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Swaney EEK, Babl FE, Rausa VC, Anderson N, Hearps SJC, Parkin G, Hart-Smith G, Zaw T, Carroll L, Takagi M, Seal ML, Davis GA, Anderson V, Ignjatovic V. Discovery of Alpha-1-Antichymotrypsin as a Marker of Delayed Recovery from Concussion in Children. J Neurotrauma 2024. [PMID: 38597719 DOI: 10.1089/neu.2023.0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Of the four million children who experience a concussion each year, 30-50% of children will experience delayed recovery, where they will continue to experience symptoms more than two weeks after their injury. Delayed recovery from concussion encompasses emotional, behavioral, physical, and cognitive symptoms, and as such, there is an increased focus on developing an objective tool to determine risk of delayed recovery. This study aimed to identify a blood protein signature predictive of delayed recovery from concussion in children. Plasma samples were collected from children who presented to the Emergency Department at the Royal Children's Hospital, Melbourne, within 48h post-concussion. This study involved a discovery and validation phase. For the discovery phase, untargeted proteomics analysis was performed using single window acquisition of all theoretical mass spectra to identify blood proteins differentially abundant in samples from children with and without delayed recovery from concussion. A subset of these proteins was then validated in a separate participant cohort using multiple reaction monitoring and enzyme linked immunosorbent assay. A blood protein signature predictive of delayed recovery from concussion was modeled using a Support Vector Machine, a machine learning approach. In the discovery phase, 22 blood proteins were differentially abundant in age- and sex-matched samples from children with (n = 9) and without (n = 9) delayed recovery from concussion, six of whom were chosen for validation. In the validation phase, alpha-1-ACT was shown to be significantly lower in children with delayed recovery (n = 12) compared with those without delayed recovery (n = 28), those with orthopedic injuries (n = 7) and healthy controls (n = 33). A model consisting of alpha-1-ACT concentration stratified children based on recovery from concussion with an 0.88 area under the curve. We have identified that alpha-1-ACT differentiates between children at risk of delayed recovery from those without delayed recovery from concussion. To our knowledge, this is the first study to identify alpha-1-ACT as a potential marker of delayed recovery from concussion in children. Multi-site studies are required to further validate this finding before use in a clinical setting.
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Affiliation(s)
- Ella E K Swaney
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vanessa C Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Georgia Parkin
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gene Hart-Smith
- Australian Proteomics Analysis Facility, Macquarie University, Sydney, New South Wales, Australia
| | - Thiri Zaw
- Australian Proteomics Analysis Facility, Macquarie University, Sydney, New South Wales, Australia
| | - Luke Carroll
- Australian Proteomics Analysis Facility, Macquarie University, Sydney, New South Wales, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Marc L Seal
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Fotuhi M, Khorrami ND, Raji CA. Benefits of a 12-Week Non-Drug "Brain Fitness Program" for Patients with Attention-Deficit/Hyperactive Disorder, Post-Concussion Syndrome, or Memory Loss. J Alzheimers Dis Rep 2023; 7:675-697. [PMID: 37483322 PMCID: PMC10357116 DOI: 10.3233/adr-220091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/25/2023] [Indexed: 07/25/2023] Open
Abstract
Background Non-pharmacologic interventions can potentially improve cognitive function, sleep, and/or mood in patients with attention-deficit/hyperactive disorder (ADHD), post-concussion syndrome (PCS), or memory loss. Objective We evaluated the benefits of a brain rehabilitation program in an outpatient neurology practice that consists of targeted cognitive training, lifestyle coaching, and electroencephalography (EEG)-based neurofeedback, twice weekly (90 minutes each), for 12 weeks. Methods 223 child and adult patients were included: 71 patients with ADHD, 88 with PCS, and 64 with memory loss (mild cognitive impairment or subjective cognitive decline). Patients underwent a complete neurocognitive evaluation, including tests for Verbal Memory, Complex Attention, Processing Speed, Executive Functioning, and Neurocognition Index. They completed questionnaires about sleep, mood, diet, exercise, anxiety levels, and depression-as well as underwent quantitative EEG-at the beginning and the end of the program. Results Pre-post test score comparison demonstrated that all patient subgroups experienced statistically significant improvements on most measures, especially the PCS subgroup, which experienced significant score improvement on all measures tested (p≤0.0011; dz≥0.36). After completing the program, 60% to 90% of patients scored higher on cognitive tests and reported having fewer cognitive and emotional symptoms. The largest effect size for pre-post score change was improved executive functioning in all subgroups (ADHD dz= 0.86; PCS dz= 0.83; memory dz= 1.09). Conclusion This study demonstrates that a multimodal brain rehabilitation program can have benefits for patients with ADHD, PCS, or memory loss and supports further clinical trials in this field.
