Can a blood test be developed
to assess mTBI?
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Home › Our Approach › Perspectives › Can a blood test be developed to assess mTBI?
Brain injury is unpredictable in its consequences, affecting who we are, the way we think, act, and feel1. Identifying a brain injury early-on can impact treatment therapy and can improve patient outcomes. A partnership between Philips and Banyan Biomarkers of San Diego, is working to address this challenge. Those suffering from ‘post-concussion syndrome’ often struggle. Persistent symptoms adversely affect quality of life, spark behavioral changes and delay the patient’s ability to return to work/duty. The question often asked is, how can we assess mTBI in its earliest stages to treat it more effectively? A simple blood test may be the answer.
The U.S. Department of Veterans Affairs is excited to announce an inaugural public-private partnership brain health event that focuses on mild TBI and PTSD. The event is designed to promote forward-thinking dialogue among industry, national sports organizations, the DoD and other Federal Agencies, innovators, scientists, clinicians - and the Veterans and caregivers they serve.
What is mild Traumatic Brain Injury?
Traumatic brain injury is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force3. It is classified as mild (more than 80% of TBI at the ED), moderate, or severe. The phrase ‘mild traumatic brain injury’ (mTBI) is a bit misleading as the word “mild” is used in reference to the severity of the initial physical trauma that caused the injury. It does not indicate the severity of the consequences of that injury4. Symptoms of mTBI may be limited at the time of injury. Post concussion syndrome may appear hours, days, and even weeks after the primary event. When they do manifest, they are similar to symptoms of PTSD.
According to the US CDC, there are approximately 2.5 million Emergency Department visits, hospitalizations, or deaths associated with traumatic brain injury in the US annually2. Causes of TBI can be as varied as the people it affects including damage by explosive devices, falls, and motor vehicle accidents.
Know the signs…
15% of people with mTBI have symptoms that last one year or more5. mTBI symptoms can include:
mTBI: tough to diagnose and risk stratify
Early identification of patients at risk for long-term neuropsychological dysfunction could greatly improve opportunities for effective, targeted therapies. Yet, currently there is no simple point-of-care test available to physicians in the emergency room or hospital that can accomplish this.
Physicians struggle to provide a quick and proper diagnosis of mTBI. Often the person looks, moves, and acts normally. While 90% of patients with minor head injury have no CT scan abnormalities, many go on to exhibit long-term neuropsychological dysfunction. Failure to make a correct diagnosis and timely selection of the appropriate treatment can have serious implications.
A blood test for early diagnosis of mTBI?
Dr. Joseph Frassica, Chief Science Officer for Philips Research North America sets the premise, “We asked ourselves, is there a biomarker of some sort – whether it’s an imaging biomarker, a chemical biomarker, or some physiological biomarker – that we can use to predict which patients with mTBI will go on to have post injury psychiatric problems?” In answer, Banyan has discovered two protein biomarkers that rapidly appear in the blood of patients soon after injury, and they have developed assays to quantify these proteins. Detecting these biomarkers may provide early indications of brain trauma in patients and lead to improved treatment decisions.
The growing number of TBI patients in the DoD/VA healthcare system has had a detrimental impact on patient volume. To better manage this volume Philips and Banyan Biomarkers are collaborating with the Department of Defense to develop a point-of-care blood test to quickly evaluate traumatic brain injury.
mTBI: tough to diagnose and risk stratify
Early identification of patients at risk for long-term neuropsychological dysfunction could greatly improve opportunities for effective, targeted therapies. Yet, currently there is no simple point-of-care test available to physicians in the emergency room or hospital that can accomplish this. Banyan Biomarkers, with support from the U.S. Department of Defense has successfully conducted several human feasibility studies and completed enrollment of 2000 patients for an international pivotal study. "A rapid and objective point-of-care test to evaluate traumatic brain injury will help millions of patients throughout the world," stated Jackson Streeter, MD, Chief Medical Officer of Banyan Biomarkers. Another recent independent study published online by JAMA Neurology also favorably supports the ability of biomarkers to help evaluate mTBI. This quick, accurate blood test may do more than help change the course of care. It may change the course of someone’s life.
Physicians struggle to provide a quick and proper diagnosis of mTBI. Often the person looks, moves, and acts normally. While 90% of patients with minor head injury have no CT scan abnormalities, many go on to exhibit long-term neuropsychological dysfunction. Failure to make a correct diagnosis and timely selection of the appropriate treatment can have serious implications.
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Scenario
Point-Of-Care Test (POCT) for patients with head injuries will help clinicians reach decisions.
Bedside neurological examination performed
Minicare TBI POCT presents positive or negative results
Positive results followed up by neuroimaging
An open platform strategy
“The collaboration with Banyan Biomarkers is another example of Philips open platform strategy to allow other companies to use our Minicare I-20 system. We are open to novel TBI biomarkers which aim to improve the rule-in/rule out for mild TBI.” – Marcel van Kasteel, CEO of Philips Handheld Diagnostics.
A noninvasive intracranial blood pressure test?
In a parallel initiative, Philips is teaming up with researchers in MIT’s Institute for Medical Engineering and Science (IMES) and surgeons at Boston Medical Center’s Department of Neurosurgery to test and refine a noninvasive way to measure intracranial pressure (ICP) using ultrasound technology. “Today,” says Dr. Frassica, “for patients that have head/brain injuries, one of the things we need to do is follow the pressure inside the skull. In cases of severe brain injuries we put catheters through the skull to continuously measure the pressure and then drain fluids or administer medication to decrease as required. However, we hesitate to insert catheters into patients who are on the borderline between moderate and severe, because it is an invasive procedure that carries significant risk. In those patients we wonder if noninvasively measuring the ICP would alter our treatment. I suspect it certainly would.”
1 Living with Brain Injury, Brain Injury Association of America, website, accessed 3/29/16, https://www.biausa.org/livingwith-brain-injury.htm 2 Injury Prevention & Control: Traumatic Brain Injury & Concussion, Centers for Disease Control and Prevention, website, accessed, 3/29/16, https://www.cdc.gov/traumaticbraininjury/get_the_facts.html 3 Menon, David K., et. al., Position Statement: Definition of Traumatic Brain Injury, Archives of Physical Medicine and Rehabilitation, November 2010, Volume 91, Issue 11, Pages 1637-1640, website, accessed 3/29/16, http://www.archivespmr.org/article/S0003-9993%2810%2900650-7/abstract 4 Mild Brain Injury and Concussion, Brain Injury Association of America, website, accessed 3/29/16, https://www.biausa.org/mild-brain-injury.htm 5 TraumaticBrainInjury.com, https://www.traumaticbraininjury.com/symptoms-of-tbi/mild-tbi-symptoms/
