Concussion biomarkers (Eric Thelin episode 3)

Concussion biomarkers (Eric Thelin episode 3)

Table of Contents

Concussion biomarkers are wanted. That’s as a result of the present imaging machines like MRI and CT as a rule cannot visualize a concussion. This typically ends in docs saying that there’s nothing improper with us, or that the signs we’ve got are psychological. If a easy blood check can present you sustained a concussion and are in danger for lingering signs, concussion care would enhance very a lot. Eric Thelin takes us on a deep dive into the realm of concussion biomarkers.

Desk of contents

04:06 Finding brain injury biomarkers
05:10 Concussion biomarkers
07:47 Concussion and inflammation
10:08 Concussion awareness

Concussion Tales podcast introduction

[00:00 Melanie] If I say there may be hope for full restoration for individuals with a concussion, you say…?

[00:07 Professor McCrea] 100%!

[00:08 Professor Maas] And actually, you didn’t solely really feel it you had been outdoors the common medical system, as a result of they weren’t excited about you.

[00:16 Professor Sitskoorn] Neuroplasticity really opens you as much as the world. It makes it potential to develop; it makes it potential to rehabilitate.

[00:25 Professor Wilson] Traumatic brain injury has been referred to as a silent epidemic for that motive, as a result of it consists of modifications and disabilities that aren’t apparent to different individuals.

[00:35 Dr. Zasler] If, as a doctor, you felt you had nothing to supply a affected person, then I believe ethically, you have to say] “I don’t suppose there’s something I can give you. Perhaps you must see Dr. M.”

[00:48 Professor Diaz-Arrastia] Traditionally, we’ve got referred to as these items delicate traumatic mind accidents, which suggests that, effectively… It might be a brain injury, nevertheless it’s not going to have nice penalties, proper? And that’s frankly not true.

Concerning the Concussion Tales podcast

[01:05 Melanie] Welcome to Concussion Tales, a Lifeyana podcast sequence crammed with hope. I’m right here to let that you’re not alone in your post-concussion restoration journey. My identify is Melanie and I spent six and a half years studying, experimenting, and coaching to be able to discover a strategy to heal myself from post-concussion syndrome.

After making a full restoration by the tip of 2018, I launched into this mission to make the restoration journey simpler for you. For this reason I began this podcast, wrote detailed blog post and downloadable guides, provide coaching and likewise the course that I want I had again after I was recovering — instructing you every part that I wanted to know to be able to make my restoration occur.

On Concussion Tales, we dig deep whereas discussing hopeful tales of restoration in addition to the exhausting stuff within the messy center. Let’s dive proper in!

Eric Thelin

That is the third and final episode with Eric Thelin. If you happen to haven’t learn, listened to or watched the primary two episodes, please discover them proper right here:

Eric makes a speciality of neurointensive care after brain injury at Karolinska College Hospital in Sweden.

Concussion biomarkers

In right now’s episode, we’re going to dive into the position of concussion biomarkers current in blood in each the acute and lingering concussion phases. We’re additionally going to find out about neuroinflammation. And the place Eric thinks this comes from. That is Eric Thelin.

[02:31 Eric] What we want is extra goal markers of power TBI pathology. 

‘Psychosomatic’ concussion signs

I don’t understand how you’ve got been dealt with by the well being care system within the Netherlands, however there have most likely been just a few docs that didn’t consider in your signs. Or maybe they didn’t actually perceive and thought: “You’re most likely affected by some sort of psychiatric drawback inflicting your somatic signs. That’s most likely the rationale: it’s not your concussion, it’s different points.”

Concussion biomarkers are wanted

It will be good if there have been an ideal blood pattern or some type of check that would really point out: this can be a structural brain injury, and this can be a psychiatric drawback. If we may triangulate these sufferers, we may very a lot enhance the type of triage and the pathways within the healthcare system very early on for these sufferers. I believe that can assist tremendously.

[Timestamp needed Melanie] Sure, I believe this is among the coolest issues that’s rising from CENTER-TBI, to have the ability to simply pinpoint with a blood check: what is going on with sufferers? That will be really easy.

[Timestamp needed Eric] Yeah. Precisely! I did my PhD on traumatic brain injury  biomarkers. So I’m very glad that CENTER-TBI has embraced this as effectively. 

Discovering brain injury biomarkers

You’ll want to follow-up these sufferers for an extended time period: you have to pattern them in additional power phases. 

Extreme TBI biomarkers

That is one thing that we do in sufferers with extreme TBI, 10 to fifteen years down the road. These sufferers have main lesions on MRI: half their mind is usually injured, and they’re having extreme issues right now. Perhaps they’ll’t transfer a hand or an arm, or they’ve extreme cognitive issues and extreme fatigue syndrome. So, they may most likely present fairly a robust sign of their TBI biomarkers.

Gentle TBI biomarkers

Nonetheless, in a gentle TBI cohort, you have to have fairly a pattern dimension like CENTER-TBI has to be able to really see a sign in all of the noise. That’s as a result of delicate TBI can be lots of noise, contemplating that the trauma can generally not even be visualized on the present imaging methods.

