Svetlana A Dambinova, Richard L Sowell and Joseph C Maroon
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.
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