Cobbers on the Brain

In recent years and with developing research, the severity of concussions has started to become more identified and recognized. Concussions are caused by some bio-mechanical force to the head. This could be due to a collision in sports, a car accident, a fall or any circumstance where the heat experiences a great force. Most people are familiar with the initial symptoms associated with concussions like headaches, memory issues and sensitivity to light; however, there are chemical changes happening in the brain to cause these symptoms and can explain long term changes that happen to one’s brain after a concussion.

What’s your brain doing?

These are the main events that occur in the brain after incurring a concussion.

1. The membranes of the neurons stretch as a result of the force or jolt to the head. This causes increased potassium efflux and calcium influx as well as glutamate release. The excess of glutamate release impairs learning and memory because the excitatory inhibitory balance is off and these processes are glutamate dependent.
2. There is an increased activity of ATPase (an enzyme that cleaves ATP to ADP) which causes more ATP to be consumed. This leads the body to go into hyperglycolysis in order to restore the energy that was used by trying to restore the ion balance.
3. Calcium becomes sequestered in the mitochondria which leads to impairment of glucose metabolism. This is associated with deficits in spatial learning and behavioral impairments.
4. Due to these conditions, there is more anaerobic metabolism occurring which leads to a build-up of lactate which could eventually lead to acidosis.

Long term risks

Effects of a concussion can last much longer than just a few weeks after the event occurs. It is possible to have symptoms that last years or even throughout one’s lifetime. It has been shown that having multiple concussions and not allowing enough recovery time can increase symptoms of depression in athletes. Additionally, the prevalence of anxiety was in collegiate athletes with multiple concussions. There is also an increased risk of development of Alzheimer’s Disease, Parkinson’s Disease and ALS with history of a traumatic brain injury.

Chronic Traumatic Encephalopathy (CTE) is a degenerative disease commonly found in those with a history of repetitive brain trauma. This does not necessarily mean having multiple concussions but rather hundreds of small, hard hits on the head that impact the brain over the timeframe of multiple years. CTE consists of a build-up of tau proteins that spreads throughout the brain and kill the brain cells which results in the degeneration. Symptoms usually affect one’s mood and behavior and can include aggression, depression and paranoia. When the disease is more advanced, symptoms can include difficulty with memory and thinking, confusion, dementia and loss of good judgement.

Recovery

It is extremely important that enough recovery time is allowed before returning to regular daily activities and sports after experiencing a concussion. The treatment of concussions depends on the severity of the symptoms that are experienced. In general, rest is the best way for one’s brain to recover from a concussion. This entails resting both physically and mentally which may include eliminating screens, reading, working and driving for a certain amount of time.

It is crucial to the brain’s health to allow sufficient time to recover, because repeat concussion events can cause cumulative effects on the brain. This is often difficult for many people to understand as concussions are an injury that is not visible to outsiders. When looking at someone, we may assume they seem able to play or return to their daily activities when in reality they are still suffering from symptoms that are not visible. These injuries to the brain are very serious and should be treated as such even though there may not be any physical impairment to someone’s body.

This is it. The moment you’ve been waiting for. You’ve invested blood, sweat, and tears to get here, and you’re excitement level is so high that you can hardly stand it. Your heart is racing. Your palms are sweaty. It’s the championship basketball game, your team is down by one point, there are three seconds left on the clock, and you’ve got the ball. You go for the shot, and just when the ball is leaving your fingertips, you get blindsided. An elbow hit to the head. You collapse, your mind goes blank, and the world around you fades to black. The clock runs out, the final buzzer sounds, and the other team runs onto the court to claim their trophy.

Your team, disappointed by the loss, begins to wonder why you’re being so quiet, confused, and why you can’t seem to remember anything.
They think, “It’s probably just a concussion.”

No big deal, right?

Wrong. 

Each concussive event disrupts the way the brain normally functions, and each consecutive concussion induces more damage than the previous one. In fact, repeated concussive events can  leave you more likely to develop depression, anxiety, and Alzheimer’s Disease.

So what happens to your brain after a concussion anyway?

• For starters, your brain gets overstimulated:
  • Your brain will get “too excited”
    • Right after impact, your brain’s environment will get disrupted. Positive neurotransmitters, such as glutamate, will randomly be released into the synapse inducing the firing of action potentials.

    • 

      As a result, your brain will send way too many signals.

      • In addition to the influx of glutamate, your ion channels also get disrupted. Functional ion channels are necessary all over your body.
      • Ion channels are responsible for keeping ion concentrations at optimal levels.
        • For instance, if you have too many positive ions flowing into the cell, as is the case after a concussion, your brain becomes more likely to fire signals.
      • If too many signals are getting fired, your brain becomes unable to focus on the important signals and block out the unnecessary ones. Soon your brain becomes so overwhelmed that it can’t even think straight.

• Next, your brain will try to restore it’s “normal” environment
  • This restoration isn’t cheap, and it will require currency in the form of energy, particularly ATP. This ATP is necessary to power the pumps that will put the ions back where they belong.
  • In order to produce enough ATP to power the pumps, the brain goes into a metabolic crisis by recruiting all of the stored energy available.

