Concussion, PCS, & mTBI

The importance of proper healing from Mild Traumatic Brain Injuries (mTBIs), such as concussions, has been historically undervalued(1). Thankfully, recent years have brought an increased focus towards mTBIs in the United States, especially towards their potential long-term consequences(2).

Acute symptoms such as slow response time, irritability, and low energy may resolve on their own, but sometimes they can persist and evolve into long-lasting cognitive, behavioral, and communicative disabilities(2). When these symptoms remain present 3 months post-injury, the individual is considered to have “Post-Concussion Syndrome” or “PCS”(3).

We strongly recommend Hyperbaric Oxygen Therapy (HBOT) as a primary treatment for mTBIs and PCS. We also recommend Neurofeedback Therapy, IV Therapy, and Pulsed-Electromagnetic Field Therapy (PEMF) as supporting therapies to maximize your healing.

Extivita Therapies for Concussion, PCS, & mTBI:

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EXTIVITA THERAPIES FOR CONCUSSION, PCS, & mTBI RECOVERY:

Hyperbaric Oxygen Therapy for Concussion

Hyperbaric Oxygen Therapy

Neurofeedback Therapy for Concussion

Neurofeedback

Supplements for Concussion

Supplements

Nutritional IV Therapy for Concussion

Nutritional IV Therapy

Pulsed Electromagnetic Field Therapy (PEMF) for Concussion

Pulsed Electromagnetic Field Therapy

Listen to John’s experience with Hyperbaric Oxygen Therapy to treat his Concussion & Post Concussion Syndrome

Hyperbaric Oxygen Therapy for Concussion:

Hyperbaric Oxygen Therapy - Chapel Hill

HBOT has repeatedly been shown to improve many PCS symptoms, even years after initial injury(4-7). Specific categories of improvement include memory, depression, anxiety, post-traumatic stress disorder (PTSD) ratings, sleep quality, and overall quality of life(4-6). These positive findings are typically achieved after completing 40 HBOT treatments, most commonly at a pressure of 1.5-2.0 atmospheres(4-6).

 

Research suggests that these improvements are due to improved tissue oxygenation, cellular metabolism, and mitochondrial function as well as a well-regulated inflammatory response. These effects are a direct result of HBOT(8). Lastly, the benefits of HBOT for mTBI are likely most significant when administered soon after initial injury, although studies have found that improvements can still occur up to 5 years post-mTBI(7).

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Effects of HBOT on Concussion, PCS, & mTBI:

Grows New Blood Vessels

New Blood Vessel Formation

Hyperbaric oxygen therapy stimulates the formation of new blood vessels, healing injured tissues that were unable to get nutrients and oxygen.
Increases Stem Cell Production

Increased Stem Cell Activity

Hyperbaric oxygen therapy mobilizes stem progenitor cells (SPCs) from the bone marrow, creating the opportunity for tissue regeneration.
Decreases Inflammation

Decreased Inflammation

Hyperbaric oxygen therapy reduces systemic inflammation by increasing anti-inflammatory gene expression and decreasing proinflammatory genes.
Neurofeedback Therapy in Durham, NC

Neurofeedback for Concussion:

Neurofeedback may be a beneficial adjunctive therapy for those experiencing mTBI or PCS symptoms. After a mTBI, the brain must form new neural pathways to account for any brain tissue damaged by the mTBI. These new connections play a vital role in restoring healthy brain function, and neurofeedback has been shown to help establish and strengthen such connections(9). While there are few studies on neurofeedback and mTBIs specifically, existing research has found improvements in attention in people with mTBI following neurofeedback therapy(10).

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IV Therapy for Concussion:

Both our Myer’s cocktail IV and NAD+ Trio IV can help mTBI recovery. After mTBIs occur, the brain typically shows higher levels of inflammation and oxidative stress, both of which contribute to brain cell damage and persistent mTBI symptoms(11-12).

Replenishing the brain with Vitamin C, a component of the Myer’s IV cocktail, decreases this inflammation and oxidative stress, slows down cell damage, neutralizes toxins, and reduces brain swelling(13). Vitamin B12, which is also in the Myer’s cocktail, has been reported to promote nerve repair after TBI as well(14). The combined benefits of vitamin C and B12 on the brain can help minimize brain cell damage and improve cognitive function.

