Rewiring the brain is possible: Adriano Mollica shares his thoughts on concussion care

September 24 is Rowan’s Law Day, which brings awareness to concussions and concussion safety. Adriano Mollica (MD ’19) is an Azrieli Brain Medicine Fellow from the department of medicine and a neuropsychiatrist in the Hurvitz Brain Sciences Program at Sunnybrook Health Sciences Centre. He cares for patients with all forms of traumatic brain injuries, including concussions, and recently spoke about his work.

What drew you to this area?

The interface between brain, mind and body has always interested me. While the vast majority of people recover from a concussion within the expected time frame of a few short weeks, a small proportion can experience persisting symptoms for many months or years. A person’s response seems to have more to do with the way brain networks have rewired after injury, as opposed to permanent damage to the brain’s tissue.

Before medicine, I used to be a music therapist and was awed by seeing how the brain could be engaged and rewired with music. Seeing how the brain, mind, and body interact was foundational to my journey to neuropsychiatry, which requires integration of these aspects of health.

I find this message hopeful: recovery, and rewiring the brain, is possible.

What is the relationship between concussions and mental health?

Your mental health can be affected by a concussion as your mind and brain both live in the same system. We know that those who have experienced a concussion are at higher risk of developing depression, anxiety and sleep disorders. We also know the reverse is true: those living with mental health conditions are at a higher risk of acquiring a concussion and experiencing persisting symptoms after concussion.

What do you keep in mind when you assess patients?

It really helps to understand that there are two parts to the story. First, I want to understand what’s happened – essentially how the brain has been injured. Secondly, and just as important, I want to understand the person. I’ll spend 60 to 90 minutes uncovering a person’s story to understand what is happening and why.

Is there any new research around concussions?

Sunnybrook’s Harquail Centre for Neuromodulation is studying repetitive transcranial magnetic stimulation (rTMS) for the treatment of persistent symptoms, including headache and depression, following a concussion. rTMS uses non-invasive magnetic pulses to stimulate specific brain regions to rebalance connectivity. It’s exciting and we’re hoping we find that rTMS rebalances brain connectivity that may have been disrupted by a concussion.

A recent research study published in Nature Mental Health, led by our team at the Hurvitz Brain Sciences Centre and Harquail Centre, identified a network in the brain that appears to be uniquely disrupted for those experiencing persisting symptoms after concussion. This is novel because previous rTMS trials were borrowing stimulation targets from other conditions. It’s called the salience network, and it seems to be involved in amplifying attention towards physical symptoms. It’s also involved in regulation of cognition and mood. We’re targeting this newly identified network with rTMS and hoping this will be a step forward in care for patients with persisting symptoms after concussion.

What’s your advice for people who play sports, or coach teams?

There are obvious preventative measures you should take, like wearing a helmet and protective gear. It’s helpful to recognize there’s a risk that comes when you play sports. In other words, be prepared and know what to do in case something does happen.

I believe it comes down to a culture of safety, and taking head injuries seriously. A spirit of competitiveness can be healthy, but it can also be a barrier to admitting you’ve had an injury. For young athletes, parents and coaches, I would warn there are consequences to powering through a concussion. If you or a loved one suspect a concussion, it’s always best to seek out a medical opinion.

For more information on active research studies and potential eligibility please contact our TBI research coordinator erica.reyvas@sri.utoronto.ca.

You can also check out this online concussion guide.