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Affiliation(s)
- Majid Fotuhi
- Department of Psychological & Brain Sciences, George Washington University, Washington, DC, USA
- NeuroGrow Brain Fitness Center, McLean, VA, USA
| | | | - Cyrus A. Raji
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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Swaney EEK, Cai T, Seal ML, Ignjatovic V. Blood biomarkers of secondary outcomes following concussion: A systematic review. Front Neurol 2023; 14:989974. [PMID: 36925940 PMCID: PMC10011122 DOI: 10.3389/fneur.2023.989974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 01/31/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Blood biomarkers have been identified as an alternative tool for predicting secondary outcomes following concussion. This systematic review aimed to summarize the literature on blood biomarkers of secondary outcomes following concussion in both pediatric and adult cohorts. Methods A literature search of Embase, Medline and PubMed was conducted. Two reviewers independently assessed retrieved studies to determine inclusion in systematic review synthesis. Results A total of 1771 unique studies were retrieved, 58 of which were included in the final synthesis. S100B, GFAP and tau were identified as being associated with secondary outcomes following concussion. Seventeen percent of studies were performed in a solely pediatric setting. Conclusions Validation of biomarkers associated with secondary outcomes following concussion have been largely limited by heterogeneous study cohorts and definitions of concussion and mTBI, presenting a hurdle for translation of these markers into clinical practice. Additionally, there was an underrepresentation of studies which investigated pediatric cohorts. Adult markers are not appropriate for children, therefore pediatric specific markers of secondary outcomes following concussion present the biggest gap in this field.
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Affiliation(s)
- Ella E K Swaney
- Department of Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Tengyi Cai
- Department of Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Marc L Seal
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Vera Ignjatovic
- Department of Haematology, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,Department of Pediatrics, Johns Hopkins University, Baltimore, MD, United States
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Davis GA, Rausa VC, Babl FE, Davies K, Takagi M, Crichton A, McKinlay A, Anderson N, Hearps SJ, Clarke C, Pugh R, Dunne K, Barnett P, Anderson V. Improving subacute management of post concussion symptoms: a pilot study of the Melbourne Paediatric Concussion Scale parent report. Concussion 2022; 7:CNC97. [PMID: 35733949 PMCID: PMC9199568 DOI: 10.2217/cnc-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/07/2022] [Indexed: 11/21/2022] Open
Abstract
Aim: To pilot a modification of the Post Concussion Symptom Inventory, the Melbourne Paediatric Concussion Scale (MPCS) and examine its clinical utility. Materials & methods: A total of 40 families of concussed children, aged 8–18 years, were recruited from the emergency department. Parent responses to the MPCS in the emergency department and 2-weeks post injury determined child symptomatic status. Association between MPCS symptom endorsement and symptomatic group status was examined. Results: All additional MPCS items were endorsed by at least 25% of the parents of symptomatic children at 2 weeks. MPCS items were classified into nine symptom domains, with most falling in mood, neurological, autonomic and vestibular domains. Conclusion: The additional items and domain classifications in the MPCS have the potential to improve subacute diagnostic precision, monitoring of clinical recovery and identification of appropriate interventions post pediatric concussion.
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Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Neurosurgery, Austin Hospital, 3084, and Cabrini Hospital, 3144, Melbourne, Australia
| | - Vanessa C Rausa
- Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, 3052, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, 3052, Australia
| | - Katie Davies
- Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, 3052, and Turner Institute for Brain and Mental Health, Monash University, 3800, Melbourne, Australia
| | - Alison Crichton
- Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Audrey McKinlay
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Psychology, University of Canterbury, Ilam, 8041, New Zealand
| | | | | | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Remy Pugh
- Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, 3052, Australia.,Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, 3052, Australia
| | - Peter Barnett
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, 3052, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, 3052, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, 3052, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, 3052, Australia
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