Post Concussive Symptoms
Conditions
Brief summary
The goal of this study was to investigate the biomarkers, neurofilament light chain, inflammatory markers, calcitonin-gene-related peptide, and metabolites from the kynurenine pathway in patients with severe post-concussive symptoms. The main question it aimed to answer was: * Are the biomarker concentrations significantly changed in patients with severe post-concussive symptoms compared to healthy individuals? * Do the biomarker concentrations change at follow-up? Participants were recruited from a recently published randomized controlled trial (Clinicaltrials.gov no. NCT02337101 / PMID: 31891145 ). The biomarker concentrations were compared to a healthy control group recruited from the Blood Bank at Aarhus University Hospital in 2022.
Detailed description
In the previously published RCT-study (PMID: 31891145), 86 participants with severe post-concussive symptoms provided blood samples at baseline (4 months after the concussion). Severe post-concussive symptoms were defined as having a Rivermead Post Concussion Questionnaire \>20. Around 7 months later, a follow-up blood sample was obtained from 54 participants. These blood samples were used to investigate blood biomarkers for the condition.
Interventions
BEHAVIORALEarly intervention programme
For more information, please go to the original registration of the RCT-study (NCT02337101) or the published article (PMID: 31891145).
BEHAVIORALEnhanced usual care
For more information, please go to the original registration of the RCT-study (NCT02337101) or the published article (PMID: 31891145).
Sponsors
Sygekassernes Helsefond
Fonden til Lægevidenskabens Fremme
Direktør Emil C. Hertz og Hustru Inger Hertz Fond
Helga Og Peter Kornings Fond
Region MidtJylland Denmark
University of Aarhus
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 30 Years
Healthy volunteers
Yes
Inclusion criteria
Patients with severe post-concussive symptoms: Inclusion Criteria: 1. Concussion caused by a head trauma based on the diagnostic criteria recommended by the World Health Organization (WHO) Task Force 2. Age between 18 and 30 years 3. Able to understand, speak and read Danish. 4. A score of 20 or more on the Rivermead Post Concussion Symptoms Questionnaire (RPQ).
Exclusion criteria
1. Objective neurological findings indicating neurological disease or brain damage. 2. Previous concussion leading to persistent post-concussional symptoms within the last two years. 3. Severe misuse of alcohol, prescription drugs and / or illegal drugs. 4. Severe psychiatric, neurological,or other medical disease that would impede participation in the intervention 5. Inability to speak and read Danish Healthy control group (recruited from December 2021 - March 2022): \- Individuals from the Blood Bank at Aarhus University Hospital in Denmark. Inclusion criteria were: 1. Age between 18-30 years 2. Equal distribution between the genders (60 men and 60 women). This number was based on a power analysis using published data from neurofilament light chain.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Neurofilament light chain at baseline (primary outcome) | The baseline blood sample was taken up to 7 months after the concussion (4 months median). | The investigators hypothesized: The concentration of neurofilament light chain (ng/L) is significantly increased at baseline in patients compared to the healthy control group. |
| Neurofilament light chain at follow-up (primary outcome) | The follow-up blood sample was taken up to 12 months after baseline (7 months median) after the baseline blood sample. | The investigators hypothesized: 1)The neurofilament light chain concentration (ng/L) normalizes (decreases) at follow-up compared to the baseline concentration in patients. |
| Self-reported post-concussion symptoms score (primary outcome) | The baseline symptom score (RPQ) was obtained from the patients up to 7 months after the concussion (4 months median), and the follow-up score was obtained up to 16 months (10.5 median) after the concussion | The symptom score was measured at both baseline and follow-up using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) which is a self-reported questionnaire. The Rivermead Post-Concussion Symptoms Questionnaire contains 16 items which is rated from 0 (not experienced) to 4 (a severe problem). The total score thus ranges on a scale between 0-64. |
| Calcitonin-gene related peptide at baseline (CGRP) | The baseline blood sample was taken up to 7 months after the concussion (4 months median). | The investigators hypothesized: The concentration of calcitonin gene-related peptide (pg/mL) is decreased compared to the healthy control group at baseline |
| Calcitonin-gene related peptide at follow-up (CGRP) | The follow-up blood sample was taken up to 12 months after baseline (7 months median) after the baseline blood sample. | The investigators hypothesized: The CGRP concentrations (pg/mL) will normalize (increase) at follow-up compared to baseline. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quinolinic acid at baseline | The baseline blood sample was taken up to 7 months after the concussion (4 months median). | The investigators hypothesized that: The concentration of the neurotoxic metabolite, quinolinic acid (measured in nM), is increased in patients compared to healthy controls |
| Inflammatory markers at follow-up | The follow-up blood sample was taken up to 12 months after baseline (7 months median) after the baseline blood sample. | TNF-α and IL-6 (both pg/mL) decreases at follow-up compared to the baseline value in patients. |
| Quinolinic acid at follow-up | The follow-up blood sample was taken up to 12 months after baseline (7 months median) after the baseline blood sample. | The investigators hypothesized: The quinolinic acid concentration (nM) normalizes (decreases) at follow-up compared to the baseline concentration. |
| Neuroprotective index at baseline | The baseline blood sample was taken up to 7 months after the concussion (4 months median). | The investigators hypothesized: The ratio between the neuroprotective metabolite kynurenic acid (KYNA) and the neurotoxic metabolite quinolinic acid (KynA/QUIN) is lower than the ratio in healthy individuals at baseline. A higher ratio means a better outcome. |
| Neuroprotective index at follow-up | The follow-up blood sample was taken up to 12 months after baseline (7 months median) after the baseline blood sample. | The investigators hypothesized: The ratio between the neuroprotective metabolite kynurenic acid (KYNA) and the neurotoxic metabolite quinolinic acid (QUIN) normalizes (increases) at follow-up compared to baseline. A higher ratio thus means a better outcome. |
| Inflammatory markers at baseline | The baseline blood sample was taken up to 7 months after the concussion (4 months median). | The investigators hypothesized that: Tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) (both pg/mL) are increased in patients compared to healthy controls. |
Outcome results
None listed