Artistic rendering of the brain with the central nervous system outlined in blue.

Traumatic Brain Injury

The Diagnosis and Treatment of Concussions, Traumatic Brain Injury (TBI), Chronic Traumatic Encephalopathy, and Post-Concussive Syndrome

There has been a lot of attention and media coverage surrounding Traumatic Brain Injury (TBI) in veterans, professional athletes, and younger athletes. This attention is warranted due to the potential severity of the associated symptoms and illnesses that brain injuries can have on individuals, which include cognitive deficits, personality changes, increased rates of psychiatric illness as well as increased risk for neurodegenerative disorders, such as Parkinson’s disease or Alzheimer’s disease. Each year in the United States alone, there are more than 1,700,000 TBIs!

Unfortunately even after an initial evaluation, diagnosis, and treatment, symptoms and decreased function can persist for weeks to months to years after a TBI. This is where The Center for Healing Neurology can assist in the healing process by implementing a whole-body treatment approach to ensure proper healing and recovery.

What is a Traumatic Brain Injury?

TBIs are a result of structural injury and/or physiologic disruption of brain function from blunt trauma or acceleration/deceleration forces resulting in cognitive, physiological and psychological impairments. Following trauma there is a period of observed neurologic dysfunction, confusion, disorientation, and changes in consciousness or amnesia.
• Concussions are a type of TBI correlated with short-lived neurologic impairment, with or without loss of consciousness, and symptoms resolve spontaneously. They are often thought of as a mild brain injury with functional manifestations rather than structural injury.
• Mild brain injuries have normal imaging, loss of consciousness for 0-30 minutes, altered mental state or post-traumatic amnesia for 1 moment to 24 hours.
• Moderate brain injuries have normal or abnormal imaging, loss of consciousness for 30 minutes to 24 hours, altered mental state or post-traumatic amnesia for 1 to 7 days.
• Severe brain injuries have normal or severe imaging, loss of consciousness for greater than 24 hours, altered mental state or post-traumatic amnesia for days to weeks.

What is Happening to My Brain Following a TBI?

Acute trauma to the brain results in an inflammatory cascade, which is a protective mechanism for the brain to clear out dead and damaged cells. This process can last a few days to a couple of weeks, which is why mild TBI symptoms usually resolve in this time frame. Complications or persistent symptoms occur if the body cannot mount an appropriate inflammatory response due to a compromised immune system or if a second injury happens while the brain is still trying to heal the first injury. Persistent activation of inflammatory processes in the brain leads to oxidative stress, neuronal membrane excitotoxity, blood-brain-barrier dysfunction, mitochondrial dysfunction and brain cell injury resulting in more inflammation and a persistent inflammatory loop. Chronic brain inflammation overwhelms the brain’s ability to function and repair itself, ultimately resulting in nerve cell death, post-concussive syndrome and/or chronic traumatic encephalopathy, which may lead to other neurodegenerative disorders, such as Parkinson’s disease or Alzheimer’s disease.
What Happens if I Have More Than One TBI?

In a mild TBI or concussion, the brain has the initial inflammatory response to clear out damaged cells and initiate your body’s ability to heal with its own antioxidant systems. This process lasts a few days to a week and resolves itself. Problems occurs if a second injury happens while the brain is still healing, which leads to an increased amount of inflammation produced in the brain. This persistent inflammation leads to permanent damage of the mitochondria, which disrupts the vital energy supply and ultimately results in nerve cell death and more severe, chronic symptoms. This is why it is so important to allow for complete recovery before returning to competition to prevent multiple injuries occurring in a short period of time.
Post-Concussive Syndrome: Symptoms of a concussion should fully resolve within 3-4 weeks of the injury, and in most cases, they do. If symptoms persist for more than 3 months, this is called Post-Concussive Syndrome. Individuals may experience headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration and memory, ringing in ears, vision changes, and increased sensitivities. Post Concussive Syndrome is a result of the body’s inability to regulate an appropriate inflammatory response resulting in persistent activation of immune cells and inflammatory cascades in the brain.
Chronic Traumatic Encephalopathy (CTE): CTE results from repeated mild to moderate TBIs over a lifetime, leading to persistent activation of the inflammatory cascade in the brain. Short- term activation of inflammatory responses is neuroprotective, while chronic activation is involved in neurodegeneration. In a case report, 12 brains with CTE at autopsy were found to have neurofibrillary tangles and tau proteins, which are markers for Alzheimer’s disease. Another report of 3 athletes with CTE had TDP-43, an intracellular aggregate representative of several neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis. Repetitive brain trauma is one of the most common injuries in contact sports and military conflicts. CTE was diagnosed postmortem in 87% of men who played American football!

