• Home
  • About
  • Blog
  • Directory
  • Subscribe
  • Contact Us
The Brain Health Magazine
  • Home
  • About
  • Blog
  • Directory
  • Subscribe
  • Contact Us
No Result
View All Result
The Brain Health Magazine
No Result
View All Result

The Anxious Brain

Understanding Dysautonomia After Brain Injury

in Concussion, dysautonomia, Featured content
December 26, 2019
7
The Anxious Brain

by Dr. Jeremy Schmoe, DC, DACNB

I’ll make this simple: when you injure your brain, you will affect the integration between your brain-gut and gut-brain axis. This can lead to gastrointestinal dysfunction, and it is very common to develop dysautonomia. This can lead to changes in regions of the brain that can cause anxiety for physiological reasons. Changes in autonomics, fuel delivery, blood brain barrier, GI barrier, nutrition and perfusion will lead to instability in regions of the brain, causing anxiety. Various regions of the brain can be injured, which can also lead to dysautonomia due to impaired neurological regulation. Many of the patients we see with dysautonomia have anxiety.   

Yes, you read that correctly, there is a physiological reason for your anxious brain! There are changes that have occurred from the initial brain trauma which have most likely affected the frontal cortex, insular cortex, cingulate cortex, amygdala, cerebellum and other regions such as pituitary and hypothalamus that are centrally located in the brain. When injuries occur, instability in any of the above regions can lead to an overall change in function. The good news is that with a very in-depth history, neurological examination, diagnostics, specific therapies, lab testing and nutrition, the right provider can start to unravel the complex web of dysautonomia.   

Not only are various regions of the brain affected, but also various cortical networks, hubs and cellular functions. This can lead to instability and impaired communication at the neuronal level. Neurons are firing at rates that they cannot handle, which leads to instability in communication, inflammatory biomarkers are elevated, and the entire metabolic stability of these systems are affected. I like to call this the chemical soup of brain injury. There is a chemical component as well as a neurological circuitry component—and these dysfunctions can lead to an anxious brain. 

12 Key Players in the Anxious Brain

  1. Frontal Connections to the Pontine Nuclei in the brainstem (sympathetic modulation)
  2. Insular Hyperactivity (PIVC)
  3. Cingulate Cortex
  4. Amygdala
  5. Cerebellum
  6. HPA-Axis
  7. Vestibular Nuclei and Visual Systems
  8. Vagal Centers
  9. Default Mode Network
  10. Chronic Pain Loops
  11. Neuro-inflammation
  12. Microglial Priming

Frontal-Pontine Connections

When you injure the frontal connections to the pontine regions of the brainstem, this can lead to an impaired modulation of the sympathetic nervous system—which can further lead to sensitization and chronic pain. This pain may not only be in your gut, but throughout the body, and can in turn cause more anxiety!

When you are in pain, this is going to sensitize various limbic regions in the brain, a.k.a., the emotional centers. The frontal lobe is involved in modulation of the limbic regions in the brain such as the cingulate and amygdala. These regions reflexively respond to sensory stimulation in the environment, and without the frontal lobe modulating these regions, sensory stimuli such as visual motion, sound and movements can lead to feelings of anxiety and emotionality.

These regions in the brain are already hyperactive, leading to an impaired modulation of pain. A feedback loop from the painful regions in the body will lead to more instability centrally, further leading to more anxiety. It is a viscous loop that is hard to get out of. Seeing a functional neurology provider trained in assessing all things neurological, metabolic and structural, as well as working with other techniques such as CBT, hypnosis and EMDR, have been very helpful for many of my patients. 

Parietal Insular Vestibular Cortex (PIVC)

The Insular cortex is a region very deep in the brain that is involved in the interoceptive processing of your inner and outer self, emotional regulation, body homeostasis and many other functions. There are connections between the parietal lobe, insula and vestibular system in the cortex called PIVC. Many patients that I have seen who have changes in central vestibular function also have anxiety, depersonalization and emotional instability. We have seen that by performing a variety of neuro-therapies we can improve anxiety in our patients. The normatec compression boots provide feedback from one’s vasculature in his or her lower extremities. Other therapies such as listening to one’s own heartbeat, specific breathing techniques, vestibular rehabilitation, Gyrostim and tilt-table therapy have shown clinical promise in improving autonomic function as well as emotional regulation. 

