Transcript

Dr. Mavroudis  00:00

Yes. So the main question in the neurodegenerative conditions is whether a patient with mild symptoms will develop the full condition. For example, if we have a patient with mild cognitive impairment, some of these patients will develop Alzheimer's or other types of dementia, but others will not, will never develop dementia. It's really important. It's really crucial. Now, in the era of these new therapeutic methods, you know, the monoclonal antibodies that we develop these biomarkers, there are some biomarkers that are very sensitive, and we can use them to differentiate these patients,

Dr. Ayla Wolf  00:42

welcome to life after impact, the concussion recovery Podcast. I'm Dr Ayla Wolf, and I will be hosting today's episode where we help you navigate the often confusing, frustrating and overwhelming journey of concussion and brain injury recovery. This podcast is your go to resource for actionable information, whether you're dealing with a recent concussion, struggling with post concussion syndrome, or just feeling stuck in your healing process. In each episode, we dive deep into the symptoms, testing treatments and neurological insights that can help you move forward with clarity and confidence. We bring you leading experts in the world of brain health, functional neurology and rehabilitation to share their wisdom and strategies. So if you're feeling lost, hopeless or like no one understands what you're going through, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact.

Dr Mavroudis, thank you so much for joining life after impact, the concussion recovery podcast when I am doing a lot of my research on the internet on brain injuries, your name keeps coming up as somebody who has published a lot of research, but you're also a clinician and a consultant neurologist at the University of Leeds, and I think it's so important that the people that are doing research also are working with patients, or have that experience of hearing directly from patients what it is their struggles are, because I think that that informs our research so much so welcome to the show.

Dr. Mavroudis  02:23

Thank you very much. Thank you very much for this invitation. Thank you for having me today. It's my it's my pleasure and honor to to discuss with you about concussions, about brain injuries.

Dr. Ayla Wolf  02:35

Yeah, tell us a little bit about your background and how you ended up on this track. 

Dr. Mavroudis  02:41

So I studied medicine in Greece many years ago, 2026 years ago. Graduated in 2004 then I did a PhD in neuro morphology and neuropathology. And I was also fascinating by fascinated by the brain. You know, the brain has always represented to me the ultimate challenge. Of course, there are other vital and important organs, like the heart, like the lungs, even the kidneys, but the brain remains a universe of mysteries, and I would like to explore this universe because, because the brain is what we actually are. So the brain is the seat of consciousness, personality, creativity, memory, anything. Of course, meeting my mentor in my PhD was very important, crucial to my decision to do, to study neurology and neuropathology. Then I did my neurology training in Greece. The same time I finished my my PhD. Then I came to the UK, mainly to study neuropathology, diagnostic neuropathology, and to study brain biopsies and muscle biopsies, and then I jumped back to the field of clinical neurology when I started seeing many rugby players with traumatic brain injuries, and because most of These patients were undiagnosed and they never get the the treatment and the attention they needed they required. That's how I decided to shift my practice mainly into this field. So what I do now is I run a practice I mainly see patients with traumatic brain injuries, mainly mild traumatic brain injuries and the cognitive impairment, which is the aftermath of that. And because I see many things in common with functional neurological disorders, that's why I also do a functional neurological disorder clinic, trying to find things that are in common. Yeah.

Dr. Ayla Wolf  05:00

And those, those functional neurological disorders, mean those patients often have seen so many doctors they've been told there's nothing wrong with you. So I imagine you, you've heard a lot of stories, and you've seen a lot of frustrations with people that have that diagnosis. I'm curious, you know, what are you finding as a commonality between these patients?

Dr. Mavroudis  05:21

Yeah, so we have recently published at least two or three papers trying to explain the commonalities between functional neurological disorders and post concussion syndrome. Of course, post concussion syndrome is not a term that we are allowed to use, because it's not in the ICD 11 anymore, but it's a label that we can easily use and can help us and the patients to understand it's just a constellation of different symptoms. So if we see a patient with functional cognitive disorder and if we see a patient with post concussion syndrome, we will notice the same things. We will notice the same mechanisms and the same triggers in their symptoms. Both groups of these patients will have the common the same triggers, such as stress. Both groups will have fatigue, which is one of the of the predominant of the main symptoms. And suggested that there are many things in common and possibly common mechanisms, which my personal position is that this is deep inside the brain, and is because of a change in the neuroplasticity and the ability of The brain to adapt.