How Does Trauma and Prolonged Inflammation in My Brain Affect My Daily Life?
Brain pathways for higher executive functions such as working memory, decision making, problem solving and mental flexibility are vulnerable to injury in TBIs and individuals may experience cognitive deficits post brain injury. TBIs may also have whole body effects by damaging our hypothalamus and pituitary areas in our brain which control and release hormones. Hormones are chemicals that help your body work properly. Hormone balance is crucial for proper development, response to stress, metabolism and sexual function.
There is also evidence that neurotransmitters, chemical messengers responsible for nerve communication, which aid in maintaining cognitive and behavioral stability are altered in TBIs. This alteration in neurotransmitters can result in an increased risk of developing various psychiatric disorders—the most common diagnoses being depression, substance abuse, and anxiety disorders.

What is an Effective Integrative, Holistic Treatment?

Sleep, Rest, and Diet: After a TBI, a patient typically needs to rest for at least 2 to 4 weeks to allow for proper healing. Sleep is essential for adequate flow of cerebral spinal fluids as well as proper function of the detoxification pathways for the brain to clear out damaged cells.
In general, the diet of someone with a history of a TBI should emphasize organic whole foods, healthy fats, berries and vegetables, while decreasing processed foods, avoiding alcohol, food colorings and additives such as monosodium glutamate (MSG) and aspartame as these are known to be toxic to nerves.

Gut-Brain Axis: Multiple routes of a two-way communication between the gut and brain have been established providing evidence of a direct correlation between intestinal permeability and blood-brain barrier permeability. Within hour to days’ post TBI there are detrimental changes in the permeability of intestinal mucosa. When we experience trauma, or ingest inflammatory foods or pesticides, the lining of the intestines gets torn, allowing larger particles and waste to get into the blood stream. Once these particles are floating around in the blood, the body recognizes them as foreign, and creates antibodies against them inciting an immune reaction and inflammatory cascade. Systemic inflammation follows. This perpetually keeps the blood-brain barrier (BBB) open and fuels further inflammation in the brain. Intestinal permeability needs to be addressed as part of an integrative, whole-body approach to healing the brain.

Antioxidants and Anti-inflammatory Supplements: Antioxidants are important to balance out the oxidative stress injury and inflammation can cause. Essential fatty acids such as fish oils, flax seed, and borage oils are examples of anti-inflammatories. Phospholipids are the actual communicating fats that sit inside cell membranes and help nutrients enter into cells. Tumeric/curcumin has both anti-inflammatory and antioxidant properties, boswellia is a great herb to help decrease inflammation, vitamin E is a powerful antioxidant and because it is fat soluble works especially well in the brain, and vitamin C is a potent anti-inflammatory/antioxidant. N-acetyl cysteine is also a potent antioxidant and a precursor for glutathione, which is one of the body’s most important nutrients to bind reactive oxygen species and eliminate toxins.

