The topic of discussion in class this week was concussions as we dove into the article “The molecular Pathophysiology of Concussive Brain Injury.” Before we even began to consider the scientific aspects of concussion, I first paused to consider how prevalent concussions are today. It is almost certain that an individual or somebody that they know have had at least one concussion in their lifetime. According to the paper, approximately 1.6 to 3.8 million athletes suffer from a concussion each year. Also known as mild traumatic brain injury, concussions drastically alter brain function. So why is it that concussions have become so common? Have we become apathetic to their effects, focusing rather on the pleasure we gain from sports? What measures should we take to better protect from and screen for concussions? While we certainly did not answer all of these questions as a class, we did discuss some interesting ideas.
In addressing concussions, it is important to first understand the mechanism by which they occur. A concussion is initiated by a mechanical trauma. This trauma causes the neuronal cell membranes to be disrupted and axons to stretch, allowing for ions to freely flow. Indiscriminant ion flow allows for the disruption of many cellular processes (nonspecific depolarization, release of excitatory neurotransmitters, potassium efflux, increased activity of membrane ionic pumps, hyperglycolysis, lactate accumulation, calcium influx, decreased ATP production, initiation of apoptosis). Although the exact mechanism may not be interesting to everybody, the most important thing to understand is that the cells of the brain are firing at random, working extra hard, using extra energy, and may be damaged beyond repair.
Symptoms of a concussion include behavioral changes, memory and attention impairment, headache, and unsteadiness, among many other possible symptoms. Early on, an individual can expect to suffer from headaches, dizziness, nausea, vomiting, and lack of awareness. As time progresses, individuals can suffer from persistent headaches, sleep disturbance, diminished concentration and attention, memory dysfunction, and lack of awareness. Depending on the severity of the trauma, severe brain injury can be sustained. In terms of treating a concussion, there’s not much that can be done. It is imperative that an individual suffering from a concussion takes the time to allow his or her body to heal. This includes proper rest, not engaging in strenuous activity (both physical and mental) and eating a nutrient rich diet. Some research has shown that a ketogenic diet may be the best diet after a concussion has been sustained. Ketone bodies have been found to improve mitochondrial function as well as regulate the expression of genes related to apoptosis, inflammation, neurotrophins and molecular chaperones.
With the effects of a concussion being so clear, are we taking the proper precautions to prevent them? The NFL has been taking steps to decrease the incidence of riskier hits, including stronger enforcement of helmet to helmet collisions. While this is great, should we be doing more? I am by no means an expert on the topic, but I still think there are improvements that can be made. One of the biggest topics of our discussion was how concussions are handled in college. While it is important that students have the proper amount of time to rest and heal, the rate at which college classes move makes it nearly impossible to return to the classroom after a concussion. With many student athletes at Concordia, this could drastically affect their college career. We discussed the need to implement a system that aids students that have suffered a concussion so that they may more easily return to the classroom. While I certainly do not have the answers to this problem, I believe it is important that better screening is implemented to check for concussions. In addition, I believe it is important to allow for proper healing time. By making some changes in how concussions are handled, hopefully we will be able to decrease the incidence of lasting brain damage.
