Medication (Amantadine)
There is very little research evaluating pharmacological treatment following sport-related concussion. [9] There is no scientific evidence that medication speeds recovery from concussion in humans. [10] A wide variety of medications, sush as non-steroidal anti-inflammatories, sleep agents, methylphenidate, antidepressants and anticonvulsants, have been used for persistent headache, sleep problems and other symptoms following mTBI in civilian and military personnel. [9]
In a first-of-its-kind study [3], researchers at the University of Pittsburgh Medical Center recently found that Amantadine - a drug originally developed as a medication to treat or prevent illness caused by the flu virus, and later shown to improve symptoms of Parkinson's disease and cognitive function in patients with serious brain, spinal cord, or nerve-related illnesses and injuries - may be useful in treating adolescents who have not spontaneously recovered from concussion following a period of cognitive and physical rest. [9]
Given 100 mg of amantadine twice daily at breakfast and lunch, a small treatment group of 25 student-athletes (ranging in age from 13 to 19 and with an average age of 15.54 years) who were experiencing persistent neurcognitive deficits and concussion symptoms at 3 to 4 weeks post-injury, reported a significant decrease in reported symptoms and performed better on verbal memory and reaction time on neurocognitive tests compared to a control group of concussed student-athletes with post-concussion syndrome treated conservatively (i.e., rest) and without medication.
The findings "provides tentative support for the efficacy of amantadine as pharmacological treatment for patients who fall outside of the normal recovery trajectory (i.e., more than 3 weeks) following concussion," writes lead author, Cara Camilio Reddy, MD, Director, Brain Injury Program, Department of Physical Medicine and Rehabilitation and Medical Advisor to the Sports Concussion Program in the Department of Orthopedic Surgery at the University of Pittsburgh Medical Center.
"These results highlight one possible treatment for patients with prolonged recovery from concussion," Reddy says, although it "may not be the treatment of choice for all patients with post-concussive symptoms" because "individualized concussion management requires [an] in-depth interview to evaluate the symptoms and to tailor a management plan based upon each individual's symptom profile."
Due to limitations in the study (small sample size, retrospective nature, a non-randomized design resulting in both subjects and clinicians being aware the drug was being used which could have resulted in placebo and experimenter bias), the study authors said the results "should be viewed cautiously" until double-blind randomized control trials of the efficacy of amantadine following concussion in a sufficiently large sample could be conducted to collaborate the study's findings. In addition, as the authors of a recent meta-analysis on the effects of rest and treatment following sport-related concussion [9] note, the individuals in the treatment group were at a lower baseline at the start of the study for verbal memory and visual memory, and they reported more symptoms.
As with all medications, Amantadine has side effects, but is generally well tolerated and is so safe that the current FDA approval for the drug is for use by healthy children during an influenza outbreak, in order to prevent them from getting the flu. It use cannot be stopped abruptly because of the risk of developing malignant hyperthermia, a medical condition that causes painful rigidity of the muscles and high fevers.
Because of a concern for the potential for birth defects in the children of women who are pregnant or who become pregnant while taking Amantadine, careful thought should be given to the potential risks and benefits of taking the drug when deciding whether it should be used to treat concussion.
For an article by a New Jersey mother describing her teenage daughter's successful experience with Amantadine in recovering from post-concussion syndrome, click here.
Chiropractic neurology (CN)
Chiropractic, now considered a branch of mainstream medicine, is best known, of course, for the adjustments DCs do of the vertebra of the neck and back to correct misalignments (subluxation) which irritate the spinal nerves, reducing muscle strength and setting off spasms, or other painful symptoms.
Chiropractic neurology was developed by Dr. Ted Carrick and is a much more recent sub-specialty focusing specifically on brain function. The CN view of concussion suggests that, following the injury, symptoms linger due to the swelling of neurons in the damaged area of the brain, causing dysfunction of those neurons and possibly the death of connections. The goal of CN is to identify the damaged areas using simple, yet sophisticated, diagnostic techniques which explore brain function. Its aim is to restore normal brain function by locating the injured (target) area in the brain via non-invasive, stimulative techniques - such as very simple, non-strenuous, visual exercises, the use of specific colors and pattern of target lights - which reveal sensory or musculoskelatal responses indicating either normalcy or dysfunction, and then perform therapy according to the observed responses to the targeted environmental stimuli.
The CN view of concussion suggests that symptoms linger due to the swelling of the neurons in the damaged area of the brain. One specific brain area which may be damaged in a concussion is the vestibular system, which may cause dizziness and/or dysfunction of the brain's vascular (blood flow) system, among other symptoms. CN is designed to promote the formation of new connections in damaged areas of the brain (neuroplasticity), the consequence of which is to improve brain function. Among the therapies a CN may suggest in the treatment of PCS is warm baths with Epsom salts.
