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Published on: November 22, 2018
Does your sex affect how your brain responds to concussions and other injuries?
According to recent research involving mice, the answer might be “Yes.”
In a study published earlier this year in the journal Glia, researchers concluded that male and female mice responded to traumatic brain injury (TBI) in different ways. After experiencing a TBI, male mice had a “faster and more robust” inflammatory response than female mice. As a result, male mice showed more signs of brain tissue loss in the first week following injury.
In contrast, the inflammatory response in female mice got off to a slower start, but it later accelerated. After a month, male and female mice showed similar levels of brain tissue loss. “Females appear to be protected in the acute phase post-injury, but by the time we got to 30 days, there really wasn’t much difference between the sexes.” Mark Burns, associate professor of neuroscience at Georgetown University Medical Center.
“With the inflammatory response in females, we believe we’ve got a larger clinical window where we might be able to go in and modulate the immune responses, maybe try to switch on beneficial responses, and really harness that initial protective effect,” he added.
Burns hopes that his ongoing research in mice will help shed light on other potential gender differences in TBI, including treatment strategies for male and female patients.
Historically, most animal research has involved only male mice. But in recent years, the National Institutes of Health (NIH) has taken steps to address the imbalance, calling on scientists to include both male and female animals in studies.
“Certainly for us, we’re going to be including females in all our studies moving forward. And we’ll make sure we look to see how the responses are different in male vs. female,” Burns said.
Effects of sex uncertain
Past studies on sex-related differences in concussions and other TBIs have yielded inconsistent results.
For example, when investigators from Columbia University analyzed the medical records of 1,203 athletes, they found that 23 percent of women and 17 percent of men experienced at least one concussion over the course of their collegiate career.
In contrast, some studies have found no sex-related differences in rates of concussions. Similarly, some investigators have found that female patients tend to experience worse symptoms or longer recovery times following concussion, while other scientists have found no such differences.
“While many researchers are trying to understand the mechanism, risk factors, and recovery of concussion, there remain many unanswered questions in the field, and we have a long way to go until we understand this common but complex brain injury,” Cecilia Davis-Hayes, co-author of the Columbia study, told Healthline.
“The factors that account for the gender differences in concussion are as yet unknown, but research is ongoing to explore potential anatomical, biomechanical, hormonal, or behavioral differences between males and females,” she noted.
More research is needed to not only identify potential gender-related differences in the incidence and outcomes of concussion, but also to determine the cause of any disparities.
For instance, differences in anatomy, hormone levels, and brain function might impact how bodies respond to brain injury. Social norms may also lead girls and women to report symptoms more frequently than boys and men, which might contribute to perceived sex differences in concussion risk.
Medical care available
No matter what your sex, it’s important to seek medical help if you suspect that you have a concussion or other TBI.
Concussions can cause a wide variety of physical, cognitive, and emotional symptoms, from headaches, to trouble concentrating, to personality changes. To diagnose concussions, doctors largely rely on clinical judgement and imaging technologies.
“When patients come to the emergency department, we’re always concerned for intracranial bleeding or bruising of the brain. So we typically do a very good history, a physical exam, a neurological exam, and then we have decide whether we need to get a CAT scan or not to look for bleeding or bruising on the brain,” Dr. Linda Papa, a physician in the Department of Emergency Medicine at Orlando Health.
“Usually that’s based on clinical judgement, but now we’re working on developing a blood test that can help us do that,” she continued.
While there’s no “magic bullet” available to treat concussions, doctors can prescribe a wide variety of supportive therapies to help manage patients’ symptoms.
“Normally, there’s either a neurologist or a neuropsychologist who will follow up with the patient, and they have cognitive exercises they can do,” Papa explained. “There’s behavioural therapy and exercises. There’s physical and occupational therapy if they’re having physical limitations or trouble getting back on the job. Some people with balance issues go through vestibular therapy. There’s also medications to help with anxiety and the like.”
While many people recover from a concussion within 10 days, and most recover within a month, some people experience symptoms for longer.
“Patients shouldn’t give up,” Papa said. “We’re learning new things about the brain every day and how it heals. As we understand concussion better, the better we will get at providing patients with treatment.”
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