A new blood test can detect brain damage in people who have sustained head injury, and could help predict clinical outcomes and identify risk of dementia.
A study has used a pioneering new test to measure the protein biomarker in the blood, which will enable simpler and more accurate results.
Around 50 million people each year worldwide experience TBI as a result of head injury. In the brains of these individuals, the nerve cells encounter severe stretching and sheering forces which cause damage to their axons, the part which transmits electrical signals.
Axonal damage is the best predictor of clinical outcomes and recovery but has been difficult to measure in patients.
Now, a team from the UK Dementia Research Institute’s (UK DRI) Care Research and Technology Centre, based at Imperial College London, has identified a chemical that could be easily detected in the blood – a biomarker – that can accurately reflect this axonal damage in the brain after TBI.
Dr Neil Graham, joint first author and Alzheimer’s Research UK Clinical Research Fellow based at the UK DRI’s Care Research and Technology Centre, based at Imperial College London, said: “I’m extremely excited by the ultrasensitive blood test technology we used here as it has opened up a whole new world of possibilities when it comes to precise injury diagnosis and prediction of outcomes after head injury.
“This is particularly useful in the area of dementia risk assessment after TBI, which is very challenging at present.”
The study involved over 200 patients who had experienced moderate to severe TBI, recruited from eight major trauma centres across Europe.
In 56 per cent of cases the injuries were classed as ‘high energy’, involving falls from over three metres or collisions at more than 30km/hour, with the majority of these caused by road traffic accidents.
The biomarker identified in the study, neurofilament light, is a protein found in neurons, important for the overall structural stability of these cells. It has become a useful tool for diagnosis, monitoring and prognosis across neurodegenerative disease like Alzheimer’s, but its potential for use in TBI had not been fully assessed and optimised until now.
In the study, the researchers harnessed cutting-edge technology called single molecule array (SiMoA) that can measure sub-femtomolar (10-16) levels of chemicals in the blood.
In the multicentre study, the researchers began by detecting proteins that are important to the structure of the nerve cell axons. They found that measuring blood levels of neurofilament light, a protein important for axonal structure provided a remarkably accurate long-term prognosis for the patient.
The team also used advanced types of brain imaging to validate blood test findings. Blood levels of neurofilament light were found to be closely related to measures from diffusion MRI, an advanced type of imaging which also provides measures related to damage to axons.
The team also compared blood levels of neurofilament light with a special type of brain imaging that measures shrinkage (atrophy) of the brain, indicating the loss of nerve cells. They found that blood levels of neurofilament light tracked extremely well to brain atrophy and importantly predicted further nerve cell degeneration up to one year after the injury.
These findings mean future blood tests could provide similar information to MRIs, but in a more cost-effective and accessible manner.
Dr Graham continued: “If we could roll the neurofilament light test out across the country, it would be hugely impactful. We’re gearing up to offer it to NHS patients at Imperial in the near future.”
Dr Karl Zimmerman, joint first author and postdoctoral researcher based at the UK DRI’s Care Research and Technology Centre, based at Imperial College London, said: “These results are exciting as they pave the way for the use of these advanced biomarkers in the assessment of head injuries in other contexts.
“We have studied and shown that there may be similar changes occurring in professional athletes exposed to head injuries. We’re setting up more research to look at this in detail to improve care of sportspeople concerned with later life risk of dementia.”
Professor David Sharp, senior author of the paper and Director of the UK DRI’s Care Research and Technology Centre based at Imperial College London, said: “Outcomes after TBI are very difficult to predict. This is a major challenge for doctors trying to care for patients recovering from head injuries of all severities.
“What we need are more accurate diagnostic tests that can be used in our major trauma units and clinics. Our work shows that measuring neurofilament light soon after head injury helps predict who will develop long-term problems.
“We are applying this in various contexts, including for the investigation of sporting TBI, and will be investigating whether this blood test can be used to predict those at high risk of developing dementia”
Dr Rosa Sancho, head of research at Alzheimer’s Research UK, added: “Traumatic brain injury is a risk factor for dementia, and identifying the long-term impact of individual head injuries remains an important goal for research.
“This work gets us closer to a blood test able to predict how brain changes develop up to one year after injury. Dementia develops over many years and we need to build on these findings to help improve longer-term prognosis and to reliably determine an individual’s risk of dementia following a head injury.”
Expert panel to assess future of brain injury rehab
The webinar on Wednesday will examine the challenges and opportunities in neurorehab now and into the future
Experts from across the world of brain injury rehab are coming together to assess the future of the sector at an event this week.
The webinar – What does the future of brain injury rehabilitation look like? – brings together leaders in their field of assess what challenges and opportunities lie ahead.
Scores of people have already signed up for the hour-long live online event, on Wednesday at 4.30pm, with places still available and questions can be submitted in advance.
The expert panel comprises:
- Dr Edmund Bonikowski, founder of NRC Medical Experts, who will chair the event
- John Davis, consulting principal lawyer at Slater + Gordon
- Catrin May, co-founder and director of Breakthrough Case Management.
- Ian Pearce, director of NeuroProactive
The event marks the second webinar held by NRC Medical Experts, in association with NR Times, following a successful debate about the Rehabilitation Prescription earlier in the year.
The upcoming webinar will focus on brain injury rehab, and the advances made in innovation to better meet the needs of people living with life-changing injuries.
Through changes in technology, developments in medicine and the advances in neurorehabilitation, brain injury patients should face an outlook which is better than ever before.
However, the lack of resource within health services, exacerbated by the ongoing impact of COVID-19 and mounting pressures on the NHS, mean that progress and change is not being seen at the rate many would hope for.
