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Advanced Diffusion Imaging in The Hippocampus of Rats with Mild Traumatic Brain Injury
Published on: August 14, 2019
Advanced biomarkers of pediatric mild traumatic brain injury: Progress and perils
Andrew R Mayer1, Mayank Kaushal2, Andrew B Dodd3
1The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States; Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychology Department, University of New Mexico, Albuquerque, NM, 87131, United States.
Insights
Biomarker research for pediatric mild traumatic brain injury (pmTBI) lacks high-quality studies in the sub-acute phase. More longitudinal research is needed to understand pmTBI
Area of Science:
- Neuroscience
- Pediatric Traumatology
- Biomarker Discovery
Background:
- Growing concern exists regarding chronic neurodegenerative changes following pediatric mild traumatic brain injury (pmTBI).
- Current diagnostic and prognostic tools for pmTBI lack objective biomarkers.
- Sub-concussive blows, both clinically apparent and silent, are implicated in pmTBI outcomes.
Purpose of the Study:
- To systematically review the existing literature on diagnostic and prognostic biomarkers for pediatric mild traumatic brain injury (pmTBI).
- To assess the quality and impact of current biomarker studies in the sub-acute phase of pmTBI.
- To identify research gaps in understanding the pathophysiology of pmTBI.
Main Methods:
- Systematic literature review of diagnostic and prognostic biomarker studies for pmTBI.
- Analysis focused on the sub-acute injury phase (time post-injury).
- Included studies examining various forms of pediatric mild traumatic brain injury.
Main Results:
- A paucity of high-quality, clinically impactful biomarker studies was identified in the sub-acute phase of pmTBI.
- Most reviewed studies focused on adolescent pmTBI.
- Limited research exists on objective biomarkers for diagnosing pmTBI or predicting recovery.
Conclusions:
- There is a critical need for well-powered, longitudinal studies with robust control groups to investigate pmTBI.
- Standardized inclusion criteria (time post-injury, severity, history) are essential for future research.
- Further investigation is required to elucidate the complex pathophysiology underlying pmTBI and post-concussive symptoms.
Abstract:
There is growing public concern about neurodegenerative changes (e.g., Chronic Traumatic Encephalopathy) that may occur chronically following clinically apparent and clinically silent (i.e., sub-concussive blows) pediatric mild traumatic brain injury (pmTBI). However, there are currently no biomarkers that clinicians can use to objectively diagnose patients or predict those who may struggle to recover. Non-invasive neuroimaging, electrophysiological and neuromodulation biomarkers have promise for providing evidence of the so-called "invisible wounds" of pmTBI. Our systematic review, however, belies that notion, identifying a relative paucity of high-quality, clinically impactful, diagnostic or prognostic biomarker studies in the sub-acute injury phase (36 studies on unique samples in 28 years), with the majority focusing on adolescent pmTBI. Ultimately, well-powered longitudinal studies with appropriate control groups, as well as standardized and clearly-defined inclusion criteria (time post-injury, injury severity and past history) are needed to truly understand the complex pathophysiology that is hypothesized (i.e., still needs to be determined) to exist during the acute and sub-acute stages of pmTBI and may underlie post-concussive symptoms.
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