Dr. Ayla Wolf  06:40

And does that come back to, say, mitochondrial dysfunction, or is there some other mechanism that is affecting the neuroplasticity?

Dr. Mavroudis  06:51

Yeah, the mitochondria play very, very important a viral load to role, to how, how the brain and how the neurons work. They provide the energy, and not only the energy, they do more things than that, but I believe that the problem is mainly in the synapse, where the neurons communicate when they send information. So there are two different mechanisms. It's the long term depression and long term potentiation. These are the two mechanisms where the Ayla mechanisms where the the ability of the brain relies on and I believe that these mechanisms are disrupted, and this is why the brain in these patients is is not able to adapt to the post injury or the post fnd diagnosis daily. Life. And speaking of that, I found many things in common with prolonged the prolonged the persistent post, sorry, the long covid syndrome. There are many things in common, and I believe that there is, there are similarities in the pathological mechanisms in this condition too.

Dr. Ayla Wolf  08:03

I know you had published a paper speaking to the similarities and symptoms between post concussion syndrome and long covid, bringing up long term potentiation brings me right back to neurology. 101, so it comes back to the basics, right of just understanding synaptic neuroplasticity, how the brain communicates. And so you're seeing that the commonality between a lot of these persistent syndromes is this idea of the synapses struggling to communicate. Which brings me to an interesting paper that you also just published on microglial exosomes. And so what is the role of the immune system in all of this and neuroinflammation?

Dr. Mavroudis  08:48

Absolutely, absolutely, the role of microglia is very important. So the microglia are specialized cells. They're part of the autoimmune of the of the immune system. It's they're not part of the central nervous system, but they are specialized. They go into the central nervous system very early in the life, and this is why they are allowed to be there, because that we have the blood brain, brain barrier. So nothing from the blood can cross this barrier under normal circumstances. These cells, they have the same role as the protective cells have in the blood. So what they do? They get activated when there is inflammation. But sometimes this inflammation can cause damage, and this inflammation, because of the increased demand of energy, can affect the mitochondria, as you said before, and this can affect how the brain works, because if there is lack of energy into the neuron, then this long term potentiation and the overall neuroplasticity will be affecting then the neurons will not be able to communicate effectively.

Dr. Ayla Wolf  10:00

Right? Yeah. And so in your clinical practice, how are you unraveling all this? How are you addressing this mess of both, mitochondrial dysfunction, microglial dysfunction, the persistence of neuroinflammation affecting neuroplasticity? Where do you jump in to try to kind of fix all of that?

Dr. Mavroudis  10:22

Yeah, this, this is not easy. So first of all, we need to to focus on the trans translational neuroscience. So we need to to translate the research results and the results from the papers we do and publish into the clinical practice. This is not always easy, but it's something we need to do in order to help our patient our patients, first step is to listen to the patients, to understand the needs, understand the symptoms, try to explain them based on the basic knowledge we have obtained from medical school and from early years in our training, and this way, you're able to to send the patients to the right pathway, recovery pathway and treatment pathway.

Dr. Ayla Wolf  11:13

And are you utilizing certain medications, or are you really focusing on, you know, lifestyle changes, diet. Where are you kind of recommending people start Yeah.

