An Evaluation of the Emerging Techniques in Sports-Related Concussion.

SUMMARY: 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.

PAK1 protein expression in the auditory cortex of schizophrenia subjects.

Deficits in auditory processing are among the best documented endophenotypes in schizophrenia, possibly due to loss of excitatory synaptic connections. Dendritic spines, the principal post-synaptic target of excitatory projections, are reduced in schizophrenia. p21-activated kinase 1 (PAK1) regulates both the actin cytoskeleton and dendritic spine density, and is a downstream effector of both kalirin and CDC42, both of which have altered expression in schizophrenia. This study sought to determine if there is decreased auditory cortex PAK1 protein expression in schizophrenia through the use of quantitative western blots of 25 schizophrenia subjects and matched controls. There was no significant change in PAK1 level detected in the schizophrenia subjects in our cohort. PAK1 protein levels within subject pairs correlated positively with prior measures of total kalirin protein in the same pairs. PAK1 level also correlated with levels of a marker of dendritic spines, spinophilin. These latter two findings suggest that the lack of change in PAK1 level in schizophrenia is not due to limited sensitivity of our assay to detect meaningful differences in PAK1 protein expression. Future studies are needed to evaluate whether alterations in PAK1 phosphorylation states, or alterations in protein expression of other members of the PAK family, are present in schizophrenia.