Concussion in the media is a growing topic, and rightfully so, as 1.7 million people in the United States sustain a concussion each year, resulting in 1.3 million emergency room visits and 275,000 hospitalizations, costing $60 billion in health care dollars.1
Concussion is sustained through a variety of traumas, including motor vehicle accidents and sports, which causes the brain to bounce around within the skill. This results in cellular and chemical changes which are known as concussion. Symptoms include headache, nausea, vomiting, balance problems, dizziness, fatigue, problems with sleep, feeling slowed down or foggy, memory problems, and difficulty concentrating.1
The good news is that for 50% of people, symptoms go away within 10-14 days of sustaining a concussion.2 Other people have persistent symptoms after several weeks. This phenomenon is called prolonged post-concussion syndrome (PPCS). These people who have difficulty recovering from a concussion and require physical therapy to aide in their cognitive and physical rehabilitation. Physical therapy for PPCS includes retraining of the vestibular-ocular system as well as static and dynamic balance retraining, and functional reactivation.3,4
Though risk factors such as high age, female gender, prior trauma, and history of headaches have been thoroughly explored in their relationship to PPCS, genetics have recently been linked as well.5 A gene called methylenetetrahydrofolate (MTHFR) has specifically shown to be associated in decreased ability to recover from the cellular and chemical damages associated with brain injury such as concussion.6
MTHFR is essentially the amino acid which the body needs to convert folic acid, which is ingested from food, into methyl-folate, the active form of folate the body is able to process and breakdown.6 The body needs methyl-folate in order to regulate homocysteine and methionine, amino acids responsible for proper cell growth, maintaining healthy blood vessels, providing oxygen to blood cells, and cardiac health.6,7 Mutations in the MTHFR gene can cause further damage to cells and blood vessels supplying the brain, which results in poor recovery after a concussion.
With about ½ of the population having some type of MTHFR genetic mutation and the increasing number of people sustaining a concussion each year, a solution must be made to the public in order to decrease the incidence of PPCS related to MTHFR gene mutation.6 Luckily, there is a fairly simple solution which many physicians are beginning to implement. Firstly, blood tests may be done to determine the levels of homocysteine in your blood.7 ,8 If the levels read high and you are having difficulty recovering from your concussion, you likely have an MTHFR mutation.
When high homocysteine levels are confirmed by blood test, supplementation of methyl-folate would be the next step. Methyl-folate supplementation has been shown to provide appropriate levels of homocysteine and methionine in the blood, thus allow proper cardiac and vascular health, subsequently allowing appropriate recovery of the brain after a trauma.9 Methyl-folate is available both as a prescription and over the counter. It is important to consult with your physician prior to taking any supplementation in order to decide what is most appropriate for you as an individual in your specific situation. A combination of physical therapy and methyl-folate supplementation might be the solution to appropriate recovery from PPCS.
- S. Alla, S.J. Sullivan, P. McCrory, L. Hale. Spreading the word on sports concussion: citation analysis of summary and agreement, position and consensus statements on sports concussion. British Journal of Sports Medicine, 45 (2) (2010), pp. 132–135.
- S. John Sullivana, Sridhar Allaa, et al. The understanding of the concept of ‘rest’ in the management of a sports concussion by physical therapy students: A descriptive study. Physical Therapy in Sport. 13 (4) (2012), pp 209-213.
- Alsalaheen B, Whitney S, Mucha A, Morris L, Furman J, Sparto P. Exercise Prescription Patterns in Patients Treated with Vestibular Rehabilitation After Concussion. Physiotherapy Research International [serial online]. June 2013;18(2):100-108. Available from: CINAHL with Full Text, Ipswich, MA.
- American Physical Therapy Association. The Physical Therapist’s Role in Management of the Person With Concussion, HOD P06-12-12-10 [Amended HOD P06-11-15-18], 2012. Available at: https:// www.apta.org/uploadedFiles/APTAorg/ About_Us/Policies/Practice/Management Concussion.pdf.
- S. Mondello, K. Schmid, R.P. Berger, F. Kobeissy, D. Italiano, A. Jeromin, et al. The challenge of mild traumatic brain injury: role of biochemical markers in diagnosis of brain damage. Med Res Rev, 34 (2014), pp. 503–531 2.
- Genetics Home Reference. MTHFR. April 2016. https://ghr.nlm.nih.gov/gene/MTHFR.
- Asghar Rahmani, Masoud Hatefi, et al. Correlation Between Serum Homocysteine Levels and Outcome of Patients with Severe Traumatic Brain Injury. World Neurosurgery. (27) (2016), pp 507-515.
- Miller AL. The methionine-homocysteine cycle and its effects on cognitive diseases. Altern Med Rev. 2003;8:7-19.
- Dr. McCaddon, Dr. Hudson, et al. L-methylfolate, Methylcobalamin, and N-acetylcysteine in the Treatment of Alzheimer’s Disease-Related Cognitive Decline. Primary Psychiatry | May 21, 2013.