Blood test to help diagnose and manage mild traumatic brain injury

Dr Stuart McDonald, from the Monash Trauma Group, in the Department of Neuroscience, CCS, and his colleagues have been awarded an NHMRC Ideas Grant of $1,092,780 for his research on blood markers of mild traumatic brain injury (mTBI).

This grant was one of 283 grants announced by the Minister for Health, the Hon Greg Hunt MP on Tuesday 15 December, with a total budget of $260 million. The Ideas Grants provide an opportunity for researchers to make future advances in health and well-being, with projects being funded for 3-5 years.

Dr McDonald said that mild traumatic brain injuries (mTBIs), such as concussions, account for >80% of TBI cases. He said, "Mild TBIs can lead to debilitating long-term neurological disturbances." These include persistent post-concussion symptoms (PPCS) that affect >20% of mTBI patients. Nonetheless, he said, "the identification and management of mTBIs remains notoriously difficult."

Diagnosis is reliant on physical signs and self-reported symptoms that are often subtle and rapidly evolving in nature. As such, many mTBIs are undiagnosed or misdiagnosed. No objective tools are available to help identify those that are at high risk of conditions such as PPCS, nor to determine if/when the brain has neurobiologically ‘recovered’.

Without objective prognostic tests, those that may benefit from increased management or interventions cannot be identified. Without tools to identify recovery, it is likely that individuals return to work/play while the brain is still highly vulnerable to repeated mTBI.

Exciting new data from pre-clinical and clinical studies by the mTBI experts at Monash University, indicate that blood measures of a protein called neurofilament light (NfL), an indicator of damage to axons, may have great potential to objectively assist in the identification and management of mTBI.

The goal now is to build on the findings by bringing together a multidisciplinary team led by Dr Stuart McDonald, (Research Fellow and Director of Fluid Biomarker Research at the Department of Neuroscience), Professor Biswadev Mitra (Emergency Physician and Director of Emergency Medicine Research at Alfred Health), and Associate Professor Catherine Willmott (Neuropsychologist and Academic Lead of the Clinical Neuropsychology and Concussion Clinics at the Monash Psychology Centre) with associate investigators Associate Professor Sandy Shultz, Professor Terence O'Brien , Associate Professor Richelle Mychasiuk, Dr Zhibin Chen, Dr Christopher French, and Professor Jennie Ponsford.

The team of clinical and basic science mTBI experts will now investigate how serum NfL levels can be used to assist in mTBI diagnosis, and the identification and management of individuals at risk of suffering persistent or chronic neurological problems. The program will feature athletes and patients admitted to emergency, as well as a clinically relevant rat model of mTBI. The Monash Trauma Group aims to improve the understanding and treatment of TBI by utilizing a translational research approach that incorporates both animal model and patient studies.

Dr McDonald said, “We are excited to now determine exactly how this blood test can take some of the guesswork out of mild TBI management. Ultimately, we hypothesise that this test will have particular use for helping to identify individuals at greater risk of experiencing persisting symptoms after mild TBI, and in the sporting or military context, if and when the brain has recovered and is no longer highly vulnerable to repeated injury.”