• The brain soon can’t keep up with the energy demand, and the ugly sides of the concussion start to take place.
  • Using all of this energy will lead to the production of lactic acid.
  • Before long the mitochondria, which produces ATP, will start to dysfunction.
  • Soon, the mitochondria will no longer be able to produce the ATP needed to restore the brain’s proper environment, or enough ATP for it to perform its regular functions. The result? The neurons start to die.

And there you have it, concussions can actually lead to the death of the cells that make your brain function properly.

So what can be done? 

1. Abolish the “it’s just a concussion” mindset.
   • Concussions are serious events that lead to serious consequences. In fact, in some situations if the individual is to experience a second concussive event before their brain is completely healed from the first one, they may experience something known as “second impact syndrome”, an often fatal incidence of brain swelling.

2. Concussions are a treatable injury

• This  source lists a variety of ways in which you can protect yourself and your loved ones from getting a concussion.
• https://www.brainline.org/article/preventing-concussion

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC155411/

Over fall break this year, I had the opportunity to travel to North Carolina to visit the UNC Graduate School and shadow a Neuropsychologist at the UNC Rehabilitation Clinic. That specific facility has the opportunity to see many patients that are retired NFL players, as funded by the NFL Players Association.

The experiences I had at UNC contribute to my knowledge on this week’s topic: Concussions. Many people understand that hitting your head probably isn’t the best thing to do. But fewer understand how serious concussions may be, especially in the case of repeated injury. At the UNC Rehabilitation Clinic, the Neuropsychologists see many retired NFL players because of a neurodegenerative disease that arises from frequent head injury. This is called Chronic Traumatic Encephalopathy (CTE) and is known to correlate with a future development of Alzheimer’s Disease, Parkinson’s Disease, ALS, and many mental illnesses. Although neurodegenerative disease does not always occur in cases of prolonged head injury, many cases of CTE show similar neuromolecular characteristics seen in these other diseases.

At UNC, we discussed CTE during a journal club that the PhD students and faculty held. Throughout the Neuropsychology community, it is disagreed upon whether CTE is a neurodegenerative disease in itself or if it is rather a risk factor for other neurodegenerative diseases. Although the consensus seems to be that CTE is a neurodegenerative disease provoked by repetitive head injury, the community agrees that “bad brain is bad brain.” This means that since there are so many working parts involved in neurological function and so many similarities between neurodegenerative diseases, that at some point of progression, all cases look similar–it becomes hard to differentiate between neuromolecular symptoms and symptom onset.

All things considered, society needs to start taking concussions more seriously–it is a brain injury, after all. We tend to think that it is more important to return to playing a sport or return to class than it is to properly care for a concussion. I personally have had experience with a few concussions. Specifically, sophomore year, I was involved in an accident that resulted in a major Traumatic Brain Injury (TBI). I lack any memory for months following the event. The one memory I do have is of sitting in class, about a week post-injury, and trying to take notes. I was nauseous, dizzy, and close to passing out. I had to leave class because I felt so sick. When I looked back on those notes a few weeks later, they were merely scribbles and random lines. I then realized that I should not have forced myself into going back to class so soon. I needed the rest. But society values us for our productivity, whether academically or athletically. When that “go go go” mentality is ingrained in us, it becomes hard to step back and take care of ourselves. This needs to change. Major TBIs and frequent head injury can lead to issues with mental health, cognition, memory, and neurodegenerative disease such as CTE. Just like we would take care of a broken leg, we must take care of our brains.  

Addictive practices arise from similar chemical pathways in our brain. The development of these pathways is through exposure to substances or other uncontrollable compulsive behavior. These pathways result in the euphoric feelings from the release of dopamine from the reward. This can result in an addiction, where your brain develops a sensitization to the substance or activity that triggers the reward pathway. This develops and rewires portions of your brain to crave the substance or activity. Following this, the addiction requires more substance to deliver a similar rewarding response, thus the user develops a tolerance, potentially leading to the user having an overdose of the substance.

Over the past 30 years increasing number of individuals are becoming addicted to opioids. This has resulted in a major number of deaths, and millions of individuals that attempt to self medicate with other street drugs.

So what are potential solutions?

Mitigating the usage of opioids, and utilization of alternative painkillers. There should be more regulation and documentation of prescribed opioids, like antibiotics, abuse of something good can result in severe problems.

In the US  Drug related deaths result in more deaths(64,000) annually than automotive accidents(40,000), and firearm related deaths(39,000). Approximately two-thirds of those deaths are related to the abuse of synthetic opioids. So besides the constraints placed on the healthcare system to minimize opioid prescription, what other factors could be utilized to address this? Gateway drugs still remain widespread, and are sought by many for recreational use. These may not result in being potentially fatal, however the normalization of these in society, and the push for legalization further contributes to this problem. The justification to smoke recreational drugs is somehow normalized, when there is a major push to eliminate the usage of cigarettes because of their harmful effects. Yes legalization allows for more fiscal gain and control of the substances by the government, though this still will take a major toll on the healthcare of our country in a few decades due to the side effects of substance abuse. Where there will be some gain from taxes, the implications of substance abuse will result in costing the system more over the course of time, as this will increase the number of individuals experimenting with opioids, further increasing the opioid crisis in the US.

Sources:

https://www.hhs.gov/opioids/about-the-epidemic/index.html

https://www.centeronaddiction.org/the-buzz-blog/we-asked-you-answered-did-guns-car-crashes-or-drug-overdoses-kill-more-people-2017