Thomas S. Bottiglieri, D.O.

Post-concussion syndrome (PCS) is a disease state in which the injured brain does not recover completely after a concussion (brain injury).  There is a disruption immediately following a brain injury in the electrical and chemical signaling pathways in the brain as well as a disruption in cerebral blood flow and brain metabolism.  The symptoms associated with this include headache, dizziness, sensitivity to sound/light, brain fog, sleep disturbance among others.

Although many references consider PCS only after 4 weeks post-brain injury, when a combination of the above symptoms persist beyond the expected recovery period (typically 7-14 days) we call this post-concussion syndrome.  Post-concussion syndrome may include some of the initial symptoms noted, or can include complaints that evolve during the acute and sub-acute phases.  Commonly headaches, brain fog, difficulty reading, fatigue, depression, anxiety, sleep disturbance, and feelings of isolation are apparent during the sub-acute and chronic phases of post-concussion syndrome.  The syndrome can persist for an indefinite period of time.

The prolonged recovery can be secondary to severity of injury, repeated injury during the symptomatic phase, prior history of headaches, ADHD, and other learners such as those with dyslexia.  One less commonly described phenomena that can lead to PCS is that of the high stress learner or “type A” personality.  In addition the severity of the initial injury and prior history of concussions (especially > 3 prior injuries) can be a predictor of a more prolonged recovery from brain injury and PCS.  We think of PCS in the same light as complex pain syndromes such as amplified musculoskeletal pain syndrome in which the response to injury causes a hypersensitivity and positive pain/dysfunction feedback loop.  Breaking the cycle of pain is important and recalibration of normal brain function by advancing activities slowly/methodically is important.  It has been shown that absolute rest is not a great idea. Student-athletes kept from participating in sports and academics often feel a sense of loss and even depression or anxiety.  Tolerable activities should continue, and social engagement is important as well.

Typical treatments include academic modifications, neuropsychology evaluation, cognitive rehabilitation, vestibular therapy, ocular coordination training, prism glasses, supplemental vitamins, and medications.  Other treatments preferred in my practice include HRV training and the exertion protocol.  Every person recovers at a different rate and with different interventions.  The use of an activity/symptoms journal is very helpful in monitoring recovery and modifying interventions.