Concussion biomarkers


[05:10 Melanie] How then–? I do know there may be one marker that everybody is specializing in now, proper? Is it as shut as that? Quickly we all know that one marker means delicate TBI, so you’ve got a concussion or you can be in danger for post-concussion syndrome? Or will this example nonetheless take some time?

S100 calcium-binding protein B (S100B)

[05:33 Eric] I believe there might be 2 markers that can come out of this. There may be 3. One would be the protein S100B, which is at present employed within the Scandinavian pointers to display screen for sufferers which have delicate TBI when it comes to hemorrhages. So, if a affected person is beneath a sure cutoff degree, you possibly can ship them residence, they usually don’t need to endure a CT scan.

Neurofilament mild polypeptide (NF-L)

Nonetheless, one of many 2 proteins that I believe will come out of all of this when it comes to post-concussion syndrome, is the protein neurofilament light polypeptide (NF-L or Nfl). There have already been research displaying that when you have elevated ranges 2 to three weeks after an harm, this can be a protein that’s launched. It continues to be launched as a result of it has a really lengthy half-life in serum (blood). If you happen to pattern it about three weeks or so after an harm, it has been related to extra post-concussion syndrome in boxers, as an illustration, or different shut contact sport gamers. So, I believe that’s the blood concussion biomarker.

Glial fibrillary acidic protein (GFAP)

However one other fascinating protein that now emerged is glial fibrillary acidic protein, or as Individuals say: GFAP. It’s a protein that can most likely change S-100-B within the emergency room to display screen if a affected person has a hemorrhage in a gentle TBI or concussion situation. Latest research additionally reveals that in long-term TBI sufferers, a yr down the road, it’s nonetheless elevated. So, I believe that we’ve got an ongoing inflammation-ish protein in GFAP, and we’ve got the post-concussion protein in neurofilament mild.

Concussion and irritation

[07:47 Melanie] Okay. Let me ask a layman’s query.

[07:54 Eric] Shoot.

[07:56 Melanie] The place does this irritation in post-concussion syndrome come from? Is it the mind? Is it elsewhere?

The place does the irritation come from?

[08:04 Eric] That may be a excellent query, I need to say. We don’t know right now. We all know that there’s an interaction between the systemic, the blood, the physique, and the mind. We all know it exists in different pathologies, comparable to a number of sclerosis. The inflammatory cells come from the physique and enter the mind.

Microglia, astrocytes and migrant inflammatory cells

In traumatic brain injury, it’s most likely very comparable. There would be the microglia, that are the immune cells of the mind, and astrocytes, that are additionally immuno-competent cells within the mind that can activate and create an ongoing irritation. Nonetheless, in the event that they activate, they may also recruit migrant inflammatory cells from the blood that can then migrate down the blood mind barrier and are available into the harm.

Cytokines within the mind

I do consider that there’s an interaction between the mind, the inflammatory cells and the physique’s inflammatory cells. We revealed a paper on this a yr in the past. It involved extreme traumatic brain injury sufferers. Sufferers who had pneumonia within the intensive care unit, additionally had a tool of their mind that measured cytokines, that are a measure of irritation. 

Sufferers who suffered from pneumonia had completely different ranges of sure cytokines of their brains. So there may be positively an interaction occurring with regard to how the affected person is doing, at the very least very early on. Nonetheless, I believe there may be even an interaction in later phases as effectively.

[09:50 Melanie] That is tremendous fascinating. I really feel like that is the primary time that I dug so deep with somebody within the space of blood markers and irritation markers. I hope that listeners have an interest as effectively. 

Concussion consciousness

I actually need to thanks additionally on behalf of sufferers as a result of I really feel it’s actually essential work that you’re doing, although it can take a very long time for every part to translate everywhere in the world.

[10:20 Eric] Oh yeah.

[10:21 Melanie] It’s transferring, and that’s the most essential half.

[10:24 Eric] It’s. And thanks for creating consciousness about this pathology and serving to individuals. I believe it is rather essential and your job must be acknowledged.

[10:36 Melanie] Thanks very a lot. I like doing it. That helps rather a lot.

Ship us your questions

This concludes the three concussion tales episode with Eric Thelin. With all my coronary heart, I hope that their contents could assist you to. Please know that you could be all the time contact me to ask or inform Eric one thing and I’ll reply to your query or comment.

Share your ideas with me?

Now, I’d love to listen to from you. What do you are taking away from this episode? Is there one thing which you can apply to your life instantly? Head on over to and go away your remark now.

And if you wish to hear and skim extra Concussion Tales, actionable steps and inspiration, be sure you subscribe to the Lifeyana electronic mail listing whilst you’re there, so that you just by no means miss out on new supplies we always make for you.

If you wish to assist this podcast, head on over to Thanks for listening to this concussion tales episode by Lifeyana. Could you be effectively and should you be completely happy.

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