Chronic Traumatic Encephalopathy

Chronic Traumatic Encephalopathy

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder caused by recurrent mild traumatic brain injuries (TBI), which are commonly a result of sports injuries.  Given the popularity of contact sports, research on the prevalence and development of CTE has grown in recent years. One study examining the brains of professional football players post-mortem has confirmed a high rate of CTE in this group (1).  While there are a number of risk factors related to the development of CTE, it is clear that repeated head injury is a primary cause. Therefore, there is a growing urgency for proper treatment of post-concussion syndrome in general that will address symptoms as well as prevent future head injury.  Additionally, our understanding of the psychological disturbances related to CTE is growing and multiple treatment options for these behavioral health symptoms are available.

Alternative Treatments

There are a number of alternative treatment options for post-concussion management and care. Following a sports-related concussion, it is recommended that individuals do not return to play until the concussion has fully resolved (2). Additionally, it is recommended that resuming any activity in general be managed as a gradual process in order to minimize feelings of failure and frustration (3). Evidence also supports the use of cognitive restructuring following a concussion with the goal of educating individuals about the concussion and guiding reattribution of their symptoms (i.e. understanding that a headache may not be linked to the concussion), which will serve to alleviate comorbid anxiety and depression (3). Research has found cognitive restructuring to be associated with a decreased proportion of individuals who develop post-concussion syndrome (2).

Preliminary evidence suggests that neurofeedback and biofeedback may also be successful in mitigating post-concussion effects. Studies have found significant differences in heart rate variability (HRV) among individuals post-concussion compared to control subjects (4). Interventions that aim to remediate this atypical HRV include the use breathing exercises coupled with biofeedback to help individuals learn to appropriately pace their breathing (4). One study suggests the usefulness of pairing HRV biofeedback with neurofeedback, with the idea that targeting both the heart and brain will enhance treatment given the connections between the two structures (1). While there are few direct treatment options available for CTE, these alternative concussion treatments may help prevent the progression of head injury to CTE.

Psychological Symptoms and Treatments

In addition to the cognitive symptoms of CTE (such as memory and attentional disturbances), there are numerous comorbid psychological conditions that may range from mild to severe. These conditions may be due to disease-related brain changes and/or psychological reaction to disrupted quality of life (5). Depression is often common in CTE, and can occur at any point during the disease course. One study found that out of 51 people with CTE, 48% indicated signs of dysphoria (general dissatisfaction with life) and it has been suggested that individuals with CTE are more likely to experience vegetative symptoms of depression such as disrupted sleep or appetite rather than overt mood disturbance (5). Increased rates of suicide have been suggested to occur in CTE, however empirical evidence for this is mixed and should be approached with caution (6).

Another common psychological symptoms of CTE include increased impulsivity and/or aggression. In the previously mentioned study of 51 CTE patients, a large amount exhibited significant behavioral symptoms that included aggression, irritability, and agitation. Other symptoms of CTE include anxiety, emotional lability (changes in mood), and hypomania (5). Treatment of psychological symptoms include medication and cognitive-behavioral therapy, although more research is needed with individuals diagnosed with CTE specifically (5).

Biofeedback and Neurofeedback Treatments for CTE

There are some neurofeedback and biofeedback treatments that have been described by Drs. Lynda and Michael Thompson for those who have acquired chronic traumatic encephalopathy (1).  These professionals have been combing neurofeedback and biofeedback for brain disorders for many years, and have written major texts in the field (7).  An advantage of these methods of treatments is that medications can be reduced or eliminated, thereby avoiding the side effects of medication.  It is also likely that the therapeutic results will be permanent.   Some of the more severe level of cognitive impairment may have less than optimal results.

References

1. Thompson, M, Thompson, L, & Reid-Chung, A (2015). Treating postconcussion syndrome with LORETA Z-score neurofeedback and heart rate variability biofeedback: Neuroanatomical/neurophysiological rationale, methods, and case examples. Biofeedback, 43(1), 15-26.
2. Giza, C, Kutcher, J, Ashwal, S, Barth, J, Getchius, T, Gioia, G, … & McKeag, D (2013). Summary of evidence-based guideline update: Evaluation and management of concussion in sports Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 80(24), 2250-2257.
3. Mittenberg, W, Canyock, E, Condit, D, & Patton, C (2001). Treatment of post-concussion syndrome following mild head injury. Journal of clinical and experimental neuropsychology, 23(6), 829-836.
4. Conder, R, & Conder, A (2014). Heart rate variability interventions for concussion and rehabilitation. Frontiers in psychology, 5, 890.
   https://www.frontiersin.org/articles/10.3389/fpsyg.2014.00890/full
5. Antonius, D, Mathew, N, Picano, J, Hinds, A, Cogswell, A, Olympia, J, … & Leddy, J (2014). Behavioral health symptoms associated with chronic traumatic encephalopathy: a critical review of the literature and recommendations for treatment and research. The Journal of neuropsychiatry and clinical neurosciences, 26(4), 313-322.
6. Iverson, G (2016). Suicide and chronic traumatic encephalopathy. The Journal of neuropsychiatry and clinical neurosciences, 28(1), 9-16.
7. Thompson, M, Thompson, L, Reeves, A & Berenkey, M (2015). The neurofeedback book(2nd Edition).  Wheat Ridge, CO: 2017.