Current Concussion Protocols

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Clarifi mTBI, concussion saliva test

You were just in a car accident, and although there are no signs of physical injury, you could have a concussion. It is extremely common to have a concussion after you’ve experienced whiplash. When your neck and head move in a rapid motion it can cause your brain to jolt and impact the inside of your skull causing a mild traumatic brain injury (mTBI) otherwise known as a concussion. 

There may be immediate signs or symptoms of concussion such as temporary loss of consciousness, dizziness, headache, confusion, slurred speech, or nausea.   If you are experiencing any of these symptoms you should seek immediate medical attention.  Based on your symptoms (immediate or delayed) and the circumstances surrounding the suspected mTBI, your doctor can typically diagnose a concussion accurately based on standard guidelines set forth by the CDC. 

These guidelines include a series of assessments that may include: 

  • Symptom scales to review the severity of symptoms associated with mTBI

  • Vision testing tracks eye movement and pupil dilation

  • Cognitive testing tests your ability to problem-solve, remember and concentrate

  • Vestibular testing tests your balance and spatial orientation

Although there are other options available the CDC currently does not recommend neuroimaging options such as CT and MRI as they cannot diagnose mTBI; they are only recommended in more severe cases to rule out intracranial bleeds. The CDC also does not recommend the use of biomarkers outside of a research setting. 

“Understanding the current framework most of us clinicians use when we’re evaluating young children with concussion helps to discern the opportunities and the need for biomarkers to help us take better care of our patients,” explains Dr. Steven Hicks in a UCLA Visiting Scholars webinar on concussion insights.¹ 

Dr. Hicks and Quadrant Laboratories are leading the way in epigenetic research when it comes to the diagnosis and prognosis of concussion.  Biological evidence is needed to support clinical expertise when it comes to concussion protocols.  Some risk factors associated with a concussion can estimate prolonged symptoms, but the severity and recovery of each person are different.  

Current recovery protocol includes making short-term changes to your daily routine until symptoms reside and you’re comfortable returning to normal activity.  This may include rest, light physical activity, limiting screen time, and avoiding bright lights if light sensitivity leads to worsened symptoms. Once symptoms have resided for 48 hours patients can resume normal activity, however, depending on the circumstances surrounding your concussion your doctor may require additional assessments. 

Recovery assessments may include a combination of the same battery of cognitive tools, symptom scales, and balance assessments used in diagnosis, but at this stage may be subjective based on the patient's desire to return to activity. As we have seen recently in professional football these protocols just aren’t working. 

In the research Dr. Hicks and his team are conducting they found biological evidence that when paired with the current clinical tools, clinicians can more efficiently diagnose and track recovery of concussion for a safer return to activity.  They have found that miRNA found in saliva, specifically ncRNA shows altered levels after an mTBI occurs and that these levels may be altered for days or weeks after the injury occurs. These profiles are then measured and can identify patients with mTBI. Not only can these biomarkers aid in identifying concussions they may allow us to predict the duration and character of concussion symptoms.  The disrupted microRNA in the brain pathway may even be implicated to promote brain repair. 

These biomarkers show promise for tracking recovery and predicting who may have prolonged symptoms. They could even provide accurate expectations for recovery, stratify the need for intervention, and provide clinical guidance for a safe return-to-activity.² 

Quadrant Laboratories is currently working on the commercial development of this diagnostic. Using biomarkers found in saliva could change the current standards of concussion protocols. 

Read the full research paper in the Journal of Neurology: Saliva RNA biomarkers predict concussion duration and detect symptom recovery: a comparison with balance and cognitive testing



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