprised by significant long-term neurological problems.Now, thanks to some research just released, we have a good idea of how to finally bring concussion treatment into the 21st century.
Cellular disease is no mystery to us. We often do blood testing to identify a medical problem. Damaged heart muscles leak specific proteins (CPK) that we use to differentiate heart damage (heart attack) from heart pain (angina). Liver cells leak enzymes (SGOT, SGPT) when inflamed by hepatitis even though liver scans look pretty normal.
Now we may have a way to identify injured nerve cells resulting from an injured brain.
You may have heard of Tau proteins. They have been discussed in Alzheimer’s disease research for the last 30 years. They are proteins common only to nerve cells, and are defective in Alzheimer’s disease. In case you’re interested, Tau proteins help stabilize the nerve tube structure.
The fact that nerve cells leak Tau proteins when injured is the breakthrough. Using Swedish hockey players, researchers studied significant concussions and found a reliable rise in Tau protein in the blood after serious concussive head injury.
They used hockey players suffering all manner of injuries other than head, as controls. The test seems to accurately predict a serious concussion from a non-serious one. People with post-head injury elevations in blood Tau protein, have long-term trouble as a result of the concussion.
Why is this exciting? Because it should lead to better treatment of people with serous concussions.
You see medicine runs on trial and error. To study anything medically, you need to start with a group of individuals with the same problem.
That wasn’t possible when studying concussions, because they all look the same, early on. Now researchers can study groups of similarly severe concussions and figure out what interventions best work to limit long-term complications.
It’s certainly a promising time ahead for the treatment of concussions. I wonder what will happen first; a change in the game of professional football to eliminate concussions or a sideline instant blood test for Tau protein that will let the coach know who is relatively safe to send back in?
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.
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