Concussion and mTBI
What are Concussions?
A concussion is a form of mild traumatic brain injury. A concussion results in abnormal brain function, and can have a profound impact on an individual’s quality of life. Concussions are the most common form of mild traumatic brain injury, or mTBI. TBIs are usually the result of a blow to the head of some kind, however they can also be the result of rapid rotational forces that injure brain cells.
How Common are Concussions?
Traumatic brain injuries and concussions are serious problems. There are millions of mTBIs each year in the United States. According to the CDC, there were 2.87 million TBI-related emergency department visits, hospitalizations, and deaths in the US, including over 837,000 involving children (1).
What Causes Concussions?
Concussions are very common in sports, are often seen in motor vehicle collisions, and are very commonly the result of falls among older adults. Most concussions are mild injuries, and their symptoms usually go away on their own without treatment. Unfortunately, a large number of people that have suffered concussions have symptoms that persist for months and years into the future. Up to 15% of concussions result in what is called Post-Concussion Syndrome, or PCS. This can be a profoundly disabling condition that impacts every aspect of the person’s life and those of their family (7).
What are the Symptoms of a Concussion?
People injured with concussions can struggle with headaches and head pressure. They can experience debilitating dizziness and vertigo, and may struggle with balance problems. They may have difficulty with blurry or double vision. They can struggle with sensitivity to light and sound, and are frequently overwhelmed in complicated sensory environments. Concussion sufferers may experience profound fatigue, depression, increased anxiety, and may struggle with concentration, memory, word-finding, and emotional regulation (8).
What are the Consequences of a Concussion?
Concussions can have profound impacts on every aspect of your life. You can lose the ability to function in the world. Simple tasks such as reading can become exhausting and provoke your headache and dizziness. Following conversations or even basic mental tasks can be exhausting. Going to a grocery store can become a special level of hell. Driving or riding in cars can provoke headaches, dizziness, and panic attacks. Using screens or working on computers can cause all of your symptoms to increase. In short, after a concussion even the simplest tasks can become insurmountable. Depression, anxiety, post-traumatic stress disorder, and emotional distress are common long-term consequences of concussions. Rates of substance abuse are higher following concussions (2). Sleep disorders are common long-term consequences of concussion (3), as is chronic pain (4). Job and academic performance are frequently decreased, leading to wage losses and increased rates of unemployment (5). Concussions also tragically increase the risk of suicide (6).
What Happens to the Brain in a Concussion?
Brains are made up of several types of cells. The type that most people think of when they hear “brain cell” is a neuron, the primary cell involved in the electrical activity of the brain. You brain has billions of individual neurons, all continuously sending electrical messages back and forth between each other. There are also several types of supporting cells called glia. Glial cells provide important structural functions, and do things ranging from helping neurons communicate with each other more efficiently to cleaning out metabolic waste. Neurons have cell bodies, sites where other neurons attach called dendrites, and long thin projections called axons. Most of the brain’s cell bodies are found in the cerebral cortex, in the hills and valleys of the first few millimeters of the brain, also known as gray matter. The majority of the rest of the brain is white matter, made up of axons running back and forth between neurons in pathways. These axons can range from extremely short to several inches long. As axons are projections from a single cell, they are very fragile, and have poor resistance to stretch and shearing forces. When the brain undergoes either an impact, a fast twisting force, or both, axons can become damaged. Depending on the trauma, this may injure an individual group of axons, or create a diffuse axonal injury that affects multiple brain regions and pathways. Neurons within particular pathways may be damaged such that they lose efficiency, or be lost altogether (9). As the brain heals, the neurons that remain are forced to take on the function of the damaged and lost cells. Depending on the extend of the injury, this may be easy or impossible. At times neurons are forced to do more than they can handle, which can overstimulate them and cause further injury. Neurons are not like muscle cells, in that with muscles the best way to build strength is to push them to the point of failure. When neurons are stimulated past their point of fatigue, they generally die off. One of the main problems we see in post-concussion syndrome is neural pathways that are continuously fatiguing as they are required to perform not only their previous functions but those of lost cells as well (10).
How are Concussions Usually Treated?
Concussions and other forms of mTBI are first treated with instructions to rest and avoid sensory input. Unfortunately, many people that we see have received no further guidance on how to improve their persistent concussion symptoms. As symptoms improve, people are guided through a process of graduated activity, with the goal of return to their full previous activity level. In some cases, this is successful. In more complicated cases where people are struggling to improve, they can be guided through a process that involves rehabilitation involving physical therapy, speech and occupational therapy, vision therapy, and vestibular therapy (11). Many people get better with therapy, but unfortunately many others have incomplete recoveries. Millions of people suffer with long-term effects of brain injuries, and many of them have given up hope of ever living a life like they once had.
TMS Treatment
Transcranial Magnetic Stimulation, or TMS, uses an MRI-strength magnet with a focal beam to directly activate areas of the brain that are not functioning appropriately. It involves the placement of a magnetic coil over the regions we want to activate. Gentle pulses of magnetism directly stimulate the neurons we target, which helps them perform their functions more effectively and without fatigue. One of the most common changes in the brain following a mTBI is decreased activity in the left dorsolateral prefrontal cortex. This region of the brain is important for many functions and processes but one of the most important is mood regulation. Depression is a common symptom following a mTBI and stimulating this part of the brain is key in improving symptoms of depression.
Your Next Best Step
Living with the symptoms of a mTBI is extraordinarily challenging, but there is hope for relief and improvement. To see if TMS is right for you, contact our front desk and schedule a free consultation with Shauna Hahn, PMHNP.
And remember, it’s never too late to start feeling better.
References:
1. https://www.cdc.gov/traumaticbraininjury/basics.html
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094361/
3. https://www.ncbi.nlm.nih.gov/pubmed/23729938/
4. https://www.ncbi.nlm.nih.gov/pubmed/18698069
5. https://www.ncbi.nlm.nih.gov/pubmed/30846966
6. https://www.ncbi.nlm.nih.gov/pubmed/26858348
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909759/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519658/
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5751203/