Concussions are fairly common and inexpensive with the treatments we currently use (some good old rest and relaxation); as a result, it is often hard to see them as a serious injury. A broken bone causes a lot of pain and hubbub, having to get a cast and waiting months for it to heal – it’s a very apparent injury with constant reminders that something’s damaged. Considering the attention it demands, most people would probably consider a broken bone much more severe than a concussion. Although brain damage via concussion is much less apparent, it is a very serious matter, possibly resulting in decreased cognitive capacity or, in extreme cases, death. The brain is the most sensitive and vital organ we have, so the importance of its health and protection makes all others pale in comparison, even though the bills for other injuries might suggest otherwise. The question then becomes: how do we best spend our efforts to deal with injuries like concussions – in prevention or treatment?
I’ve always thought that a concussion was just bruising of the brain (which is actually a contusion), but there’s a lot more to it than some burst capillaries. Immediately following the hit to the head in a concussion, a number of things happen rapidly to offset homeostasis in the brain. Neuronal membranes are disrupted, causing the opening of K+ channels, depolarizing the neuron. Depolarization causes a random release of glutamate which binds to NMDA receptors that allow Ca2+ to flow into the cell and more K+ to flow out of the cell, depolarizing it even more. At this point there is a major imbalance in K+ concentration, which is far from homeostasis; to counter this, ion pumps in the membrane are activated to pump Na+ and K+ back into the cell. This requires energy, however, so glycolysis goes into overdrive to convert glucose to ATP to power the pumps. After brain trauma, oxidative metabolism performed by the mitochondria is also impaired, leading to reduced ATP production, calling for an increase in glycolysis. All of this glycolysis is producing a giant amount of lactate, which can induce increased cellular acidity, membrane damage, altered blood brain barrier permeability, and cerebral swelling, all leading to neuronal dysfunction and possible cell death, all characteristic of concussion.
Looking at the prospect of treatment, not only would the treatment have to be administered within minutes of occurrence, some very influential processes would have to be altered, which always worries me – either glycolysis would have to be shut off (and considering its importance to all life processes, this is likely not a great option) or the ion channels controlling K+ and Ca2+ flow would have to be blocked. Ion channel blockers have been identified and used, but they have produced mixed results and many, if not all, of them have a list of possible negative side effects as long as my arm, ranging from headaches to death. At that point, I’d rather take my chances with the concussion.
Prevention of concussion would solve the problem right then and there. Most of the concussion incidents in our society are due to sports, a setting that can be regulated to greatly control its occurrence. The issue here is that the game would be altered to such a degree that some would question whether it’s worth playing anymore. The point of competition is to give your all against the other team and whoever comes out on top had more to give and was therefore the better competitor. Forcing people to hold back would destroy the point, although the importance of health versus a game seems like an obvious choice. I guess the bottom line is, people still know the risks and put their health on the line anyway; who’s to tell them they can’t?
To choose sides, I tend toward treatment, but with a twist; I think researchers should focus on developing reliable methods for diagnosing concussions so people can know their risks with repeated injury, and any available treatment can be administered to an appropriate degree for the extent of the concussion. Overtreatment with ion channels can be an issue because homeostasis is usually the goal, so going too much in the opposite direction can swing one’s system into an equally problematic state. However, in the end, each option is complicated and has its positive and negative aspects – there may be no ideal answer. What do you think is the best route?