Is a diagnosis of “mild traumatic brain injury” a category mistake?

Rapp, Paul E.; Curley, Kenneth C.

doi:10.1097/ta.0b013e318260604b

Cited by 28 publications

(29 citation statements)

References 109 publications

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Section: Discussionmentioning

confidence: 99%

“…Rapp and Curly [51] describe mTBI as an event that may lead to the development of neurological disorders. The heterogeneous nature of mTBI makes it difficult to diagnose, based exclusively on current behavioral and neurocognitive analyses [51]. Biochemical assays for brain related proteins in serum, such as GFAP, UCH-L1 and S100β, are either not sensitive or selective for mTBI [7]–[12].…”

Section: Discussionmentioning

confidence: 99%

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Identification of Serum MicroRNA Signatures for Diagnosis of Mild Traumatic Brain Injury in a Closed Head Injury Model

et al. 2014

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Wars in Iraq and Afghanistan have highlighted the problems of diagnosis and treatment of mild traumatic brain injury (mTBI). MTBI is a heterogeneous injury that may lead to the development of neurological and behavioral disorders. In the absence of specific diagnostic markers, mTBI is often unnoticed or misdiagnosed. In this study, mice were induced with increasing levels of mTBI and microRNA (miRNA) changes in the serum were determined. MTBI was induced by varying weight and fall height of the impactor rod resulting in four different severity grades of the mTBI. Injuries were characterized as mild by assessing with the neurobehavioral severity scale-revised (NSS-R) at day 1 post injury. Open field locomotion and acoustic startle response showed behavioral and sensory motor deficits in 3 of the 4 injury groups at day 1 post injury. All of the animals recovered after day 1 with no significant neurobehavioral alteration by day 30 post injury. Serum microRNA (miRNA) profiles clearly differentiated injured from uninjured animals. Overall, the number of miRNAs that were significantly modulated in injured animals over the sham controls increased with the severity of the injury. Thirteen miRNAs were found to identify mTBI regardless of its severity within the mild spectrum of injury. Bioinformatics analyses revealed that the more severe brain injuries were associated with a greater number of miRNAs involved in brain related functions. The evaluation of serum miRNA may help to identify the severity of brain injury and the risk of developing adverse effects after TBI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Identification of Serum MicroRNA Signatures for Diagnosis of Mild Traumatic Brain Injury in a Closed Head Injury Model

et al. 2014

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“…However, the clinical presentation of concussion is highly individualized, with symptoms and impairments often evolving over time. The non-specific nature of associated symptoms can reduce the accuracy of concussion assessments such as symptom checklists and clinical interviews [7]. In addition, some tools that assess concussion measure indirect behavioural performance related to underlying brain injury rather than directly measuring the underlying brain injury itself with neurophysiological approaches.…”

Section: Introductionmentioning

confidence: 99%

Preliminary investigation of Brain Network Activation (BNA) and its clinical utility in sport-related concussion

et al. 2017

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Background: The clinical diagnosis and management of patients with sport-related concussion is largely dependent on subjectively reported symptoms, clinical examinations, cognitive, balance, vestibular and oculomotor testing. Consequently, there is an unmet need for objective assessment tools that can identify the injury from a physiological perspective and add an important layer of information to the clinician’s decision-making process. Objective: The goal of the study was to evaluate the clinical utility of the EEG-based tool named Brain Network Activation (BNA) as a longitudinal assessment method of brain function in the management of young athletes with concussion. Methods: Athletes with concussion (n = 86) and age-matched controls (n = 81) were evaluated at four time points with symptom questionnaires and BNA. BNA scores were calculated by comparing functional networks to a previously defined normative reference brain network model to the same cognitive task. Results: Subjects above 16 years of age exhibited a significant decrease in BNA scores immediately following injury, as well as notable changes in functional network activity, relative to the controls. Three representative case studies of the tested population are discussed in detail, to demonstrate the clinical utility of BNA. Conclusion: The data support the utility of BNA to augment clinical examinations, symptoms and additional tests by providing an effective method for evaluating objective electrophysiological changes associated with sport-related concussions.

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“…For instance, there is a long and complex history of attempting to develop classification and diagnostic standards for MHI [19]. The Glasgow Coma Scale (GCS) [20], a system used to assess coma and impaired consciousness, is the most common diagnostic index to classify severity of injury, mild being GCS 13-15.…”

Section: Implications For Clinical Practice and Service Planning And mentioning

confidence: 99%

The epidemiology of a specialist neurorehabilitation clinic: Implications for clinical practice and regional service development

et al. 2014

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Data gathered from the cohort gives increased understanding of the characteristics and numbers of patients requiring rehabilitation and adds to the evidence-base. Integration with new and complementary service developments has optimized the function/aims of the clinic and enhanced its role in terms of patient service and outcome and as a research resource. The model provides principles which may be applied to planning, organizing and providing follow-up/rehabilitation services for HI/TBI.

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Is a diagnosis of “mild traumatic brain injury” a category mistake?

Cited by 28 publications

References 109 publications

Identification of Serum MicroRNA Signatures for Diagnosis of Mild Traumatic Brain Injury in a Closed Head Injury Model

Identification of Serum MicroRNA Signatures for Diagnosis of Mild Traumatic Brain Injury in a Closed Head Injury Model

Preliminary investigation of Brain Network Activation (BNA) and its clinical utility in sport-related concussion

The epidemiology of a specialist neurorehabilitation clinic: Implications for clinical practice and regional service development

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