TMS for Concussions (Football Disorder)

What is Concussion?

Concussions are a condition that disrupts normal brain function. Concussions are caused by one or more blows to the head. This is much like the related conditions of mild-type traumatic brain injury (mTBI) and Chronic Traumatic Encephalopathy (CTE). It was previously thought that the effects are temporary. Now we know that they could have long-term effects such as headaches, inability to concentrate, memory loss, poor verbal articulation, cognitive impairment, as well as loss of balance and coordination. 

In sports like football, boxing, soccer, bike racing, and MMA concussions can occur without obvious signs. Other causes include falling, the violent shaking of children, and not restraining children properly in a car. This causes jerking of the head and upper body motions, which can cause concussions. 

The common perception about concussion is that it always causes loss of consciousness, but today we know that there are types of concussion that do not cause loss of consciousness. The effect of concussion will change your life in ways that often last a lifetime. This makes it necessary to be treated as soon as it happens. 

The most deceiving part of concussion is that people usually feel that they recover fully from it. Nevertheless, it is a common occurrence in athletes’ lives. It might come as a surprise that every year about 4 million sports-related concussions occur in the U.S. according to the statistics of the main US national health agency, the CDC.  Also, it might be eye-opening that “The percentage of children aged 17 years and under who had ever had a diagnosis of a concussion or brain injury by a health care provider was 3.9%” [1].

Could Normal Brain Imaging
Diagnose mTBI

Presently, standard medical imaging modalities like X-ray, CT, and MRI cannot detect damages to the brain due to mTBI. This is because the damages to the brain are incredibly subtle like astrocytosis, perivascular neuroinflammation, myelinated axonopathy, microvascular injury, and phosphorylated tau protein pathology.  Such damages have functional implications and a powerful imaging technique like resting-state functional magnetic resonance imaging (rsfMRI) was needed to visualize the damages to specific brain regions and disruption of brain networks. 

The situation is exacerbated by the fact that no other lab test, like drawing blood or saliva tests, with the ability to determine if a patient has a concussion presently exists. Standard operating protocol (SOP) in medicine is to make a concussion diagnosis by looking for behavioral signs of concussion and what patients report as the consequence of it. rsfMRI has shown capable of detecting subtle changes in brain function after concussion [2].

How rsfMRI Can Diagnose and Help Treat mTBI?

Recent studies have shown that rsfMRI is capable of measuring functional connectivity (FC) of various brain regions and FC correlates with clinical recovery [3] from concussion. We use FC and sophisticated mathematics to construct whole brain networks. This approach allows us to see the interaction between nodes and between networks. Given that presently the only diagnosis and treatment options are clinical assessment, cognitive rest, and symptom management, there is a real danger of allowing the patients to resume normal activities.

This will raise the risk of cumulative injuries that will eventually lead into a much more complicated condition. rsfMRI measures the activity of each brain region, down to the size of a grain of rice, and uses sophisticated neuroscience and physics to find the network malfunctions. Our technology enables us to deliver the exact location of those malfunctioning regions to our treatment room through advanced computers. This lets our TMS specialists guide the magnetic pulses to those exact regions, stimulating them and fine tuning them back to their original working condition.  This is the distinct feature of our service that is unmatched by any other treatment. 

How rsfMRI-Guided TMS Can Treat mTBI?

TMS is a non-invasive neuromodulation technique. There are reports showing improvement by treating mTBI patients with standard TMS [4]. Usually, after mTBI injury patients experience symptoms like spatial disorientation, light-headedness, dizziness, nausea, and fatigue that have been effectively treated by TMS [5, 6].  But, this is only the effect of standard TMS in which neither imaging technique is used to diagnose the mTBI, nor is it used for guiding TMS treatment. Given vast improvement in the precision of rsfMRI-guided TMS that has occurred in our experience with TBI treatment, we are offering this treatment to more patients with more conditions. We will treat concussion, mTBI and CTE patients who have similar, or even more severe, injury mechanisms and symptoms.

References

1.       https://www.cdc.gov/nchs/products/databriefs/db423.htm#:~:text=In%202020%2C%206.8%25%20of%20children,a%20concussion%20or%20brain%20injury.

2.       Meier TB, Giraldo-Chica M, España LY, Mayer AR, Harezlak J, Nencka AS, Wang Y, Koch KM, Wu YC, Saykin AJ, Giza CC, Goldman J, DiFiori JP, Guskiewicz KM, Mihalik JP, Brooks A, Broglio SP, McAllister T, McCrea MA. Resting-State fMRI Metrics in Acute Sport-Related Concussion and Their Association with Clinical Recovery: A Study from the NCAA-DOD CARE Consortium. J Neurotrauma. 2020 Jan 1;37(1):152-162. doi: 10.1089/neu.2019.6471. Epub 2019 Sep 18. PMID: 31407610; PMCID: PMC6921290.

3.       Kaushal M, España LY, Nencka AS, Wang Y, Nelson LD, McCrea MA, Meier TB. Resting-state functional connectivity after concussion is associated with clinical recovery. Hum Brain Mapp. 2019 Mar;40(4):1211-1220. doi: 10.1002/hbm.24440. Epub 2018 Nov 19. PMID: 30451340; PMCID: PMC6365215.

4.       Mollica A, Safavifar F, Fralick M, Giacobbe P, Lipsman N, Burke MJ. Transcranial Magnetic Stimulation for the Treatment of Concussion: A Systematic Review. Neuromodulation. 2021 Jul;24(5):803-812. doi: 10.1111/ner.13319. Epub 2020 Nov 12. PMID: 33184973.

5.       Paxman E, Stilling J, Mercier L, Debert CT. Repetitive transcranial magnetic stimulation (rTMS) as a treatment for chronic dizziness following mild traumatic brain injury. BMJ Case Rep. 2018 Nov 5;2018:bcr2018226698. doi: 10.1136/bcr-2018-226698. PMID: 30396889; PMCID: PMC6229180.

6.       Koski L, Kolivakis T, Yu C, Chen JK, Delaney S, Ptito A. Noninvasive brain stimulation for persistent postconcussion symptoms in mild traumatic brain injury. J Neurotrauma. 2015 Jan 1;32(1):38-44. doi: 10.1089/neu.2014.3449. PMID: 24955920.

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Neurotherapeutix is the leading clinic for functional imaging guided transcranial magnetic stimulation (TMS), a safe, innovative, and non-invasive methodology for treating a wide range of acute and chronic mental disorders and brain injuries. Our advanced fMRI technology allows us to map the brain for the… Learn More »

Published: March 24, 2023NYC

Last Reviewed: January 10, 2024

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