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Solutions for managing traumatic brain injury, post concussion syndrome and CTE — the ultimate guide
🕑 Added 2024-05-21 19:32:38 +0000 UTCPost-concussion syndrome, thematic brain injuries, CTE and other forms of head trauma can cause a complex array of symptoms that persist long after the initial head injury has occurred. Sometimes for a lifetime. When left untreated, PCS can lead to the development of various psychiatric disorders, complicating the recovery process and significantly impacting quality of life. Conditions such as depression, anxiety disorders, PTSD and even bipolar disorder can emerge from head injuries.
Other symptoms like headaches, dizziness, cognitive impairments, and emotional instability are often present as well.
It’s important to note that head injuries are not like other injuries. The urgency of immediate intervention after a concussion cannot be overstated. In this article, we will be discussing some things to have on hand, as well as options for seeking both immediate treatment (after an acute insult) as well as options for managing old injuries and post acute sequelae.
Neuroprotective compounds and treatments, such as BPC-157, plasmalogens, and hyperbaric oxygen can play a massive role in mitigating brain damage and promoting recovery immediately after injury. So we will be covering therapeutic options, as well as providing a comprehensive list of supplements and modalities that can be used (listed in order or priority/importance)
Before we do this, let’s cover a little groundwork. This is not meant to be a full diagnostic criteria, but I do want to mention a few common symptoms of PCS and post-TBI. Even minor head injuries should be addressed accordingly, and a careful eye should be kept on the patients symptoms.
A critical aspect of PCS that requires attention is the dysregulation HPA axis, a central component of the body’s stress response. Concussions can disrupt the balance of the HPA axis, leading to either hypercortisolism (high cortiso) or hypocortisolism (low cortisol). hormonal imbalances can have profound effects on mood, cognition, and overall health. For instance, chronic high levels of cortisol can damage neurons, particularly in areas of the brain responsible for memory and learning, while insufficient cortisol levels can result in fatigue and an inability to cope with stress. This dysregulation can also disrupt neurotransmitter systems, further complicating the mental health landscape of PCS.
One particularly challenging manifestation of HPA axis dysregulation is hyper sexuality and aggressive behavior. Damage to the frontal lobes, which are crucial for impulse control, can lead to disinhibited behavior, including hypersexuality. Additionally, hormonal imbalances and changes in neurotransmitter levels, particularly dopamine, can alter sexual drive, aggression and behavior. The presence of psychiatric comorbidities, such as mania in bipolar disorder, can further exacerbate these symptoms.
Pharmacological interventions, lifestyle modifications, and ongoing psychological support are integral to this approach. Early and continuous intervention is key to preventing the long-term psychiatric and cognitive complications associated with PCS, ensuring better outcomes, and enhancing the quality of life for those affected.
Therapeutic strategies for early management (essentials/big rocks)
While many of the things listed here will be useful for both acute injury as well as the post concussion sequelae, we’ll cover early intervention first since it’s the most important
First, let’s briefly touch on why controlling neuro inflammation is important, and how some of the mentioned therapies can help with the acute and post-acute inflammatory damage causesd from head injuries
Neuroinflammation is a critical factor in the pathology of brain injuries, including traumatic brain injuries, strokes, and other forms of neurological damage. While the initial mechanical injury obviously causes immediate damage to brain tissue, the subsequent inflammatory response can exacerbate this damage, leading to secondary injury which often tends to be where a lot of the real issues from TBI and concussion stem from.
Neuroinflammation can lead to a cascade of secondary brain damage, characterized by the release of pro-inflammatory cytokines, free radicals, and other toxic substances. This can result in further neuronal death and tissue damage beyond the initial injury site. Inflammation can compromise the integrity of the blood-brain barrier, allowing harmful substances to enter the brain and exacerbate the injury. This can lead to edema (swelling), increased intracranial pressure, and further neuronal damage.
Persistent ne inflammation can lead to chronic neuroinflammation, contributing to long-term neurological deficits. Excessive inflammation can interfere with the brain's natural healing processes, including neurogenesis (the formation of new neurons) and synaptic plasticity (the ability of synapses to strengthen or weaken over time). This can hinder recovery and rehabilitation efforts, and may lead to functional congitnive deficits and decline for years after the initial insult. This is often the case with concussions that are not treated properly.
