BBC: How Long Concussion could offer new insights into Long Covid

[forestglip]

Link to article
By David Cox

Many of these [Long COVID] patients were presenting with a range of neurological symptoms. Mavroudis could not help but notice that their symptom patterns – fatigue, sleep disturbances, light and noise sensitivity, exercise intolerance and problems with memory and concentration – were strikingly similar to those associated with another mysterious long-term condition known as post-concussion syndrome or 'Long Concussion'.

Mavroudis was so intrigued by the overlap that he cited it in a scientific review of post-concussion syndrome, published in May 2023. But he wasn't the first to note it. Half a year earlier, a group of concussion experts at the University of Denver, Colorado, had also published their findings on the seemingly unlikely parallels between the two conditions.

When they applied standard concussion tests to Long Covid patients, the University of Denver researchers noticed the same tell-tale issues. One was problems with eye-tracking movements, as assessed via the King-Devick test, which measures the ability to scan numbers on a card from left to right in a zig-zag fashion under time pressure. The results of balance and spatial reasoning examinations also suggested that the patients had effectively experienced a traumatic injury to the brain.

Intrigued, the group suggested that the same diagnostics used for concussion could provide a much-needed way of assessing progress made by these patients. They argued that technologies stimulating the vestibular system - the sensory network in the brain which co-ordinates the position and movement of our head in space - could be trialled a new treatment approach for Long Covid.

In both incidences, he believes that the problems stem from the brainstem, stalk-like structure connecting the brain and spinal cord, becoming constricted. This can either happen due to the skull being too mobile and falling backwards, or a forceful impact.

"The brainstem coordinates connectivity in the brain," says Renz-Polster. “So, when it gets squished, that leads to a complete disruption of the connectivity and flow of information between the various centres that underlie our brain functions." He explains that this is why ME/CFS patients can have a hard time adapting to any kind of stress, whether psychological, muscular, or cognitive. "Every kind of stress sends them into dysfunction," he says.

In recent years, research has also revealed that the brainstem is particularly vulnerable to various neurotropic viruses, ones capable of accessing the brain. Studies have shown that the ACE2 receptor used by the SARS-CoV-2 virus is relatively abundant in the brainstem compared with other regions, while autopsies have even found the virus' RNA and proteins in this part of the brain. It is also thought to be particularly sensitive to damage from the excessive immune activation which can be triggered by infections.

Renz-Polster's theory is two-fold. He believes that an initial trauma - either from a forceful impact or a viral infection – can potentially impair the activity of the brainstem as well as disrupting the fragile membrane separating the brain from the bloodstream. This allows inflammatory molecules to damage the lining of the many small blood vessels which feed the brain, something which has knock-on consequences for mitochondria, the many tiny energy factories which power every cell in the body from neurons to muscle cells.

There are also other patterns which have been seen in ME/CFS, Long Covid and patients who have suffered severe concussions due to traumatic brain injury. One is the reactivation of latent viruses which are permanently ingrained in the genome, such as herpes viruses, which can cause cold sores and genital herpes, or varicella zoster virus, which causes chickenpox and shingles. Once they're reawakened, it's thought that they may lead to inflammation.

Renz-Polster suspects that in all three cases, this viral reactivation could contribute to some of the ongoing symptoms like fatigue and brain fog. While there isn’t a definitive strategy for silencing these viruses once awoken, ideas such as administering the BCG vaccine for tuberculosis have previously been explored as a way of stopping the reactivation of various herpes strains, with some success.

 

[forestglip]

Also:

Renz-Polster is particularly intrigued by the potential of psychedelic drugs such as ibogaine, psilocybin and ketamine, which modulate the default mode network, a group of brain regions including the brainstem. Earlier this year, a small study found that the combination of ibogaine and magnesium seemed to improve brain functioning in US military veterans with traumatic brain injury, while there are some anecdotal reports of Long Covid patients experiencing benefit from MDMA and psilocybin therapy.

 

[Jonathan Edwards]

The bits quoted seem pretty half baked.

The brain stem might well be relevant but all the stuff about not connecting to brain and virus reactivation and blood brain barrier and mitochondria and... seems just a minestrone of all the usual.

 

[rvallee]

I've described some of how I feel as concussed for a long time, and it makes sense to me. To a point, but still. And that it makes more sense that this is about the old brain. I'm not sold on the role of psychedelics, but if I get the chance I would try micro-dosing mushrooms.

The big problem here is that medicine doesn't do much better at treating concussions than they do with us. It's time that heals, and if it doesn't, you're pretty much boned. So this isn't really helpful to us, unfortunately. Other than possibly some future insight happening only because someone looked at the right place.

 

[forestglip]

I think with every related condition, it's a big win for everyone because it's, effectively, more scientists working on the problem for both conditions. And once it's known they're related, the two groups can collaborate and share research.

Plus the combined voices of patients are louder if they're fighting for the same thing.

