. Neurochemical Aftermath of Repetitive Mild Traumatic Brain Injury. JAMA Neurol. 2016 Nov 1;73(11):1308-1315. PubMed.


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  1. Shahim et al. studied a fairly small sample (16 hockey players and 15 controls). There was no difference between CSF NfL levels in study participants with postconcussion syndrome versus controls. However, there was a slightly significant (p=0.04) difference in a subgroup analysis between study participants with postconcussion syndrome for more than one year versus participants with postconcussion syndrome for less than one year or versus controls. It is unclear whether this subgroup analysis was planned a priori. The lack of difference between CSF NfL in postconcussion syndrome versus controls, and the significant results only in a post hoc subset analysis, raises concern that the association between NfL and PCS is either very weak or not real. Aβ42 levels were lower in PCS versus controls, but the p value was borderline (p=0.05). Replication in a larger cohort will be important to validate Shahim et al.'s findings.

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