Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; and.
J Clin Neurophysiol. 2023 Jul 1;40(5):384-390. doi: 10.1097/WNP.0000000000000879. Epub 2023 Mar 16.
Sports-related concussion is now in public awareness more than ever before. Investigations into underlying pathophysiology and methods of assessment have correspondingly increased at an exponential rate. In this review, we aim to highlight some of the evidence supporting emerging techniques in the fields of neurophysiology, neuroimaging, vestibular, oculomotor, autonomics, head sensor, and accelerometer technology in the setting of the current standard: clinical diagnosis and management. In summary, the evidence we reviewed suggests that (1) head impact sensors and accelerometers may detect possible concussions that would not otherwise receive evaluation; (2) clinical diagnosis may be aided by sideline vestibular, oculomotor, and portable EEG techniques; (3) clinical decisions on return-to-play eligibility are currently not sensitive at capturing the neurometabolic, cerebrovascular, neurophysiologic, and microstructural changes that biomarkers have consistently detected days and weeks after clinical clearance. Such biomarkers include heart rate variability, quantitative electroencephalography, as well as functional, metabolic, and microstructural neuroimaging. The current challenge is overcoming the lack of consistency and replicability of any one particular technique to reach consensus.
运动相关性脑震荡现在比以往任何时候都更受公众关注。对潜在病理生理学和评估方法的研究相应地呈指数级增长。在这篇综述中，我们旨在强调一些支持神经生理学、神经影像学、前庭、眼动、自主神经系统、头部传感器和加速度计技术领域中新兴技术的证据，这些技术在当前的临床诊断和管理标准中。总之，我们回顾的证据表明：（1）头部冲击传感器和加速度计可能会检测到可能的脑震荡，否则这些脑震荡不会得到评估；（2）场外前庭、眼动和便携式脑电图技术可能有助于临床诊断；（3）目前，关于重返比赛资格的临床决策在捕捉生物标志物在临床清除后数天和数周内一致检测到的神经代谢、脑血管、神经生理和微观结构变化方面并不敏感。此类生物标志物包括心率变异性、定量脑电图以及功能、代谢和微观结构神经影像学。当前的挑战是克服任何一种特定技术缺乏一致性和可重复性，以达成共识。