Cerebellum

Another key region involved clinically in many of our patients is the cerebellum. When the cerebellum is compromised, it can lead to poor balance, gait ataxia, midline instability, and trouble with coordination of movements. These include both eye movements and modulating vestibular function. Clinically we have seen that when the cerebellum has impaired gaiting, this can lead to overstimulation in regions of the brain. This can lead to anything ranging from anxiety, irritability, emotional reactivity, insomnia due to racing thoughts, blood pressure changes, and dysautonomia. By performing various movements with the body, eye exercises, vestibular rehabilitation, Gyrostim therapy, along with manual techniques, we can improve cerebellar function. By improving the cerebellum, you see changes in brainstem activation. The brainstem modulates autonomic function, which can improve anxiety. 

The Visual and Vestibular System

Brain trauma can destabilize the visual world around us and affect our ability to know where we are in space in relation to objects around us. This system can affect our head and neck positioning, posture, and balance, as well as overall cognitive functioning. To make things simple—if the visual system is affected, there can be symptoms noted that seem to be non-related to vision. A large percentage of the visual pathways integrate into reflexive systems along with autonomic systems. They also have integration with the vestibular system, auditory system and even the proprioceptive system. Many patients we see who have dysfunction in these pathways develop dysautonomia from impaired sensory integration and mapping of where to push blood to in the body and brain through fuel delivery.

To have a stable, accurate visual world, it is also imperative that the integration between these systems is fine tuned and coherent, allowing for vision to be dynamic, flexible and adaptable with changes in sensory input that we have to deal with on a day-to-day basis. When these systems are not fine-tuned, this leads to a massive use of energy that takes away from higher-level cognitive processing.

Eye Movements

An example would be dysfunction in pursuit eye movements. Pursuit eye movements are the type of movements that allow the eyes to follow a moving target. The circuitry is complex and involves the brain stem, cerebellum and cerebral hemispheres. An area involved in the brain stem is the neural integrator that includes the NPH and the medial vestibular nuclei. The medial vestibular nuclei integrates with the cerebellum and the peripheral vestibular structures.

If neuro-vision therapy with pursuit exercises is not fully integrating these movements back to recovery, then utilizing the proprioceptive system and combining a body-based movement with activation of the spinal musculature with a vestibular ocular exercises could be enough to drive plasticity in the brainstem. These therapies can help improve the gain of pursuits, decrease saccadic intrusions reducing retinal slip, and improve the pathology.

Having an in-depth understanding of the neuro-circuitry is what allows the functional neurology provider to make improvements in symptoms. The visual system is so complex with its integration with other sensory systems. This integration occurs to allow us to know where we are in space, which affects body positioning and motor output. This integration translates into maps of ourselves internally to allow us to shunt blood to regions that needs it.

The aspects of dysautonomia, if left unaddressed after injury, could be the missing piece to recovery. 

Vagus Nerve   

The communication between higher cortical centers and lower brainstem can be affected by TBI. The vagus nerve helps to regulate your autonomics and has parasympathetic control over your GI system. The vagal regions of the brain are very important for overall wellbeing and balance in your autonomic nervous system. Various techniques are used by a functional neurology provider to stimulate the vagal nerve, which in turn helps to dampen inflammation in the body and modulate the brain’s immune system. It does this through switching off primed microglial cells that can be turned on after TBI. When there is an imbalance between the sympathetic and parasympathetic systems, dysautonomia can develop.

Default Mode Network

Default Mode Network is compromised from multiple regions of the brain and is the primary resting-state network in the brain. Research has shown hyper connectivity in this network of the brain. These regions are involved in memory, executive function and attention. The hyper-connectivity in this network could explain the inability to disengage the network and switch task demands, explaining the cognitive deficits seen in concussion.

This hyper-connectivity could also explain the inability to get into resting-state mode that could lead to anxiety, racing thoughts, and an inability to utilize higher cortical centers in the frontal lobe to modulate autonomics and limbic regions of the brain.

