224 Concussion Blood Test – Beyond MRI or CT – Lewis

concussion, blood test, TBI, CTE, recovery, prevention

Concussion Blood Test & Treatments for CTE, TBI and Brain Impairments

Dr. Michael Lewis – Reports on a blood test for a concussion and what to do about CTE or TBI. The Brain Trauma Indicator Test at Banyan Biomarkers measures two biomarkers: proteins known as UCH-L1 and GFAP, that are released upon injury to the brain and pass through the blood-brain barrier. Elevated levels of these proteins can be detected within 15 or 20 minutes of injury. The test can be taken within 12 hours of injury, and results can be obtained within three or four hours.

Patients are currently diagnosed with concussion based on a combination of symptoms as well as imaging. However, CT scans don’t always detect concussion.

“Over 90% of CT scans (for concussion) are negative. And you get 200 times the radiation of a chest X-ray. It’s expensive; it’s not terrific,” said Hank Nordhoff, chairman, and CEO of Banyan Biomarkers, maker of the new test. It can help determine whether a patient further needs a CT scan, based on a physician’s concerns.

It’s not concussions that cause CTE. It’s repeated hits, a study finds.

Second Interview at CBJ on Concussion

Listen up as Dr. Lewis, a West Point-trained Army officer and physician with specific interests in brain injury was a previous excellent CBJ Guest at CBJ/171, details improved diagnosis and treatment for brain injury.

Photo by Aimee Vogelsang on Unsplashcon

Dr. Lewis’ Brain-Focused Bio

In late 2011 upon retiring as a Colonel after a distinguished thirty-one-year career in the US Army. His pioneering work in the military and since has helped thousands of people around the world and is regularly featured in the media, including CNN’s Sanjay Gupta, MD, show and numerous radio shows and podcasts.

A graduate of the US Military Academy at West Point and Tulane University School of Medicine, Dr. Lewis is board-certified and a fellow of the American Colleges of Preventive Medicine and Nutrition. He completed postgraduate training at Walter Reed Army Medical Center, Johns Hopkins University, and the Walter Reed Army Institute of Research.When Brains Collide: What Every Athlete and Parent Should Know About the Prevention and Treatment of Concussions and Head Injuries: Michael D. Lewis MD

He is currently in private practice in Potomac, Maryland (BrainCARE, www.BrainCARE.center); is a consultant to the US Army and Navy as well as several organizations, institutes, and nutrition companies around the world; and is a founding member of the Pop Warner Youth Football Medical Advisory Board.

Ed Note: See his book give away offer below, open until June 20, ’18

Concussion Testing Details – Radiation Exposure Minimized

The US Food and Drug Administration has, for the first time, approved a blood test to help detect concussion in adults.

“Today’s action supports the FDA’s Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging — an effort to ensure that each patient is getting the right imaging exam, at the right time, with the right radiation dose,” FDA Commissioner Dr. Scott Gottlieb said in a statement Wednesday.

Concussion Diagnostic Costs Reduced

The test could also help reduce costs significantly. Whereas a CT scan can cost $800 to $1,500, Nordhoff predicts that the new test would cost closer to $150.

The test would be available to hospitals, Nordhoff said, and he hopes a handheld sideline device could be commercially available in the near future.

The Concussion – Subconcussion Study

The FDA approved the test as part of its Breakthrough Devices program after evaluating a clinical study of 1,900 blood samples from people thought to have a concussion or mild traumatic brain injury. The clinical trials did not include any children, though Banyan plans to include them in future studies.

When compared with a CT scan, the blood test was 97.5% as effective in detecting concussion and 99.6% effective in ruling out a concussion.

“A blood test that accurately, reliably and consistently detects the presence of brain proteins that appear in the blood after a brain injury is a major advance,” said Dr. David Dodick, a fellow of the American Academy of Neurology who specializes in sports medicine and neurology. He was not involved in the development of the test.

Though Dodick was optimistic about the blood test, he said a lot of work still needs to be done in understanding and diagnosing brain injury. He pointed out that we need better measurements to understand when brains have fully healed from trauma, as well as a better understanding of how these biomarkers act which may actually affect prognosis.

It’s also unknown how this test can determine subconcussive hits, “hits that don’t cause symptoms but do cause a brain injury,” he explained. “These occur much more often than actual concussions, especially in certain collision and contact sports.”

Note: Subconcussive or repeated hits to the head are believed to be the root of the neurodegenerative disease chronic traumatic encephalopathy or CTE.

In fact, Banyan has partnered with another company, Quanterix, to help develop a test that could eventually detect the impact of repeated hits. Quanterix aims to combine the biomarkers with Banyan with digital technology that can look at the proteins at a super-microscopic level and pinpoint low-level concentrations of the proteins.

“The key now is to use this sensitivity to evolve in more brain health and to protect athletes and keep soldiers out of harm’s way,” said Kevin Hrusovsky, president, and CEO of Quanterix.

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This Report From CNN: See the latest news and share your comments with CNN Health on Facebook and Twitter, linked below.

Dr. Gupta Weighs In on Concussion and CTE

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The FDA Considers A New Approach To Diagnosis for Concussion

The FDA believes that using the new blood test, imaging can be avoided in at least a third of patients who are suspected of having a concussion.

Stats on Brain Injury – 2.8M!