Hyperbaric oxygen
Hyperbaric oxygen occupies the top of the list for TBI recovery. Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized environment. HBO is used for various medical conditions, including brain damage from traumatic brain injuries, strokes, and other neurological disorders. The underlying principle is that the increased pressure allows the lungs to gather more oxygen than
would be possible at normal atmospheric pressure. This extra oxygen is then carried by the blood to tissues throughout the body, including the brain, which can help to reduce swelling, promote healing, and enhance the regeneration of tissues. Hyperbaric oxygen forces the release of stem cells from the bone marrow into systemic circulation, where they migrate to sources of injury like the brain.
Hyperbaric oxygen is typically carried out in a hard shell chamber at 2 atmospheres of pressure. While a hard shell chamber is typically the best option for more serious injuries (often found in hospitals and medical facilities) soft shell chambers (which typically work at 1.3-1.5 atmospheres of pressure are often more accessible and widely available. Soft shell chambers are not quite as effective as hard shells and usually require more sessions
The dosing of hyperbaric oxygen can vary, but sessions are typically 60-120min long, 5x a week for a total of somewhere between 20-60 or more sessions. The more serious the injury, the more sessions are often needed. Patients undergoing hyperbaric oxygen are advised to perform treatment as close to the time of injury as possible. Even one or two seasons (for those that can’t afford multiple sessions) can help tremendously if done promptly after the insult. More sessions may be required for injuries that were sustained a long time ago
Two fantastic video lectures have been included bellow on hyperbaric oxygen and TBI and post concussion syndrome that I would highly encourage watching:
https://youtu.be/-cIYt6lBw_M?si=EA98lU1Gr5hK-Jz1
https://youtu.be/-cIYt6lBw_M?si=EA98lU1Gr5hK-Jz1
Molecular hydrogen
As mentioned, controlling neuroinflammation is crucial in mitigating secondary brain damage and promoting recovery following brain injuries. Neuroinflammation can exacerbate the initial injury, leading to further neuronal death, BBB disruption, oxidative stress, and impaired healing. Molecular hydrogen inhalation therapy is a powerful way to controlling neuroinflammation through its selective antioxidant activity, modulation of inflammatory pathways, reduction of pro-inflammatory cytokines, maintenance of BBB integrity, and neuroprotective effects. By addressing the inflammatory response (without blunting the entire signaling cascade), hydrogen therapy can help limit secondary brain damage and support better outcomes for patients with brain injuries.
Hydrogen is typically inhaled for 5-8 hours a day for those with acute traumatic injuries. It’s safe and has no side effects or contraindications. It’s best performed immediately after hyperbarics to optimize oxygen transport and utalization. Hyperbarics and molecular hydrogen compliment each other nicely.
The device I use: https://hydrogen4health.com/hx900-pure-hydrogen-inhaler-with-pulse-mode-and-bg/
PEMF therapy
Occupying another spot here at the top of our list of interventions is pulsed electromagnetic field therapy. There are a few unique ways PEMF therapy works to address traumatic brain injuries that works synergistically with hyperbaric oxygen (in particular) as well as the other
PEMF therapy is a non-invasive treatment that uses electromagnetic fields to stimulate and promote healing in various tissues, including the brain. PEMF Enhances cellular metabolism by stimulating the mitochondria, leading to an increase in the ATP necessary cellular repair and regeneration. Another hallmark of head injuries is poor circulation and drainage of waste from the brain. PEMF therapy can improve microcirculation and blood flow, enhancing the delivery of oxygen (perfectly stacked with hyperbarics) as well as nutrients to injured brain tissues. In addition to reducing inflammation and preventing further oxidative damage to neural tissue, PEMF can also attract stem cells to the site of injury and promote their differentiation into neurons and other brain cells. So we can release more stem cells from the bone marrow with hyperbarics, and then guide them to the brain with PEMF. Red light therapy can also do this which we’ll talk about.
For head injuries, you’ll need to find someone local that does high intensity PEMF therapy. HIGH intensity PEMF is often delivered with large coils placed on the head, and treatment is usually delivered for 30-45min for serious injuries. It’s best to do PEMF therapy as often as possible, multiples times a week (3-6 sessions) after the injury.
Red light therapy (Photobiomodulation)
Red light therapy works very similarly to PEMF therapy, particularly in regard to ATP production within mitochondria. This increase in ATP production can provide cells with the energy they need to carry out essential functions, including the repair and regeneration of damaged tissues. Red light is absorbed by chromophores within the mitochondria, such as cytochrome c oxidase, leading to the activation of the mitochondrial respiratory chain. This process can result in the upregulation of cellular metabolism and the production of reactive oxygen species, which in turn can trigger signaling pathways involved in tissue repair and regeneration. There is also some evidence that RT may increase both systemic and tissue specific stem cell mobilization.