Dr. Mavroudis  11:26

So to be honest, I'm not a fan of medications. I try not to give too many medications to my patients. So for example, for fatigue in the United States, there are some tablets that are prescribed here in the UK and in my own practice, we try to avoid that. We try, mainly to help the patients without any medication, to advise them on the amount of rest they need, the amount of sleep they need. I believe, I'm a big believer of behavioral therapies and neuropsychology. I believe that Neuropsychology can help patients, both in post concussion syndrome and functional neurological disorders, to to have a better treatment and a better outcome. So we always try to advise on right exercise, right amount of exercise, not too intense exercise, low intensity, 4045, minutes of walking or lie joking in the morning is the best exercise, because this way you're able to manage your stress better. Stress is not in a lie in this war. Then diet is very important, you know, the usual stuff, nothing special. But we always try to advise the patients to drink plenty of fluids, to avoid alcohol or anything else that can harbor the brain can cause more harm to the brain, and to try loads of antioxidants and things like that, just the general healthy stuff. Of course, we have specialized dietitians that will see the patients in the end, if with this general advice on diet, if it's not helpful, we have coaches that can help the patients, can give them the right exercises, the right programs that can help them in the gym. So we basically try to provide a tailored program to each patient. If this doesn't work, we will repeat some of the tests that we do after three and six months, and if there is no improvement, then we might try some medications. But to my experience, the only medications that can help are very low doses of antidepressants, just to fight stress and to help the mood. This is the only thing that has place in the treatment of these conditions.

Dr. Ayla Wolf  14:01

And you mentioned that one of your focuses is on the cognitive symptoms that people are describing. Are you doing different cognitive exercises or training programs with people as well?

Dr. Mavroudis  14:12

Yeah, so first of all, in terms of diagnosis, we don't do the usual diagnostic tests such as the MOCA, the main mental state examination on the Aden groups, because these tests are not sensitive for patients with traumatic brain injuries, I personally prefer to do a computerized test, the impact test, which is widely known and widely accepted, and it can with this test, you can study different aspects of the cognitive functions. We also try we also do a test using virtual reality. It's an eye tracking test because the ocular movements are very important in the recovery of these patients. These are the tests we do. And then, in terms of recovery, we use our own tests. We have developed a couple of video games that we try to use in patients that love video games. These video games, they have some cognitive challenges. They have some eye tracking challenges. And then, of course, it's the the golden standard, the cognitive behavioral therapy with the experienced neuropsychologists.

Dr. Ayla Wolf  15:26

And you're seeing that with use of the virtual reality, at least, to people who can can handle that, that that's actually helping in terms of some of their ocular motor symptoms, as well as maybe things like reaction time and other cognitive processes.

Dr. Mavroudis  15:41

Absolutely, absolutely. This test is very useful because, of course, you can, you can study them, the ocular movements, but at the same time, there are some other parameters that you can study. For example, there is the cervical element. You ask the patient to do some neck movements, having the VR set on their heads. And this way you can see if anything changes. And this is an indication of an injury to the cervical spine, because there is no concussion, no traumatic brain injury, without cervical injury, as we know. And then there are some cognitive challenges as well. So we have the saccade, the saccade movements when we ask the patient to follow a flashing light, but at the same time, we have the anti saccades when we ask the patient to look the opposite side. And this has a cognitive element as well.

Dr. Ayla Wolf  16:34

Yeah, yeah. That's such a great window into that prefrontal cortex and impulse control. I do that test at the bedside, and I often see people struggle with it when they've had concussions.

Dr. Mavroudis  16:46

Absolutely, absolutely, absolutely, yeah, this is my favorite bedside test. It's the vestibulocular test, which I always do. But in my practice, I prefer to do the VR test, which is a bit more impressive. And of course, it's something that you can video, and you can document everything on the patient, and you can repeat that after three and six months. And using the same standards you have, you can have a good understanding of the progress or the changes. Yeah.

Dr. Ayla Wolf  17:22

My mentor, Dr Carrick, had published a study on the he tested a lot of people's ocular motor movements. Olympians in the 2024 Olympics. His team went there and studied the eye movements of people that were in high impact sports like boxing, versus people who were in sports that didn't involve high impact and they were able to really show differences in eye movements and the people that were performing these high impact sports, even if they hadn't had that concussion diagnosis, they were still kind of evidence of some dysfunction there. So I love that the the spotlight on the importance of eye movements is getting a lot more more attention, which is great because it is a window into so many parts of the brain, because eye movements are so complex, and they also take up a lot of cognitive energy too, and so when people are struggling with their ocular motor system, that can create a lot of that brain fatigue that we see symptomatically,

Dr. Mavroudis  18:22

absolutely, absolutely, and doing that, we're able to offer vestibular rehabilitation to help our patients. Because most patients, you know, when they come to see me or to see one of my colleagues in clinic, even five or six or seven years after the injury, they've never had the right test. They've never had the chance to get the right treatment.

