Pathophysiologic Mechanisms of Concussion, Development of Chronic Traumatic Encephalopathy, and Emerging Diagnostics: A Narrative Review

Localization of Brain Injuries Using Cranial Electromagnetic Fields

BACKGROUND

Atraumatic brain injury and traumatic brain injury (TBI) have been demonstrated to be associated with changes in brain electromagnetic field (EMF) activity due to alterations in the structure and function of neural circuitry. Modulation of abnormal EMF activity through EMF stimulation may promote neural regeneration and may be more beneficial when the specific change in EMF frequency that is correlated with either computed tomography (CT) imaging changes, neurological changes, or both can be precisely localized. The authors investigate the efficacy and feasibility of a noninvasive portable helmet with sensors and built-in signal generators to measure and localize specific changes with frequency and amplitude from brain EMF for both atraumatic and TBI patients.

METHODS

This prospective clinical study was conducted from January 2025 to February 2025 and enrolled patients greater than 18 years old diagnosed with atraumatic and TBI, including negative image concussion. Baseline EMF activity was recorded using a helmet equipped with 20 sensor stimulators. Localization of EMF activity was determined based on sensor activity corresponding to the patient's neurological deficits on exam and/or structural lesion(s) on CT. EMF data were collected using the DAQami software (Dataq Instruments, Akron, OH) and analyzed using fast Fourier transformation with the Igor Pro 8 software (Wavemetrics Inc., Lake Oswego, OR) to localize normal and abnormal brain EMF signals by comparing opposing and adjacent sensors.

RESULTS

Ten patients were enrolled in this study with a mean age of 47.1 years. Mechanisms of injury included spontaneous hypertensive intracranial hemorrhage (one patient) and head trauma after motor vehicle collision (auto vs. auto; auto vs. motorcycle; and auto vs. pedestrian), dirt bike accident, and ground-level fall (nine patients). Radiographic findings included spontaneous basal ganglia hemorrhage (one patient), isolated traumatic subdural hematoma (one patient), traumatic subarachnoid hemorrhage (one patient), and no intracranial abnormalities (seven patients). Abnormal EMF activity was recorded and correlated with neurological deficits on exam, CT findings, or both, demonstrating the usefulness of EMF in localizing brain injuries.

CONCLUSIONS

These results demonstrate the efficacy and feasibility of utilizing a noninvasive portable helmet for real-time EMF recording and localization of brain abnormalities in atraumatic and TBI patients, including image-negative concussions. EMF measurements may aid in monitoring recovery after atraumatic brain injury and TBI and enable the clinician to tailor treatment plans based on the patient's unique brain EMF patterns.

Glymphatic system: a self-purification circulation in brain

The glymphatic system theory introduces a new perspective on fluid flow and homeostasis in the brain. Here, cerebrospinal fluid and interstitial fluid (CSF-ISF) moves from the perivascular spaces (PVS) of arteries to those of veins for drainage. Aquaporin-4 (AQP4) plays a crucial role in driving fluid within the PVS. The impairment to AQP4 is closely linked to the dysfunction of the glymphatic system. The function of the glymphatic system is less active during waking but enhanced during sleep. The efficiency of the glymphatic system decreases with aging. Damage to the glymphatic system will give rise to the development and progression of many brain diseases, such as Alzheimer's disease (AD), Parkinson's disease (PD), chronic traumatic encephalopathy (CTE), and vascular dementia (VaD). Here, we reviewed previous research associated with the glymphatic system, including its concepts, principles, and influencing factors. We hypothesize that AQP4 could be a target for the prevention and treatment of certain brain diseases through the regulation on the glymphatic system.

A Review of Glymphatics and the Impact of Osteopathic Manipulative Treatment in Alzheimer's Disease, Concussions, and Beyond

Glymph is a fluid that circulates in the brain interstitium and, under pathological conditions, unusually accumulates and enhances the buildup of other noxious molecules. The study of this process of circulation, accumulation, and clearance is called glymphatics. We review the physiology of glymphatics and then dive into recent innovative research surrounding this neurological field of study and how it has applied to mainstream pathological processes, including Alzheimer's disease and spectrums of traumatic brain injury that range from a concussion to chronic traumatic encephalopathy (CTE). Furthermore, we explore the implications of glymphatics and a new and developing frontier of healthcare in space travel; with the advent of a Space Force and the introduction of space travel to consumer markets, this is an exciting time to develop novel techniques in enhancing its safety and optimizing human physiology for best outcomes. Therefore, we also propose that osteopathic manipulative treatment (OMT) plays an intuitive role in the treatment of abnormal glymphatics, as adjunctive therapy in Alzheimer's and CTE, and as a future staple before, during, and after space travel for the benefit of both enhancing healthcare in chronic conditions and advancing the capabilities of the human race in its shining new endeavor.