Review Article
Svetlana A Dambinova, Richa
Abstract
This mini-review analyzes advantages and limitations of current methods of assessment of cerebral concussions considering functional, structural and metabolic factors in decision making for return to play. Novel neurotoxicity biomarkers, AMPA and NMDA receptor peptide/antibodies are proposed for evaluation of subtle brain injury following concussions. Neurotoxicity biomarkers can now be detected in the blood and are associated with severity of concussion and transient or persistent changes in the brain including diffuse axonal injury and microvascular dysfunction (edema formation). We surveyed 84 students (20.5 ± 2.5 years) participating in contact-sports and enrolled at Kennesaw State University. Based on neurotoxicity biomarkers values and diminished ImPACT scores, 18 athletes with concussions were selected for longitudinal assessment (1.5 year). Within the study, values of four neurotoxicity biomarkers decreased to normal in 11 (61%) concussed athletes while seven subjects maintained at least one acute and chronic biomarkers elevated reflecting structural changes in the brain defined by 3T DTI. It was demonstrated that neurotoxicity biomarkers in conjunction with neurocognitive testing might improve diagnostic certainty of suspected concussions. Additionally the use of biomarkers may provide valuable information on severity of concussions and help select subjects (about 2%) for advanced neuroimaging. Athletes with abnormal levels of neurotoxicity biomarkers and structural changes on DTI should be withheld from contact sports and be considered for therapeutic intervention and treatment to protect the brain from further neurological complications.