Wednesday, April 13, 2011

Blood Test for Brain Trauma

There are days when I especially love this job -- because I have the chance to tell you something positive that can benefit all of us. And that is this -- Army doctors have made a tremendous breakthrough developing a simple blood test that can detect mild brain injury and concussion. This has been a dream of our armed forces doctors -- especially in recent years, as they work with such a high percentage of soldiers injured in bomb blasts during combat operations. If a concussion is misdiagnosed -- even a mild one -- and then a second concussion occurs soon after the first, permanent brain damage is more likely to result. And this breakthrough test is going to help anyone who might one day receive a mild concussion -- not just soldiers on a battlefield, but teen athletes, car accident victims or any of us.

A little background: Certainly a first concussion can cause brain damage, but doctors tend to worry about a second concussion as most likely to do significant harm. Until now, brain injury could be accurately detected only with X-rays, CT scans and/or MRI scans... and even then, only moderate to severe brain trauma was revealed. Mild brain injuries could easily be missed. Doctors have had to depend on a patient's medical history and neurologic exams -- from simple in-office visits to EEGs, MRIs and brain scans, to attempt a diagnosis.

But now the Army has identified unique proteins that spill into the blood when brain cells are damaged. Earlier on, scientists had assumed proteins did not cross the blood-brain barrier, but through laboratory tests on rats, Army researchers found proteins normally present only in the brain that were clearly measurable in the body afterward. Next, they found the same thing held true in humans.

A New Field of Study

Army Colonel Dallas Hack, MD, MPH, Combat Casualty Care Research Program director, US Army Medical Research and Materiel Command, told me that the study of proteins in the body -- called "proteinomics" -- has advanced greatly in the past decade. The search for a brain trauma protein was inspired by the momentous 1970s' discovery of a protein released into the blood by damaged cardiac tissue, which changed the way doctors identify heart disease. After years of rigorous trials, that test was approved by the Food and Drug Administration in the 1980s, became available to the whole medical field -- and is now run routinely to diagnose cardiac injury.

To win FDA approval for the new brain trauma blood test, the Army will have to conduct three successive phases of testing on humans. Phase I was concluded in early 2010, and Phase II in late 2010. Phase III will take another 18 months and will include about 1,200 subjects at civilian trauma centers around the country.

Dr. Hack told me that the new blood test for the brain trauma protein is "very accurate, very sensitive and very specific." Tests for other biomarker proteins have been discovered that may be able to screen for subacute and chronic brain injury and will enable military doctors to make early diagnoses and monitor brain injury over time. Dr. Hack eventually wants to see test results sent directly from the lab to the battlefield.

This Will Change the Whole Field

It isn't hard to imagine the tremendous effect this test may have on civilian health, too. In fact, we don't have to just imagine -- Dr. Hack's team is already working with the National Football League to define requirements for concussion screenings in its players. School athletes will also benefit tremendously from such a clear-cut diagnosis. All too often symptoms such as dizziness, headache and disorientation are downplayed by athletes who risk serious injury when they continue playing. The test will be equally useful for people who have been in vehicle accidents... children who bang their heads on playgrounds... elders who fall... and even people who simply have persistent, unexplained headaches, which can be a symptom of a mild blow to the head -- one that actually is a concussion -- that someone might not even remember sustaining. And finally, there will be safety measures that can be taken, whether it's giving someone on the bomb squad a desk job, taking a soldier out of combat -- or an athlete off the field.

So there you go: A piece of good news for all of us that is, in fact, a game changer.

Army Colonel Dallas Hack, MD, MPH, director, Combat Casualty Care Research Program, US Army Medical Research and Materiel Command, Fort Detrick, Frederick, Maryland.

Have a good day, be well and take care

a simple natural lifestyle and a chuckle a day keeps the doctor away'

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