According to the US Centers for Disease Control and Prevention, there were approximately 2.8 million incidents involving traumatic brain injury emergency department visits, hospitalizations and deaths in 2013.

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Enter Drawing For 2 of His Books

When Brains Collide

HERE – Closes June 20, 2018 

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Treatment Links and References, Amended 6-2-18

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Multiple Additional CBJ Experts on TBI, CTE

  • http://corebrainjournal.com/vets Our CBJ Dedicated to the Vets Page – Must Listen to Jocko there
  • CBJ/012Concussion and Suicide – Liu
  • CBJ/127Brain Injury Resource Support Group – Bono
  • CBJ/114Hemingway’s Brain and CTE – Farah
  • CBJ/176Cannabinoids and Brain Injury – Patel
  • CBJ/162Brain Injury Insights – DeWitt

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Thanks

Thanks, Dr. Lewis, for joining us here at CBJ to review these personal observations about your useful insights on the evolution of self-management.

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Questions

In closing, if you have any questions, drop a comment on any posting here at CBJ, and I’ll get back to you. This discerning show of world-class experts is here for you, your families, and your clients – to tighten our collective dialogue for more precise answers.

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Our Next CoreBrain Journal Episode

224 Corinne Zupko, a licensed counselor and Mindfulness-Based Stress Reduction teacher, undertook her study of psychology out of necessity when debilitating anxiety threatened to derail her life. Seeking ways to do more than temporarily alleviate her symptoms, Corinne began to study A Course in Miracles (ACIM), mindfulness meditation, and the latest therapeutic approaches for treating anxiety.

As Corinne healed her own mental anguish, she compiled the perception-shifting process she describes in her book: From Anxiety to Love: A Radical New Approach for Letting Go of Fear and Finding Lasting Peace (New World Library, February 14, 2018).

From Anxiety to Love helps readers learn to undo anxiety-based thinking by internalizing the teachings of ACIM, fostering mindful shifts in their thoughts and actions, and connecting to their Inner Therapist, the deeply gratifying, enormously comforting inner voice that affirms our safe oneness with the universe rather than our ego’s perception of danger and separation. Whether struggling with everyday stress or near-crippling discomfort, readers will find that Corinne’s approach offers a new way of healing from — rather than just coping with — fear and anxiety.

About our mission, Dr Charles Parker

Our CBJ hosting objective is critical: upgrade mind and brain data through informed dialogue with neuroscience experts to build more predictable, more comprehensive, more understandable solutions for you and your family. Today's technology drives significantly improved mind-prognosis - beyond traditional psychiatric measures. Inaccurate labels, speculation, and guesswork are out - critical thinking, data, and measurement are in. Let's work together to connect advanced biomedical wisdom with everyday street reality. Start today. Advance informed care. Stay consistent. Subscribe here. Pass it on.

2 Comments

  1. Emily on 05/29/2018 at 4:03 PM

    I am wondering if the Banyan concussion test would be useful as a potential biomarker for patients with ME/CFS and/or fibromyalgia as well? Given that several studies have shown activated microglia in these conditions, it seems like there might be increased levels of GFAP protein in this population as well, but I’m not sure if it applies to chronic illness, or just to acute injuries? https://www.nature.com/articles/nature21029

    Also, I’m curious if you see low or high levels of IgG when you test? Do you see any pattern in subclass deficiencies as well, or do you only test total IgG?

    I’d like to know if Dr Lewis megadoses the raw CBD oil at first like he does the Omega 3s? Or is it typically just one 5 mg softgel/day?

    Finally, I’d like to know if either of you have any thoughts about Coromega as a fish oil replacement. It’s much more palatable, especially for younger clients, but I wonder about the formulation. It is supposed to be more bioavailable, but that means it is also more highly processed. That said, it doesn’t seem to suffer from rancidity problems either. Curious about your opinion on this product, if you have one.

    Thank you! Great episode!

    • Dr Charles Parker on 06/03/2018 at 5:38 AM

      Thanks, Emily – I do strongly recommend this interesting article in Nature shared in your link here and briefly abstracted here:

      “Reactive astrocytes are strongly induced by central nervous system (CNS) injury and disease, but their role is poorly understood. Here we show that a subtype of reactive astrocytes, which we termed A1, is induced by classically activated neuroinflammatory microglia. We show that activated microglia induce A1 astrocytes by secreting Il-1α, TNF and C1q, and that these cytokines together are necessary and sufficient to induce A1 astrocytes. A1 astrocytes lose the ability to promote neuronal survival, outgrowth, synaptogenesis and phagocytosis, and induce the death of neurons and oligodendrocytes. Death of axotomized CNS neurons in vivo is prevented when the formation of A1 astrocytes is blocked. Finally, we show that A1 astrocytes are abundant in various human neurodegenerative diseases including Alzheimer’s, Huntington’s and Parkinson’s disease, amyotrophic lateral sclerosis and multiple sclerosis.”

      I personally do not do quantitative IgG, even though that’s an excellent question, and will ask Dr. Lewis to weigh in on your several points. My treatment experience is directed to the more frequently overlooked and disparaged qualitative IgG encouraged by such luminaries as Dr. Fasano at Harvard – his book: http://geni.us/fasano – Videos on IgG qualitative can be found at 1. on this PDF: http://corepsych.com/tests – I’ll send of to Dr. Lewis this AM, thanks!
      cp

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