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not all concussions are equal: understanding different types of brain damage

researchers are beginning to understand how injuries to different areas of the brain may affect different systems, but cause similar symptoms.

by chris arnold

may 23 2022
read time 3 minute read
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why do concussions affect us differently?
concussions are not caused specifically by blows to the head, but instead by the brain rattling around inside the skull and impacting the sides. getty
researchers have found various types of brain damage, caused during a concussion, can lead to similar symptoms in children. 

scientists from mcgill university looked into how brain damage from concussions impacted the structural connection network, called white matter. they then used modelling techniques to see how the changes in white matter impacted 19 different symptoms. 

looking at data from 306 children aged nine to 10 years old, all of whom had experienced a concussion, the researchers determined that injuries to different areas of the brain may impact different systems but result in similar symptoms. for example, damage to one area of the brain may impact sleep/wakefulness control, while injury to another area may cause depression-like symptoms. both injuries may result in similar symptoms — constantly wanting to sleep — but for different reasons.
currently, treatment for all types of concussion are similar. more detailed information on how and where the damage takes place, and how this translates to classic concussion symptoms, is a first step in developing more precise treatments.

“despite decades of research, no new treatment targets and therapies for concussions have been identified in recent years,” guido guberman, lead author of the study said in a statement . “this is likely because damage to the brain caused by concussions, and the symptoms that result from it, can vary widely across individuals. in our study, we wanted to explore the relationships that exist between the symptoms of concussion and the nature of the injury in more detail.”

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andrée-anne ledoux, a scientist at the cheo research institute and a professor at the university of ottawa, is the lead author of a newly published study that compared children and youth between the ages of five and 18 who had been diagnosed with concussions and those who had been diagnosed with orthopaedic injuries, such as broken bones, over a 10-year period.

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classifying concussion subtypes: new treatment targets for concussion symptoms

concussions are not caused specifically by blows to the head, but instead by the brain rattling around inside the skull and impacting the sides. the researchers found that certain types of brain damage were associated with symptoms. 
“the methods used in our study provide a novel way of conceptualizing and studying concussions,” maximne descoteaux, author on the study, said. “once our results are validated and better understood, they could be used to explore potential new treatment targets for individual patients. more broadly, it would be interesting to see if our methods could also be used to gather new insights on neurological diseases that likewise cause varied symptoms among patients.”

concussions are often resolved within a few weeks, with an average of 10 days until the person is back to normal, according to the mayo clinic .

researchers say the heterogeneity, or variation among outcomes, contributes to a lack of understanding and treatment options available. although most children can recover from a concussion, there are some who will experience lingering symptoms such as headaches, nausea, dizziness, over-tiredness, difficulty sleeping, depression, anxiety, aggression, and attention problems. 

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“patients with concussions can express these different concussion subtypes to varying degrees,” the study reads. “we theorize that the combination of these different subtypes and how much they are expressed is what determines the clinical syndrome a person will display.”
essentially meaning that when the brain is moving around inside the skull, whichever part of the brain gets the most impact will be the more likely to show symptoms. however, the subtypes can still play a role, meaning that the areas of the brain that were less impacted are still potentially causing symptoms. the multitude of impacts can act as a tag team. 
“early multi-tract multi-symptom pairs explained the most covariance and represented broad symptom categories, such as a general problems pair, or a pair representing all cognitive symptoms, and implicated more distributed networks of white matter tracts,” the study reads. “ further pairs represented more specific symptom combinations, such as a pair representing attention problems exclusively, and were associated with more localized white matter abnormalities.”
 
chris arnold is a toronto-based writer.
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