This podcast discusses concussions and head trauma, covering their definition, pathophysiology, symptoms, treatment, and recovery. Dr. Micky Collins, a leading concussion specialist, shares his expertise and insights into this complex injury, emphasizing the importance of early and effective treatment to prevent long-term complications.
The six types of concussions discussed are: cognitive fatigue, vestibular, ocular, migraine, anxiety, and neck-related. Their symptoms vary depending on the affected system. For example, vestibular concussions involve dizziness and balance problems, while ocular concussions affect eye coordination and may cause blurred or double vision. Cognitive fatigue involves mental fogginess and difficulty concentrating. Migraine-type concussions present with headaches, nausea, and light or noise sensitivity. Anxiety-type concussions manifest with increased anxiety and nervousness. Neck-related concussions cause symptoms stemming from neck problems. Patients may experience one or more of these types simultaneously.
On the field, dizziness is six times more predictive of a longer recovery than loss of consciousness. Fogginess (feeling one step behind or detached) is the second most predictive symptom. Other symptoms, such as fatigue, light or noise sensitivity, blurred vision, and headache, also indicate a potentially longer recovery period.
The recommended treatment approach for concussion is active rehabilitation, not rest. Treatment focuses on retraining affected systems. This includes vestibular therapy for balance problems, exertion therapy to challenge the body and improve nervous system regulation, and addressing anxiety through techniques like regulated sleep and exposure to triggering environments. The goal is to target and treat the specific problem(s) caused by the concussion.
Medications are considered only after behavioral therapies have been attempted. The choice of medication depends on the specific symptoms. Examples include SSRIs (selective serotonin reuptake inhibitors), tricyclic antidepressants, Wellbutrin (bupropion), and others to address anxiety and nervous system issues. Sertraline is mentioned specifically for its potential effect on both vestibular and nervous system symptoms. The decision on medication is often made in conjunction with a psychiatrist.
The discussion also touched upon these topics:
The history of concussion research and treatment: Dr. Collins describes the evolution of understanding concussions, from a time when little was known about the injury to the current state of specialized treatment. He highlights the role of his own research and the creation of the first concussion clinic.
Risk factors for worse concussion outcomes: Pre-existing conditions like a history of migraine, car sickness, lazy eye, or anxiety can make an individual more susceptible to concussions and influence the type and severity of symptoms experienced.
The effect of age and gender on concussion recovery: Adolescent brains take longer to recover than adult brains, and females are generally more vulnerable and experience longer recovery times than males due to hormonal factors.
The role of early intervention: Seeking medical attention within seven days of a concussion significantly improves recovery outcomes.
Alternative treatments: The effectiveness of hyperbaric oxygen therapy and the potential benefits of synthetic ketones are discussed, with Dr. Collins expressing skepticism toward hyperbaric oxygen and a lack of current research on ketones in this context.
The natural history of untreated concussions: The long-term consequences of untreated concussions can be severe, leading to chronic symptoms that significantly impair quality of life.
The relationship between concussions and chronic traumatic encephalopathy (CTE): While acknowledging ongoing research, Dr. Collins mentions that current studies haven't established a definitive link between repeated concussions and CTE, though this remains an area of active investigation. The possibility that some individuals diagnosed with CTE may actually have untreated concussions is raised.
Advice for parents of children playing sports: Parents are advised to seek specialized care quickly if their child shows concussion symptoms, emphasizing early intervention for optimal recovery.
Funding for concussion research: The sources of funding for Dr. Collins' research are mentioned, including NIH, the NFL, and the Chuck Knoll Foundation. The increasing amount of research being done in the field is noted.
The prevalence of concussions: The staggering number of concussions occurring annually in the U.S. is highlighted, emphasizing the widespread nature of this injury. Equestrian sports are highlighted as having a surprisingly high rate of concussions.
The role of the APOE4 genotype: The discussion notes a lack of definitive research establishing APOE4 as a significant risk factor for concussion severity.
