While assessing for the tau protein is useful in detecting CTE pathology, the most effective line of action is immediately assessing for biomarkers of traumatic brain injury (TBI) during any case of head trauma.
Ultra-early detection and intervention for traumatic brain injury can prevent further exacerbation to the point of acquiring CTE. As of February 2018, the Food and Drug Administration (FDA) approved a novel blood test to immediately detect TBI: the Banyan Brain Trauma Indicator (Banyan BTI).
The Banyan BTI identifies two brain-specific protein biomarkers: Ubiquitin Carboxy-terminal Hydrolase-L1 (UCH-L1), and Glial Fibrillary Acidic Protein (GFAP). These proteins have been detected in blood serum from people suffering from mild TBI within hours of sustaining head injuries.
Such findings suggest that UCH-L1 and GFAP are ideal biomarkers for the near-immediate detection of TBI (Diaz-Arrastia et al., 2014; Papa et al., 2016). Given that CTE is a long-term manifestation of repeated occurrences of TBI, there is another potential assessment that could be administered immediately following a head injury: using the Banyan BTI blood test to assay for UCH-L1 and GFAP in athletes’ blood samples upon any instance of suffering a significant blow to the head.
While biomarkers may present a major sign of TBI or CTE, it must be noted that UCH-L1, GFAP, and tau may be detected in minute quantities in all athletes, even in those who are seemingly healthy.
Presence of Biomarkers Doesn’t Mean End to Sports Participation
It is erroneous to suggest that the mere presence of such biomarkers would always require the drastic action of terminating athletes’ involvement in sport. The key is to support athletic well-being while enabling participation in sport. This is when the process of conducting regular neuropsychiatric evaluations in concert with biomarker assessment becomes essential.
Examination for biomarkers of acute TBI (UCH-L1 and GFAP) or CTE (tau) should be supplemented with neuropsychiatric evaluations to provide an added dimension for athlete testing.
With respect to immediate response from a single head injury, the Glasgow Coma Scale (GCS) is a proven, highly intensive evaluation to administer in tandem with biomarker assessment.
This is a complex test that assesses eye, verbal, and motor responses to stimuli, gauging head trauma severity. Scoring ranges from 3 (unconsciousness) to 15 (full alertness) with any score below 9 indicating severe brain injury.
Following administration of the GCS, the next line of action involves carrying out requisite and timely intervention to treat cases of head trauma. The course of action is dependent on the severity of the injury.
Treatment may range from simple rest to, in the process of more severe TBI, hyperbaric oxygen therapy, using sedatives or diuretics to reduce excess intracranial pressure (ICP), and/or cognitive rehabilitation in an inpatient setting (Morries et al., 2015).
Medical Team Essential for Treatment
In any case, having a team of neurologists, Physical Medicine and Rehabilitation (PM&R) physicians, and mental health professionals working together is essential for efficient treatment of brain injuries.
After treatment, athletes should be re-evaluated, to determine whether they are ready to resume their involvement in their respective sports.
The Rancho Los Amigos Scale, when used in tandem with the GCS, is an effective post-treatment evaluation, which assesses neurocognitive, behavioral, and motor responses in the event of recovering from head trauma (Flannery et al., 1993). If, long after treatment, the athlete continues to present with CTE or TBI biomarkers, low scores on neuropsychiatric batteries, as well as a discernible decline in neurological and motor function, the medical staff should consult with the player and his coaching staff and take the necessary precaution in prematurely ending the athlete’s sporting involvement.
Otherwise, if allowed to take part in sport, the athlete would face the prospect of his/her already compromised neurological function further worsening because of the inevitable fate of repetitive head trauma that would ensue.
To prevent the exacerbation of head trauma to the point of acquiring CTE and the irreversible neuropsychiatric complications that it imposes, it is essential to respond immediately to any instance of head trauma.
Moreover, to monitor for potential CTE, all athletes – even those who have not experienced conspicuous head injuries – should also undergo periodic evaluations for biomarkers of acute and/or chronic head trauma.
The tau protein, along with the pair of UCH-L1 and GFAP proteins, provide valuable insight into long- and short-term traumatic brain injury, respectively. Assessments should be accompanied with neuropsychiatric evaluations, and timely interventions should any major warning signs to athletes’ well-being present themselves.
Implementing methods for early detection of traumatic brain injury is essential in preventing an array of potential neuropsychiatric conditions from worsening. Early analysis for biomarkers, coupled with neuropsychiatric assessments and requisite treatment, will enable current and future athletes to live healthier, more fulfilling lives, both during and beyond their involvement in sport.
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