Even a mild concussion can cause long-lasting effects on the brain, according to researchers at the University of Cambridge. Using data from a European-wide study, the team has shown that for almost half of all people who receive a blow to the head, there are changes in the way brain regions communicate with each other, which can cause long-term symptoms such as fatigue and cognitive decline.
Mild traumatic brain injury (concussion) results from a blow or jolt to the head. It can occur as a result of a fall, a sports injury, or from a bicycle or car accident, for example. But despite being labeled ‘mild’, it is commonly associated with persistent symptoms and incomplete recovery. Such symptoms include depression, cognitive decline, headaches, and fatigue.
While some doctors in recent studies predict that nine out of 10 people who experience a concussion will make a full recovery after six months, evidence is emerging that only half make a full recovery. This means that a significant proportion of patients may not receive adequate care after injury.
However, predicting which patients will have a rapid recovery and who will take longer to recover is challenging. Currently, patients with suspected concussion usually have a brain scan, either a CT scan or an MRI, both of which look for structural problems, such as swelling or bruising, but even if these scans show no damage obvious structural, a patient’s symptoms may still persist.
Dr Emmanuel Stamatakis, from the Department of Clinical Neurosciences and Division of Anesthesia at the University of Cambridge, said: “Globally, we are seeing an increase in the number of cases of mild traumatic brain injury, particularly from falls in our population. aging and increasing numbers of traffic crashes in low- and middle-income countries.
“Currently, we do not have a clear way of determining which of these patients will have a quick recovery and which will take longer, and the combination of overly optimistic and inaccurate prognoses means that some patients are at risk of not receiving appropriate care for their symptoms.”
Dr. Stamatakis and his colleagues studied functional MRIs of the brain, that is, functional MRIs, which look at how different areas of the brain coordinate with each other, taken from 108 patients with mild traumatic brain injury and compared them with scans of 76 healthy volunteers. . Patients were also evaluated for ongoing symptoms.
The patients and volunteers had been recruited for CENTER-TBI, a large European research project aiming to improve the care of patients with traumatic brain injury, co-chaired by Professor David Menon (head of the Anesthesia division) and funded by the European Union.
In the results published today in Brainthe team found that just under half (45%) continued to display symptoms as a result of their brain injury, the most common being fatigue, lack of concentration and headaches.
The researchers found that these patients had abnormalities in a region of the brain known as the thalamus, which integrates all sensory information and transmits this information around the brain. Counterintuitively, concussion was associated with increased connectivity between the thalamus and the rest of the brain; in other words, the thalamus was trying to communicate further as a result of the lesion, and the greater this connectivity, the worse the prognosis for the patient.
Rebecca Woodrow, a PhD student in the Department of Clinical Neuroscience and Hughes Hall, Cambridge, said: “Despite the fact that there was no obvious structural damage to the brain on routine scans, we saw clear evidence that the thalamus, the brain system transmission system in the brain, it was hyperwired. We could interpret this as the thalamus trying to overcompensate for any anticipated damage, and this seems to be at the root of some of the long-lasting symptoms that patients experience.”
By studying additional data from positron emission tomography (PET) scans, which can measure the regional chemical composition of body tissues, the researchers were able to establish associations with key neurotransmitters based on a patient’s long-term symptoms. For example, patients who experienced cognitive problems, such as memory difficulties, showed increased connectivity between the thalamus and areas of the brain rich in the neurotransmitter norepinephrine; patients who experienced emotional symptoms, such as depression or irritability, showed greater connectivity with serotonin-rich areas of the brain.
Dr Stamatakis, who is also a Stephen Erskine Fellow at Queens’ College, Cambridge, added: “We know there are already drugs that target these brain chemicals, so our findings offer hope that in the future, Not only can we predict a patient’s prognosis, but we can also offer targeted treatment for their particular symptoms.”
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