Nutrient Infusions: Intravenous infusions of vitamins and nutrients, especially glutathione, are important to help manage the acute inflammatory response that results in accumulation of reactive oxygen species, impaired mitochondrial function, and further neuronal damage. Glutathione binds the reactive oxygen species helping decrease further inflammation. As inflammation persists, more nutrients are consumed and are more likely to become exhausted. IV therapy bypasses digestion and allows for the delivery of high doses of nutrients directly into the bloodstream. The right balance of vitamins and minerals provides the appropriate cofactors so our brain chemistry can work properly.

Mitochondrial Support: There is an increase in energy expenditure with chronic inflammation that leads to mitochondrial dysfunction and depletion. The imbalance between a higher energy demand for repair of cell damage and decreased energy production led by mitochondrial dysfunction aggravates cell damage. Important nutrients for mitochondrial health are alpha-lipoic acid, coenzyme Q10, acetyl-l-carnitine, magnesium and ribose.

Oxygen: Oxygen is critical for the brain to function. Oxygen moves into cells bringing with it nutrients for energy and proper metabolic processes in exchange for carbon dioxide and toxins. If there is an injury, there can be a buildup of carbon dioxide in brain cells causing more damage and perpetuating injury. Increased blood saturation of oxygen will increase the concentration of oxygen to the brain, increasing the number of nutrients moving into tissues to promote healing.
Promoting dilation of blood vessels with nutrients like nitric oxide and arginine as well and increasing the amount of oxygen with oxygen therapy or a hyperbaric chamber are key for brain healing.

Acupuncture and Manual Therapies: These therapies have a powerful effect on relaxing muscles, stimulating blood flow, and promoting healing. They facilitate the movement of cerebrospinal fluid, increasing removal of damaged cells and inflammatory debris.

Stem Cells: Regenerative medicine therapies using multipotent stem cells have a growing body of evidence to support their efficacy in the treatment of TBI and neurodegenerative diseases. Stem cells are cells that have the ability to differentiate and self-replicate into other cell types. Mesenchymal Stem Cells (MSCs) have immunosuppressive properties that reduce inflammation in injured tissue. These cells have the ability to regenerate injured tissues and secrete growth factors that facilitate regrowth of neurons in the brain. There is evidence supporting the use of MSCs to alleviate negative associated symptoms and illness resulting from TBI. Studies have shown a significant improvement in sensory and motor function of damaged brain tissue using MSCs. Although many of these studies have been limited to animals, they have reported the potential mechanisms by which MSCs might enhance the function of patients’ nervous systems post traumatic brain injury.

In summary, timely, efficient treatment is critical for brain health and longevity. Even mild TBIs can lead to prolonged symptoms and long-term serious sequelae. If you have experienced a head injury and are suffering from adverse symptoms, please find a qualified healthcare practitioner who will help you address the root cause of injury.

Resources:

Hasan, Anwarul, et al. Advances in Pediatrics., U.S. National Library of Medicine, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5316525/.
Lucke-Wold, Brandon Peter, et al. “Linking Traumatic Brain Injury to Chronic Traumatic Encephalopathy: Identification of Potential Mechanisms Leading to Neurofibrillary Tangle Development.” Advances in Pediatrics., U.S. National Library of Medicine, 1 July 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4089022/.
McAllistor, Thomas W. “Neurobehavioral Sequelae of Traumatic Brain Injury: Evaluation and Management.” Advances in Pediatrics., U.S. National Library of Medicine, Feb. 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2327235/.
Bollerslev, et al. “Traumatic Brain Injury: Effects on the Endocrine System | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic.” OUP Academic, Oxford University Press, 1 Mar. 2013, academic.oup.com/jcem/article/98/3/27A/2536485.
Hasan, Anwarul, et al. Advances in Pediatrics., U.S. National Library of Medicine, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5316525/.
Bansal, Vishal, et al. “Traumatic Brain Injury And Intestinal Dysfunction: Uncovering The Neuro-Enteric Axis.” Journal of Neurotrauma, June 2009, p. 110306202455053., doi:10.1089/neu.2008-0858.

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