“We are very much looking forward to addressing the very pertinent topic of brain injury rehabilitation with our stellar panel, all of whom have a vital role to play in supporting people living with brain injuries and their families,” says Deborah Johnson, editor of NR Times.
“Innovation and technology is a hugely exciting area, but the impact of COVID on already stretched resources is of great concern.
“Our webinar will look at the challenges and opportunities that lie ahead, and what more can be done to improve the lives of patients and their families.”
To attend the webinar, registration is required in advance. To sign up, visit here
ABI strategy confirmed by Government
Huge breakthrough in support for people with brain injuries comes after Chris Bryant MP introduced the ABI Bill
The Government has today committed to producing a strategy to deliver better support to people living with acquired brain injury (ABI), following efforts from MP Chris Bryant and an array of charities and leading figures to force them into action.
In a statement, it was confirmed a strategy will be drafted with a call for evidence being launched early in the new year to help shape its development.
Gillian Keegan MP, Minister for Care and Mental Health, said the development of the strategy would be co-chaired by herself and Mr Bryant, with senior officials in all relevant Government departments invited to join the board.
“Following publication, the strategy will be kept under review and may be revised periodically to ensure that it continues to reflect the priority areas and actions needed to best support people living with ABI and their families,” the statement said.
The move by the Government marks a huge step forward in ABI provision, following years of campaigning from charities and survivors for more support. Mr Bryant recently introduced a Private Members Bill with the aim of forcing the creation of such a strategy, which was due to have its second reading in Parliament tomorrow.
Mr Bryant – chair of the All Party Parliamentary Group (APPG) on ABI and a tireless campaigner for the cause – had called on the Government to take action to ensure a more joined up approach from Government departments in supporting individuals and families affected by brain injury.
Last month, he delivered a letter signed by over 200 MPs, charities, brain injury survivors and other providers to 10 Downing Street, calling on the Prime Minister to take action. Following that, Boris Johnson confirmed in Parliament that the Department for Health and Social Care would be looking at the development of such a strategy.
It has also been supported widely by the public and via social media.
But today’s confirmation is a huge step forward and will ensure the development of an appropriate strategy, with input from families and professionals across the world of ABI.
Announcing the development on Twitter, Mr Bryant said: “ The Government has just announced it will draft a strategy on Acquired Brain Injury, set up an ABI programme board which will be co-chaired by Gillian Keegan and me, and will call for evidence very soon.
“So my ABI Bill won’t be needed. Many thanks to all who’ve helped!”
Charities who have been vocal in their support of Mr Bryant’s Bill were keen to celebrate the move, which comes after years of campaigning.
UKABIF hailed the announcement as “a gift” and the Disabilities Trust said it was “just amazing”.
The Child Brain Injury Trust added: “Fantastic news to hear. A strategy for ABI has been needed for so long. We are thrilled!”
UEFA concussion charter urges protection and education
The importance of educating players, coaches, referees, doctors and the public about dangers of concussion in football is highlighted
A European-wide football concussion charter has been launched, stepping up efforts to safeguard players and urging the education of those involved in the game around the dangers of impacts to the head.
UEFA has launched its concussion charter, which will apply to all teams taking part in men’s and women’s club and national team competitions across Europe.
The charter aims to reinforce the importance of good practice in concussion management and highlights the concussion procedures that should be followed.
It also promotes the education of players, coaches and staff about the concussion procedures in force at UEFA games. Team doctors are being asked to organise specific education sessions to brief players, coaches and staff about the concussion procedure to be followed at UEFA matches.
Furthermore, its 55 member associations are ‘strongly encouraged’ to deploy where possible, a medical video review system at their stadiums to enable immediate and informed injury assessments.
UEFA will facilitate the installation of the system with the host broadcaster. Home teams using a medical review system should offer the visiting team the same system.
Club and national teams are being urged to sign the charter to underline their commitment to safeguarding the health of their players.
In doing so, the signatories pledge their full support for UEFA’s guidance on how to recognise and manage a head injury from the time of injury through to the safe return to football.
“Everyone should know how to react and what to do,” said Tim Meyer, UEFA Medical Committee chairman.
“Concussion is undoubtedly a serious injury which needs to be managed and treated properly.
“The health and safety of any players taking part in Europe’s club and national team competitions is of paramount importance not only to UEFA, but also to national associations across the continent.
“Although research studies report a low incidence in football, everyone should know how to react and what to do in the event of a concussion on the pitch.
“By signing this charter, clubs and national teams will demonstrate their support for UEFA’s concussion awareness activities – and take a considerable step forward in helping to protect their players.”
The measure is the latest stage in efforts to safeguard players, following steps including UEFA’s implementation of a keynote concussion awareness campaign in 2019 and the Premier League becoming the first competitive league in the world to introduce concussion substitutes.
UEFA’s head injury procedure is:
• In the event of a suspected concussion, the referee will stop the game to allow the injured player to be assessed by the team doctor. Players should remain calm during the situation and not interfere with the assessment.
• The assessment should in principle not take more than three minutes, unless a serious incident requires the player to be treated on the field of play or immobilised on the field for immediate transfer to hospital.
• If the assessment cannot be made after the three minutes and/or a suspicion for a concussion arises, the player should not be allowed to continue playing.
• A player suffering a head injury that requires assessment for a potential concussion will only be allowed to continue playing after the assessment, on specific confirmation by the team doctor to the referee of the players fitness to do so.
The decision remains entirely with the team doctor. Coaches, referees and players are not allowed to interfere in the assessment and decision of the doctor.
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