Red light therapy is typically applied directly to the head, twice a day for 20min for the first week of the injury. The dose is then reduce down to 20min once daily for a few weeks, and then once every other day until the issues is resolved.
(See the red light therapy buyers guide for lost information on pickling the right device for you)
Neurofeedback
Neurofeedback, aka EEG biofeedback, is a type of biofeedback that uses real-time monitoring of brain activity to teach individuals how to regulate their brain function. It involves placing electrodes on the scalp to measure electrical activity (brain waves) and providing feedback to the person through visual or auditory signals. The goal is to encourage desirable brain activity patterns and discourage undesirable ones, thereby promoting better mental and neurological health. Think of neurofeedback as training for your brain similar to how you’d do legs extensions post ACL surgery. Neurofeedback can help manage symptoms such as headaches, dizziness, and difficulty concentrating by promoting brain stability and reducing abnormal brain wave patterns associated with concussions. It may enhance cognitive functions like attention and executive function, which are often impaired after concussions. Neurofeedback leverages the brain's ability to reorganize itself (neuroplasticity).Even In patients with minimal consciousness, neurofeedback can sometimes help in detecting and enhancing subtle brain activity, potentially aiding in the recovery of some level of awareness.
ISS or NeuroOptimal is the best form of neurofeedback in my opinion. You can search both websites (I prefer neurooptimal first if you can find a provider) to see if a practioner is in your are. NO practitioners will often let you rent a device .
Frequency specific microcurrent
FSM is a therapeutic technique that uses low-level electrical currents to treat various medical conditions, including head injuries. It’s similar to PEMF, The basic principle behind FSM is that specific frequencies of microcurrents can resonate with and influence the body's tissues and cellular activities, potentially promoting healing and reducing symptoms FSM uses microcurrents, which are extremely low levels of electrical currents (millionths of an ampere) that are similar to the body's own natural electrical signals, making them extremely safe and well-tolerated.
It’s best to seek out an FMS provider (you can find the directory on the FSM website ). However, there are some good FSM devices that are relatively affordable that have some generic ‘healing’ programs you can run. The device bellow is marketed for horses but also works in humans. There are a few different settings on the device. For a head injury, it’s best to use the setting 4 (the last setting) and skip the other settings and protocols shown in the manual. We want to skip directly to the the most healing frequency set.
Neurophone (Noninvasive sub-organ ultrasound stimulation)
Ultrasonic neuromodulation involves delivering low-intensity ultrasound to nervous system tissue, resulting in the transient modulation of neural activity. This can affect the firing of neurons and has shown promise in both scientific investigation of brain function and therapeutic modulation of brain activity as well
targeted neuromodulation within specific organs using ultrasoun been demonstrated to modulate signaling pathways within the nervous system, such as the cholinergic anti-inflammatory pathway. ultrasound stimulation within organs can provide site-selective neuromodulation to regulate specific physiological functions in the brain. Ultrasound has also been demonstrated to create structured (exclusion zone) water in the tissue, and better facilitating various biochemical reactions.
The Neurophone is an electronic device invented by Patrick Flanagan in 1958. The device is designed to transmit sound directly to the brain via the skin, bypassing the auditory system for people that are deaf. It was later discovered that the Neurophone had numerous benefits for brain health, meditation, sleep, and accelerated learning.
The Neurophone can be used after a head injury for 1-4 hours daily.
Omega-3 and omega-9 plasmalogens
Plasmalogens are a distinct subclass of glycerophospholipids. Plasmalogens are ubiquitously distributed in all of our cells but are predominantly found (in high concentrations) in the membranes of our brain cells (neurons and glial cells) , heart (cardiomyocyes) and immune cells. These lipids are essential for maintaining membrane integrity, fluidity, and functionality. They also play crucial roles in cellular signaling and antioxidative defense mechanisms. I like to think of plasmalogens almost as cellular ‘armor’. As mentioned, plasmalogens contribute to the biophysical properties of cellular membranes by primarily enhancing membrane fluidity and elasticity. They do this by packing and organization of lipid bilayers, facilitating optimal membrane protein function and signal transduction. In layman’s terms, plasmalogens are a massive component of your cell membrane that help to optimally facilitate all the wonderful things your cells to for you.
