A review published in the September 2017 issue of Frontiers in Neurology proposes use of “systems science” to better understand concussion diagnosis and prognosis. This is a discipline that analyzes complex problems as whole systems and integrates research findings from different disciplines. In explaining the need for a systems approach, the reviewers note one description of concussion that is uniformly recognized – that it is a highly heterogeneous phenomenon, with numerous factors interacting dynamically to influence an individual’s recovery trajectory. (This concept is highlighted in the title of one of the Concussion WebCasts made available by the American Association of Family Physicians : “If you have seen one concussion, you have seen one concussion.”) Read More
One of the most common symptoms following TBI is photophobia, an intense intolerance to light that can cause significant discomfort, interfere with activities of daily living, and contribute to post traumatic headaches. It can impact the ability to work at computer screens and in well-lit offices and can cause a great deal of fatigue for patients who try to return to usual activities. Avoiding light can be very limiting. Read More
In a study published in the Journal of the American Medical Association (JAMA) on December 20, 2016, Canadian researchers found that children and adolescents who returned to exercise within seven days of experiencing a concussion had nearly half the rate of persistent post-concussive symptoms a month later. This finding challenges the current cornerstone of pediatric concussion management, which is physical and cognitive rest until acute symptoms have resolved. Read More
Department of Defense researchers endorse use of eye tests as an effective screening tool for acute mild traumatic brain injury (concussion)
In prior posts we have discussed the growing recognition that one of the signature symptoms of concussion is a subtle change in visual processing. Army researchers funded by the US Department of Defense have just published findings further supporting this understanding in the November 15, 2016 issue of the Journal of the Neurological Sciences.
In the published findings, the authors note that “mild” traumatic brain injury (mTBI) is sometimes difficult to diagnose because of the overlap of symptoms with other disorders such as PTSD. This has led to a quest for biomarkers or diagnostic tests (e.g. protein, imaging, cognitive, neurosensory.) This quest is especially significant for warfighters at risk for more severe “second-impact” concussions and whose lives and safety may be endangered by visual or cognitive compromises. Read More
There’s new evidence supporting immediate removal of athletes from play following concussion.
A new study published in the September, 2016 issue of Pediatrics provides evidence that returning to play immediately following a sports related concussion, even without a “second impact” nearly doubles, on average, the length of time required to recover and exposes athletes to a greater risk of protracted symptoms. As the authors point out in their report, the Institute of Medicine and National Research Council stated in 2013 that
“the culture of sports negatively influences SRC [sports related concussion] reporting and that athletes, coaches, and parents do not fully acknowledge the risks of playing while injured.”
In our May, 2014 post, we reported on research showing that traumatic brain injury, including mild traumatic brain injury (mTBI), can damage and cause dysfunction in the pituitary gland resulting in deficiencies in key hormones released by the pituitary gland, such as Growth Hormone (GH). As we explained in that post, the anatomy of the pituitary gland makes it particularly susceptible to the sheering injuries seen in TBI. These hormone deficiencies can produce many of the persistent symptoms seen following a TBI, such as fatigue, poor memory, depression, anxiety, emotional lability, exercise intolerance, lack of concentration and attention difficulties. (Although not always the case, these deficiencies can also produce physical symptoms, such as increased fat mass – especially in the abdominal area – and increased cholesterol.) We also noted findings showing that pituitary dysfunction can worsen over the five year period following an injury – in other words, that this is an issue that deserves to be monitored on an ongoing basis. Read More
Neuroinflammation as a likely cause of persistent symptoms following traumatic brain injury (TBI), as well as increased risk of neurodegenerative complications, is leading to increased attention on anti-inflammatory strategies with diet, exercise, lifestyle and medication
Our May 28, 2015 blog post discussed the evidence offered by McMasters University researchers in support of their conclusion that the body’s immune response following injury can lead to unchecked, ultimately destructive neuroinflammation and that this likely underlies persistent symptoms following TBI as well as increased risk of neurodegenerative conditions such as chronic traumatic encephalopathy (CTE) and Alzheimers. The authors observed similar neuroinflammatory processes in patients without a history of head injury, such as patients with serious infections, PTSD and Depression. They also noted that subtle genetic differences may explain differences in inflammatory responses between patients, leading to different long term outcomes. The October 2015 issue of Trends in Neuroscience includes a review by Ohio State neuroscientists with further support for this new paradigm for understanding the brain’s response to injury. See “Priming the Inflammatory Pump of the CNS after Traumatic Brain Injury.” Read More
Research from the National Institute of Health, published in the August 3, 2015 issue of JAMA Neurology, shows that a protein that was until recently linked only to acute symptoms following traumatic brain injury, may also be responsible for chronic neurological symptoms, such as headache and dizziness, found in patients diagnosed with persistent post-concussion syndrome.
Tau is a protein known to play a significant role in the development of Alzheimer’s disease and Parkinson’s disease. Using ultra-sensitive technology, the researchers measured levels of tau in the blood months and years after injury. These levels correlated with the severity of post-concussive symptoms. If these findings are further confirmed, this could be the first biomarker that is sensitive and specific to ongoing TBI symptoms. Read More