Neuro-Inflammation and Microglial Cells

A large percentage of the brain is made up of immune cells called glial that outnumber the neurons 10 to 1. These glial cells are affected with TBI, and in healthy brains they help remove plaque and debris, and support healthy communication between neurons. When you injure your brain, this can lead to microglial cells being switched on and ramified, leading to excessive damage to neurons.   

Neurological stimulation from specific exercises, brain-based nutrition, and modulating the immune and gut health, can be very important in addressing brain-based inflammation. Any of these could be leading to instability in various regions of the brainstem that have receptors for inflammatory cytokines. This instability can be a contributing factor in dysautonomia.

In addition to brain injuries, there may even be underlying co-morbid factors involved prior to the patient hitting his head. These may set the stage for brain inflammation, such as autoimmunity, infections, diabetes, food intolerances, excessive alcohol use, leaky gut, hormonal imbalances or pre-existing anxiety/depression. 

Putting it all together

Seeing a functional neurology provider who has the ability to address structural, neurological and metabolic integrity can help many factors involved in the anxious dysautonomic-inflamed brain. This is because when you injure your brain, there will be changes in the functional ability to activate regions that stabilize the autonomic nervous system. Just a reminder that your autonomics are out of balance with anxiety and dysautonomia.

When the brain is injured, there can be a tipping into more of a sympathetic mode. This can lead to sensitization of pain structures, GI motility, leaky gut and or changes in peripheral and central inflammatory pathways. Any of these can prime regions of the brain that are involved in anxiety. Neurological networks such as default mode and hubs such as the cerebellum, brainstem, vestibular nuclei and regions of the brain involved with vision are affected, impairing the person’s ability to know where he is in space. 

This can activate reflexive limbic and autonomic responses leading to anxiety. The brain’s ability to activate the brainstem’s vagal centers to modulate the sympathetic nervous system is affected, leading to dysautonomia.

Please remember many of the feelings you are experiencing are real—and that it’s just not all in your head.

From my experience, we are able to make improvements in anxiety and dysautonomia with functional neurology rehabilitation provided in an intensive neuro-recovery program. 

 

Share on FacebookShare on TwitterShare Via EmailPinterest

Comments 7

  1. Desperate mom says:
    1 year ago

    Based on what you wrote in these two sections and your expertise – Parietal Insular Vestibular Cortex (PIVC) and Default Mode Network – would you say that multiple TBI to same/similar regions could take the anxiety levels to psychosis? If not, then is there a doctor that understands the TBI side of the person that could also work with the psychosis issues and be able to tell the difference in the symptoms?
    This TBI survivor has not received any help for their TBI – been turned away, told is normal, that they cannot help. This person has had multiple TBI that we know of, plus all the ones from falls from passing out and waking up with a massive headache – countless.

    Reply
  2. Becky Fitzgerald says:
    1 year ago

    My son also has this exact symptom afyer having a baseball size brain tumor removed.
    He was 15 now 18 they still dont believe him
    He feels with his stomach
    PLEASE help
    Becky. Fitzgerald
    Mason Fitzgerald

    Reply
    • Heidi Lerner says:
      1 year ago

      After my injury I had a lot of Gastro intestinal problems. I got into fermented foods and that has helped me a lot!
      After my injury I had a lot of Gastro intestinal problems. I got into fermented foods and that has helped me a lot!

      Reply
  3. Gary Brown says:
    1 year ago

    Some of what you have written in this article seems to relate to some of the vision issues I have had since 1974 when I had a pretty severe TBI, right, frontal, temporal lobe area. For a while after the injury, I was unconscious for 3 1/2 days, I was always able to see out of both eyes but the left eye was so far out of alignment with the right, which seems to be my dominate eye, that I could only see out of one of them at a time, or I could only pay attention to what I was seeing out of one at a time. Over months I started to force the left eye to move back more closely to it’s normal location and for quite some time I saw double images almost always. As time passed I got to where I could hold single vision most of the time and now, 45 years later, I can hold single vision almost all of the time, except when reading where I often have to close the left eye for a short period of time in order to focus clearly.
    Based on the contents of your article, I am curious if any of the treatments you were referring to might be able to help me to be able to maintain single vision a greater portion of the time?
    I will appreciate any feedback you may be able to provide me on this issue, Thank you for your time and consideration.