Plasmalogens can be particularly beneficial for both acute and chronic head injuries, and are definitely in the category of what I would consider to be an ‘essential’ nutrient. Omega-9 plasnalogens tend to work more on the myelin and glial cells, while omega-3 plasmalogens tend to be more protective of the neurons. Plasmalogens can be expensive, so I typically recommend that people prioritize ProdromeGlial (omega-9) before adding in the omega-3 (there is some overlap between them). Anywhere between 1-5 servings (higher doses being ideal in the weeks immediately followed an injury, and lower, more consistent dosing being a more affordable long term approach for restoring brain health after an old injury) is ideal. Glial in particular will attentuate a lot of the neuro inflammation very quickly.
You can read more about plasmalogens in my article bellow
https://www.patreon.com/posts/104331245?utm_campaign=postshare_creator
Cortexin
Cortexin is the Russian version of cerebrolysin. It’s a powerful neuroprotective, poly-peptide bio-regulator drug that has been shown to have high efficiency in correcting the consequences of traumatic brain injury, stroke and other neurological complications. In Russia, Cortexin is often used as a first line of defense for stroke and head injuries, as it’s particularly effective at improving the functional restoration of neurological tissue (nerve, neurons, spinal cord etc) after damage by attentuating oxidize stress, boosting neuro steroids and growth factors and increasing micro-circulation.
Cortexin is typically dosed around 10-20mg (5-10 in children) , twice a day for 10-20 days for acute head injuries. Additional mini-courses of 10-20 days at lower doses or 5-10mg can be occasionally repeated to help with continued neurological rehabilitation.
You can purchased Cortexin off cosmic nootropics and get it shipped directly from a high quality, Russian pharmacy. You will need bacteriostatic water for reconstitution. One goal is 10mg, and standard dosing is usually 1-2 vials daily. For chronic complications, of an old head injury, it may be more advisable to run Cortexin for a longer period of time (30-40 days) at 5-10mg as opposed to doing a shorter, higher doses course of the drug.
BPC-157 and thymosin beta-4
BPC and thymosin beta-4 need no introduction. These are powerful ‘healing’ peprides that should always be included in any post traumatic injury or trauma. BPC-157 and thymosin beta 4 are two of the most well known peprides for speeding up the repair of muscle, bone, tendon, ligament, nerve, and neural tissue damage after an insult. Cortexin, BPC, and TB4 are 3 peptides I always keep in the freezer just in case. For contact sports, taking BPC preventatively is huge as well. Outcomes tend to be more favorable when you’re using BPC-157 in a prophylactic manner (meaning you already have it in your system before the trauma happens). If you play a sport where head injuries are common, cruising on a low dose of 250-500mcg during the season may not be a terrible idea. Same with a low dose of plasmalogens
BPC is typically dosed around 500mcg daily, but it may be useful to inject a large bolus dose (3-4mg) initially following a head injury. This can be followed up with 1000mcg for a few weeks, and then down to maibtiance dose of 500mcg for 1-2 months. A similar protocol could be followed with TB4, wirh a large 5-10mg initial bolus dose, followed by 1mg for a week or two, and then only 2mg 2-3x a week.
My favorite source for injectable peptides is CanLabs and peptide science
Sample supplement protocol
Not everyone will be able to get access to the above treatments as some of them can be quite expensive and often not avaliable in some cities or countries. In this case, I’ve complied a ‘supplement only’ list of options. These can be used for both acute injuries and old concussions. It’s difficult to say exactly how long someone would need to continue on these, but I’d give the majority of them a solid run for 3-4 months at least. These are listed in order of importance as well in case funds are limited.
1. BPC-157: 1000-500mcg daily for 2-3 months, 2-3 capsules daily. CODE: GRANTFOWLER10
https://infiniwell.com/?rfsn=5349339.0c2b41
2. Plasmalogens (omega-9) 1-5 servings daily based on what you can afford
3. Specialized pro-resolving mediators: 6 capsules daily for 20-30 days, then reduce down to 2-3 capsules daily, (metagentics brand)
4. StemRegen (stem cell mobilizer), 2-4 capsules for 1-2 months. Code 10i for 10% of
https://www.stemregen.co/products/stemregen/?afmc=10i
5: Just Calm
5. Emoxypine (science bio brand) — 200-300mcg daily
6. Phosphatidylserine, 300-600mg daily
7. Magnesium L-threonat, 300mg daily .
8. Lithium orotate: 5-10mg daily (mitolife brand)
9.. Creatine, 5g daily
(Any brand works for the last 4 listed)
Comments
S Bajwa
I couldn't find anything about iss neurofeedback but I did find iasis microcurrent neurofeedback online. Is this the same thing?
Fowler Fitness
Yea
Tripp Vickery
Is your supplement order of importance the same for someone trying to treat a long term injury as it is for an immediate one?