 

[Sean]

When they applied standard concussion tests to Long Covid patients, the University of Denver researchers noticed the same tell-tale issues. One was problems with eye-tracking movements, as assessed via the King-Devick test, which measures the ability to scan numbers on a card from left to right in a zig-zag fashion under time pressure. The results of balance and spatial reasoning examinations also suggested that the patients had effectively experienced a traumatic injury to the brain.

Intrigued, the group suggested that the same diagnostics used for concussion could provide a much-needed way of assessing progress made by these patients.

Interesting.

 

[forestglip]

Interesting.

Yeah, reminded me of what we were talking about with eye tracking: https://www.s4me.info/threads/idea-...o-track-fatigue-accurately.38583/#post-536370

I might try to see if I can find the exact technique they used to see if it can be done without special equipment.

 

[JohnTheJack]

Link to article
By David Cox

I've said before that I've long thought my symptoms resemble those with concussion and CTE.

Since we're on this subject: article in Times (London) today on how research showing that even heading modern balls increased risk of CTE in former footballers was repressed by BMJ and the (now proven) fraud Mcrory, editor of the British Journal of Sports Medicine.

How football silenced for 25 years the men who could have saved lives
(£)https://www.thetimes.com/sport/foot...-the-men-who-could-have-saved-lives-7nwzjrc2v

Not sure if this will work for access, but hope it will.
https://archive.ph/FZAFv

 

[Hutan]

The big problem here is that medicine doesn't do much better at treating concussions than they do with us. It's time that heals, and if it doesn't, you're pretty much boned. So this isn't really helpful to us, unfortunately. Other than possibly some future insight happening only because someone looked at the right place.

I think with every related condition, it's a big win for everyone because it's, effectively, more scientists working on the problem for both conditions. And once it's known they're related, the two groups can collaborate and share research.

A couple of days ago I heard on the radio someone promoting their book about how exercise was the solution to Long Concussion. Graded exercise and graded cognitive effort. Pushing through symptoms to get to recovery. Increased symptoms were ok and even desirable up to a two points on a 1 to 10 scale e.g. if your symptoms are at a 4 in the morning, they can worsen to a six, but then you should stop, before trying again the next day.

The suggestion was that doctors were incorrectly advising people to lie in bed in a dark room until their symptoms were gone, and that actually people needed to be active to get the brain rewiring.

(There was a similar misconception about opponents to the 'challenge' rehabilitation paradigm for concussion as there is for us, that what is being advised is to withdraw and do absolutely nothing with no stimulation of any sort.)

 

[Sean]

The suggestion was that doctors were incorrectly advising people to lie in bed in a dark room until their symptoms were gone,

They do love strawman excuses.

In fairness, they don't have much else. Certainly not solid evidence.

 

[livinglighter]

The big problem here is that medicine doesn't do much better at treating concussions than they do with us. It's time that heals, and if it doesn't, you're pretty much boned. So this isn't really helpful to us, unfortunately. Other than possibly some future insight happening only because someone looked at the right place.

The approach to treating concussions and post-concussion symptoms may differ depending on whether a brain injury specialist is part of the patient's care team. Typically, TBI neurologists specialised in concussions provide guidance on rehabilitation when symptoms persist over time.

A couple of days ago I heard on the radio someone promoting their book about how exercise was the solution to Long Concussion. Graded exercise and graded cognitive effort. Pushing through symptoms to get to recovery. Increased symptoms were ok and even desirable up to a two points on a 1 to 10 scale e.g. if your symptoms are at a 4 in the morning, they can worsen to a six, but then you should stop, before trying again the next day.

The suggestion was that doctors were incorrectly advising people to lie in bed in a dark room until their symptoms were gone, and that actually people needed to be active to get the brain rewiring.

As far as I’m aware, exercise as a treatment for concussion is an area of research that has its roots in sports injury and medicine. This field of research may be one of the largest in the study of concussions and traumatic brain injuries. My observations from reading literature, is that Graded Exercise Therapy (GET) is a diluted form of Graded Exercise / Graded Exercise Testing (GXT) used to determine VO2max, which has also garnered attention in Long COVID research.

(There was a similar misconception about opponents to the 'challenge' rehabilitation paradigm for concussion as there is for us, that what is being advised is to withdraw and do absolutely nothing with no stimulation of any sort.)

It’s possible that the opposition to long-term rest advice is another complex situation involving shareholders with financial interests. However, it is noteworthy that brain injury neurology specialists are actively engaged in research and clinical care in this area, which may offer better prospects for individuals with long/post-concussion issues as they should be viewed as the experts.

I also find it interesting that while some proponents argue that post-concussion syndrome is functional neurological disorder (FND), TBI neurology recognises the distinction between functional symptoms caused by psychological issues and functional cognitive problems following brain injury (organic). In this context, collaborative efforts between long/post-concussion specialists and ME & LC could be beneficial.

 

[poetinsf]

I don't know why he had to resort to mitochondria and brain stem when there is much more obvious explanation of neuro-immune activation in TBI. The mitochondrial or brain stem injury does not explain PEM or the sex difference. Brain stem could be involved in CCI or intracranial hypertension, but it could be further upstream event that eventually precipitates in ME/CFS-like symptoms via neuro-immune activation.