    Reply
  4. Martin Matko says:
    1 year ago

    Treatable CCSVI a congenital Science CONFIRMED recognized Med condition CAUSATIVE factor MS Symptoms & role/part 43 other SO CALLED Neurological afflictions studies show is involved proper/improved Cerebrospinal Blood flow Dopamine related issues incl. Mental Health & Depression!

    Reply
  5. Pingback: The Anxious Brain – The Good Men Project – Health 4 Everyday
  6. Mark says:
    1 year ago

    Just an inquiry. I had a high fever with a viral meningitis years ago and I haven’t been the same since. Is this a possibility? I’ve been a mess ever since.

    Reply

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

I agree to the Terms & Conditions and Privacy Policy.

Next Post
Happy New Year

Happy New Year

SIGN UP

BLOG

close up of a pretty black woman with curly hair sleeping in bed closed eyes

4 Things That Most Concussion Patients Should Worry About More Than CTE

By Jonathan Chung, DC Chronic Traumatic Encephalopathy (CTE) has played an important role in bringing awareness to the long-lasting problems associated with repetitive head injuries. The high-profile deaths and autopsies, like NFL linebacker Junior Seau’s, have put contact sports under the microscope as public concerns about concussions have increased dramatically. The heightened public awareness and […]

Read more

March Tarot Reading: Balancing Act

by Sam Black It is time to shift your balancing act to a new perspective.  You are ready to put some of those balls down and instead focus on balancing responsibility with fun and play.  Allow your feet to dance, your heart to sing and your eyes to capture the beauty in nature!  By embracing movement and play […]

Read more

February Tarot Reading: The Eclipse

by Sam Black The eclipse is a gift, one that does not come to us every day.  It is important to not stare so long at the beauty that you become blinded.  Some things are meant to come in to our lives as special events to be cherished and greeted only on rare occasions as to not […]

Read more

January Tarot Reading: Embrace Your Inner Goddess

by Sam Black Your feminine/masculine power wants to show itself and your inner strength and beauty wants to shine.  Be cautious to not hide yourself behind false statements and question what truly feels true to you.  You are hungry for more and it is time to allow your inner desires to be fulfilled.  Part of nurturing others is […]

Read more

The Life and Death of an All-American, Hometown Boy

by Amy Zellmer, Editor-in-chief With the release of the book Love, Zac: Small Town Football and the Life and Death of an American Boy by Reid Forgrave, we are given an intimate look inside the diaries and journals of Zac Easter, who was convinced his increasing mental health issues were because of CTE, the result […]

Read more

New Year’s Day Workshop

 Join me for a day of extreme self care, while getting clear on what you want to bring into your life for 2021!! In this 6 hour workshop you will learn how to incorporate yoga*, mindfulness, essential oils, intentions, and affirmations into helping you create the year (and life) you WANT! Connecting the mind […]

Read more

December Tarot Reading: Loch Ness

Embrace the mysteries in our world and beyond.  There is beauty in the unknown and excitement in the stories that they leave behind.  You are a work in progress and being a little mysterious does not make you a monster.  Be true to who you are today and take inspiration from the tales that are created around your […]

Read more

BOGO Sale — Buy One Give One Print Subscriptions

This holiday season we are offering you the opportunity to give the gift of The Brain Health Magazine, while enjoying one for yourself! Buy one print subscription, give one to a friend or loved one! Terms and conditions * only your paid subscription will auto renew in one year * one year subscription for $25, […]

Read more

Black Friday through Cyber Monday SALE

This Black Friday through Cyber Monday receive discounted pricing on my book and life coaching packages! They make great Christmas gifts for a loved one in your life! In addition to getting an autographed copy of the book with FREE SHIPPING — I will be donating $1 from every book sale to LoveYourBrain on #GivingTuesday  […]

Read more

INSTAGRAM

Follow Us!

© Copyright 2019 | The Brain Health Magazine

  • Advertise With Us
  • Submission Guidelines
  • Privacy Policy
  • Terms
  • Contact Us

DISCLAIMER: THIS MAGAZINE DOES NOT PROVIDE MEDICAL ADVICE - View PDF

No Result
View All Result
  • Home
  • About
  • Blog
  • Directory
  • Subscribe
  • Contact Us
This website uses cookies. By continuing to use this website you are giving consent to cookies being used.