We also recommend our NAD+ Trio IV for mTBI due to NAD+’s role in energy production, mitochondrial function, and DNA repair. Following a mTBI, NAD+ levels become depleted, cellular detoxification is impaired, and mitochondria do not function as well(15-16). This can result in a cascade of damaging effects that leads to neurodegeneration (brain cell death). Our NAD+ Trio IV replenishes your NAD+ levels, helping restore mitochondrial function and reduce the severity and resulting damage of such a cascade(15).

Learn More About Nutritional IV Therapy
Nutritional IV Therapy in Durham, NC
Pulsed Electromagnetic Field Therapy (PEMF) in Durham, NC

Pulsed Electromagnetic Field Therapy for Concussion:

Research has shown that pulsed electromagnetic field (PEMF) therapy supports the brain in numerous ways, some of which include improving cognitive function, reducing stress, and relieving headaches(17). Specific to mTBIs, PEMF has been shown to decrease neuroinflammation, reduce cytokine levels (such as IL-1B)(18), reduce phobias, and significantly improve psychological depression following mTBI(17-18).

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News & Research for Concussion:

Neuropsychological assessments in a hyperbaric trial of post-concussive symptoms.

Aug 3, 2017 | ,

Results of studies addressing the effect of mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) on symptoms and neuropsychological assessments are mixed regarding cognitive deficits in these populations. Neuropsychological assessments were compared between U.S. military service members with mTBI only (n=36) vs. those with mTBI÷ PTSD (n=35) from a randomized interventional study of mTBI participants with persistent post-concussive symptoms (PCS). The mTBI group endorsed worse symptoms than published norms on PCS, PTSD and pain scales (⟩50% abnormal on Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Civilian, McGill Pain Questionnaire-Short Form) and some quality of life domains. Worse symptom reporting was found in the mTBI÷ PTSD group compared to mTBI (e.g., mean NSI total score in mTBI 27.5 (SD=12.7), mTBI÷ PTSD 39.9 (SD=13.6), p⟨0.001). The mTBI÷PTSD group performed worse than mTBI on the Weschler Adult Intelligence Scale digit span (mean difference -1.5, 95% CI[-2.9,-0.1], p=0.04) and symbol search (mean difference -1.5, 95% CI[-2.7,-0.2], p=0.03) and Grooved Pegboard (dominant hand mean difference -7.0, 95% CI[-11.5,-2.4], p=0.003; non-dominant mean difference -9.8, 95% CI[-14.9,-4.7], p⟨0.001). Differences were detected in ANAM simple reaction time (p=0.04) and mathematical processing (p=0.03) but not verbal fluency or visuospatial memory assessments. Results indicate increased symptom severity and some cognitive deficits in mTBI÷ PTSD compared to mTBI alone.

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Baseline EEG abnormalities in mild traumatic brain injury from the BIMA study.

Aug 3, 2017 | ,

The Brain Injury and Mechanisms of Action of HBO₂ for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (BIMA), sponsored by the Department of Defense, is a randomized, double-blind, sham-controlled trial of hyperbaric oxygen (HBO₂) in service members with persistent post-concussive symptoms following mild TBI, undergoing comprehensive assessments. The clinical EEG was assessed by neurologists for slow wave activity, ictal/interictal epileptiform abnormalities, and background periodic discharges. There is scant literature about EEG findings in this population, so we report baseline clinical EEG results and explore associations with other evaluations, including demographics, medication, neurological assessments, and clinical MRI outcomes. Seventy-one participants were enrolled: median age 32 years, 99% male, 49% comorbid PTSD, 28% with mTBI in the previous year, 32% blast injuries only, and 73% multiple injuries. All participants reported medication use (mean medications = 8, SD = 5). Slowing was present in 39%: generalized 37%, localized 8%, both 6%. No other abnormalities were identified. Slowing was not significantly associated with demographics, medication or neurological evaluation. Participants without EEG abnormalities paradoxically had significantly higher number of white matter hyperintensities as identified on MRI (p = 0.003). EEG slowing is present in more than one-third of participants in this study without evidence of associations with demographics, medications or neurological findings.