 

[Blueskytoo]

My daughter has PCS after a head injury after a bike fall. She’s lived with it for ten years now and will have it for the rest of her life - after two years we were told it would be permanent.

We’ve often noted how similar her issues are to mine in every way except PEM - the cognitive effects of her injury are almost identical apart from my memory which is better. She doesn’t make new short term memories if she’s tired or stressed which isn’t something I have a problem with, but apart from that, the executive dysfunction, issues with concentration, sensory overload (hers is MUCH worse than mine to the point where she lives in Loop earbuds and has to wear sunglasses most of the time outside even on dull days and needs a hat with a brim on bright ones. She keeps the curtains pulled a lot in her home because she struggles with the light levels and it hurts her brain. She can’t deal with visual processing of fast movement, like me, she’s easily exhausted by people talking, like me, she stuff has word finding difficulties, like me, and she has drastic and sudden drops in energy, like me. She also has neuro-fatigue, which is apparently very common in PCS, where she will be very tired after physical work that she should be able to manage given her level of fitness and she needs time, often days, to recover although it’s simple fatigue, not PEM. It’s uncanny how similar we are.

PCS has absolutely disabled her to the point where she’ll likely never work for a living, although she has a two day a week volunteer position at a local stables owned by a friend. She can only manage even that with a day off in between and the owner is thankfully completely understanding about the effects of her TBI and keeps a careful eye on her to make sure she doesn’t overdo things. But it’s been a devastating cost to her life from what initially seemed a relatively minor concussion. I’m just so thankful she was wearing a helmet when she hit the ground, it could have been so, so much worse.

Edited for spelling. Again.

 

[forestglip]

where she will be very tired after physical work that she should be able to manage given her level of fitness and she needs time, often days, to recover although it’s simple fatigue, not PEM.

Just curious why you say it's not PEM. Seems like taking days to recover from normal exertion sounds pretty similar.

 

[Yann04]

Just curious why you say it's not PEM. Seems like taking days to recover from normal exertion sounds pretty similar.

The way I understand is:

PEM is worsening of symptoms and illness after activity. Fatigue lasting longer than normal after activity might be a part of PEM, but it is not enough to constitute of PEM itself.

 

[forestglip]

The way I understand is:

PEM is worsening of symptoms and illness after activity. Fatigue lasting longer than normal after activity might be a part of PEM, but it is not enough to constitute of PEM itself.

So I guess in @Blueskytoo's daughter's case, if her cognitive issues also increase that'd be PEM?

And what if it's just fatigue, but it's delayed? Isn't delay pretty unique to PEM?

Edit: The only "symptoms" required for ME/CFS by IOM criteria are fatigue, unrefreshing sleep, and either cognitive dysfunction or orthostatic intolerance. So it should just take an unusually intense increase in fatigue, sleep issues, and one of the other two to constitute PEM.

 

[Blueskytoo]

Just curious why you say it's not PEM. Seems like taking days to recover from normal exertion sounds pretty similar.

She doesn’t have any sort of immune system response to it, unlike me. She’s just knackered. She doesn’t have ME, she doesn’t have the aches and pains, the immune type responses or any type of delay in her fatigue levels. She’s really not ill, it’s much more that she’s worked really hard at something, either physically or mentally and just needs a lot of time to recover from the effort. Like “normal” people do, it’s just she’s affected by it at a much lower level of effort, if that makes sense

 

[Yann04]

@forestglip I was more thinking vis à vis the ICC, which requires.

Postexertional symptom exacerbation: e.g. acute flu-like symptoms, pain and worsening of other symptoms

 

[forestglip]

She doesn’t have any sort of immune system response to it, unlike me. She’s just knackered. She doesn’t have ME, she doesn’t have the aches and pains, the immune type responses or any type of delay in her fatigue levels. She’s really not ill, it’s much more that she’s worked really hard at something, either physically or mentally and just needs a lot of time to recover from the effort. Like “normal” people do, it’s just she’s affected by it at a much lower level of effort, if that makes sense

Hmm, well I don't think aches, pains, obvious immune issues, or delay in fatigue are required for ME. I certainly don't have the first three.

 

[Blueskytoo]

So I guess in @Blueskytoo's daughter's case, if her cognitive issues also increase that'd be PEM?

And what if it's just fatigue, but it's delayed? Isn't delay pretty unique to PEM?

Edit: The only "symptoms" required for ME/CFS by IOM criteria are fatigue, unrefreshing sleep, and either cognitive dysfunction or orthostatic intolerance. So it should just take an unusually intense increase in fatigue, sleep issues, and one of the other two to constitute PEM.

It’s not delayed, and she doesn’t have any other symptoms apart from the ones you’d normally expect from someone who had over-exerted themselves either physically or mentally. It’s just that the levels of exertion required to provoke that response are lower than they should be. Her brain gets tired really fast, much faster than it should so it takes her longer to recover from normal levels of exertion, but the tiredness does definitely exacerbate her cognitive symptoms more than it should.