FDA Approves TBI Blood Test, Causal Link Between Smoking and Subarachnoid Hemorrhage, Inconsistencies Across EEG Education

This week Neurology News Network covered the FDA approval of the first handheld traumatic brain injury blood test, a study on the causal link between smoking and subarachnoid hemorrhage, and the inconsistencies across EEG education within residency programs.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus.

The FDA has given 510 (k) clearance for the first rapid handheld traumatic brain injury (TBI) blood test, which will help clinicians assess patients with suspected mild TBIs, including concussions, and will be ran on Abbott’s handheld i-STAT Alinity platform. The test measures specific proteins present in the blood after a TBI and provides results in as little as 15 minutes after plasma is placed in the test cartridge. CT scans, often used to diagnose concussion, can then be ruled out if a patient has a negative test result. Following a blood sample drawn from a patient’s arm, plasma is extracted with a centrifuge and applied to the test’s cartridge. The cartridge is then inserted into the handheld instrument. A positive test result can complement CT scans and help clinicians evaluate whether a patient has TBI. Abbott noted that the plasma test provides results with 95.8% sensitivity and 99% negative predictive value. It was originally developed in collaboration with the US Department of Defense (DOD), which have played a role in increasing detection and evaluation of TBI.

Findings from a 1-sample Mendelian randomization (MR) study using data from the UK Biobank revealed a causal link between smoking and the risk of subarachnoid hemorrhage. Senior author Guido J. Falcone, assistant professor of neurology, Yale School of Medicine, and colleagues built a polygenic risk score using independent genetic variants known to associate with smoking behavior, as a representative of the genetic susceptibility to smoking initiation. They found a 21% increased risk of smoking and a 10% increased risk of SAH for each additional standard deviation (SD) of the smoking polygenic risk score. The primary MR analysis, which utilized the ratio method, indicated that genetic susceptibility to smoking was associated with a 63% increase in the risk of SAH.

Data from a recently published study identified a lack of consistency in teaching and evaluating residents on electroencephalograms (EEG) during residency and presented EEG education barriers alongside possible solutions. Fabio Nascimento, MD, and Jay Gavvala, MD, MSCI, surveyed 47 program directors (PDs) of adult neurology residency programs in the US, most of them academic (89%), and found that the average number of EEGs read during a typical EEG rotation varied from more than 40, in about one-third of programs, to 0–10, in about 14% of programs. Nascimento’s findings showed that 64% of programs did not utilize objective measures to assess EEG milestones. The objective measures that were used in programs varied significantly, and included EEG tests/quizzes, oral examinations, Residency In-service Training Examination (RITE), Self-Assessment Examination (SAE), American Epilepsy Society (AES) examination, direct assessment from faculty, evaluation of EEGs logged by residents, and number of EEGs read during the rotation.

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