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References
  1. Mann, Aneetinder, et al. “Concussion Diagnosis and Management: Knowledge and Attitudes of Family Medicine Residents.” Canadian Family Physician, vol. 63, no. 6, The College of Family Physicians of Canada, June 2017, pp. 460–66.
  2. Silverberg, Noah D., et al. “Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines.” Archives of Physical Medicine and Rehabilitation, vol. 101, no. 2, Feb. 2020, pp. 382–93. ScienceDirect, doi:10.1016/j.apmr.2019.10.179.
  3. Ryan, Laurie M., and Deborah L. Warden. “Post Concussion Syndrome.” International Review of Psychiatry (Abingdon, England), vol. 15, no. 4, Nov. 2003, pp. 310–16. PubMed, doi:10.1080/09540260310001606692.
  4. Harch, Paul G., et al. “Hyperbaric Oxygen Therapy for Mild Traumatic Brain Injury Persistent Postconcussion Syndrome: A Randomized Controlled Trial.” Medical Gas Research, vol. 10, no. 1, Mar. 2020, pp. 8–20. PubMed, doi:10.4103/2045-9912.279978.
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  6. Weaver, Lindell K., et al. “Hyperbaric Oxygen for Post-Concussive Symptoms in United States Military Service Members: A Randomized Clinical Trial.” Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc, vol. 45, no. 2, Apr. 2018, pp. 129–56.
  7. Boussi-Gross, Rahav, et al. “Hyperbaric Oxygen Therapy Can Improve Post Concussion Syndrome Years after Mild Traumatic Brain Injury – Randomized Prospective Trial.” PLoS ONE, vol. 8, no. 11, Nov. 2013. PubMed Central, doi:10.1371/journal.pone.0079995.
  8. Efrati, Shai, and Eshel Ben-Jacob. “Reflections on the Neurotherapeutic Effects of Hyperbaric Oxygen.” Expert Review of Neurotherapeutics, vol. 14, no. 3, Mar. 2014, pp. 233–36. PubMed, doi:10.1586/14737175.2014.884928.
  9. Munivenkatappa, Ashok, et al. “EEG Neurofeedback Therapy: Can It Attenuate Brain Changes in TBI?” NeuroRehabilitation, vol. 35, no. 3, IOS Press, Jan. 2014, pp. 481–84. content.iospress.com, doi:10.3233/NRE-141140.
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  11. Chaban, Viktoriia, et al. “Systemic Inflammation Persists the First Year after Mild Traumatic Brain Injury: Results from the Prospective Trondheim Mild Traumatic Brain Injury Study.” Journal of Neurotrauma, vol. 37, no. 19, Mary Ann Liebert, Inc., publishers, Oct. 2020, pp. 2120–30. liebertpub.com (Atypon), doi:10.1089/neu.2019.6963.
  12. Toklu, Hale Zerrin, and Nihal Tümer. “Oxidative Stress, Brain Edema, Blood–Brain Barrier Permeability, and Autonomic Dysfunction from Traumatic Brain Injury.” Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects, edited by Firas H. Kobeissy, CRC Press/Taylor & Francis, 2015. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK299195/.
  13. Leichtle, Stefan W et al. “High-Dose Intravenous Ascorbic Acid: Ready for Prime Time in Traumatic Brain Injury?.” Neurocritical care vol. 32,1 (2020): 333-339. doi:10.1007/s12028-019-00829-x
  14. Wu, Fangfang et al. “Vitamin B12 Enhances Nerve Repair and Improves Functional Recovery After Traumatic Brain Injury by Inhibiting ER Stress-Induced Neuron Injury.” Frontiers in pharmacology vol. 10 406. 24 Apr. 2019, doi:10.3389/fphar.2019.00406
  15. Won, Seok Joon et al. “Prevention of traumatic brain injury-induced neuron death by intranasal delivery of nicotinamide adenine dinucleotide.” Journal of neurotrauma vol. 29,7 (2012): 1401-9. doi:10.1089/neu.2011.2228
  16. Klimova, Nina, Adam Fearnow, and Tibor Kristian. “Role of NAD+—Modulated Mitochondrial Free Radical Generation in Mechanisms of Acute Brain Injury.” Brain Sciences 10.7 (2020): 449. Crossref. Web
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