Dr. Ayla Wolf  18:44

Yeah, Yep, absolutely. And so switching gears a little bit, let's talk about some of the blood biomarker research. And it seems like there's, there's certain blood biomarkers that are not quite so specific to the brain exclusively, like s1, 100 B is not exclusive to brain injury, but still a marker of brain injury, potentially. And so there are some markers that kind of are meaningful within the first, you know, couple of hours after an injury, there are some pro inflammatory markers that maybe can give an indication of is this brain recovering. So I think it's very confusing for the general person to say, Okay, we've got pro inflammatory and anti inflammatory markers, and then some of them are indicating this at this time point or that at that time point. This can be a very confusing topic. So let's maybe dive into this blood biomarker research,

Dr. Mavroudis  19:41

you're absolutely right. So yes, I agree with you. Most of these biomarkers are not brain specific, but the combination of all of them and considering the history of the brain injury, can help us to understand what's going on. As you said, there are some biomarkers that can help us to understand the. About the healing process, about the inflammation. Of course, we have the light chain neurofilament light chain biomarker that it's a marker of disruption of axons in the central nervous system. Unfortunately, most of these biomarkers can be raised even in in general injuries or orthopedic injuries. What we try to do now is to develop a kind of a cloud application and a device to study these biomarkers as a group and then to feed them into an algorithm that will help us to to understand them better. Of course, always, always, always working with the patient, working with the history, and taking into account the patient's experience and the patient's side of things, if we just take a set of biomarkers, and you know, there might be raised, there might be different to the normal range. We'll never be able to make a diagnosis unless we have the patient in front of us, unless we have a medical history, unless we have a neurological examination. I believe that in the near future, probably in the next five years, the biomarkers will be able to help us with the diagnosis, a more accurate diagnosis, because in most of these cases, especially in sports concussions and in the medical legal setting, you know, road traffic accidents, things like that. Accurate diagnosis is very, very important. So hopefully, with these biomarkers and doing non invasive testing like saliva swab, because most of these, of these biomarkers now are taken from blood or CSF, taking saliva swab will make things even easier for the patients. I believe that the future is in the exosomal biomarkers, which is very sensitive in the micro RNAs. So having a combination of all of these biomarkers will give us what we need. I had the meeting with an excellent colleague of mine that we've done a lot of research together, Professor chobeke, he's a biochemist in Romania, and we had the meeting, and he said that I always ask my students when I interview them For the PhD, how many biomarkers do we have for neurological and psychiatric conditions? And they always, you know, the most students, they will say, they will tell, 10, 520, 200 and what is the what is the right number? Zero? We don't have any. It's the combination of them and the combination of the patient, the combination of the history and anything else that can help us to understand the patient and to to have an accurate diagnosis. But we need to remember that in medicine, nothing is deterministic. It's always probabilistic. So even with the best evidence, the diagnosis is based on the probability, on the balance of probabilities, and these biomarkers can help us to increase the probability of a more accurate diagnosis, right?

Dr. Ayla Wolf  23:33

And I think at this point, is it fair to say too, that, in this kind of preliminary state, that some of these blood biomarkers, when taken as a panel together, can then inform, say, a doctor in an emergency department whether or not they need to do a CT scan

Dr. Mavroudis  23:51

Exactly, exactly. I agree with that, and this is where the research is mainly focused, to save patients from getting exposed to radiation, and of course, to save money to the health systems. This, this, this can be very useful for the emergency physicians to decide whether to do or not to do a CT scan. But as I said, this alone is not enough. We always need to take into account everything else, because if we have a patient with a minor head injury and significant neurological symptoms, even if the biomarkers are not raised, we definitely need to do a scan.

Dr. Ayla Wolf  24:31

Yeah, absolutely. And then I know on the flip side of that there, you know, in certain people, maybe elderly people that have kidney failure, some of these biomarkers might also be elevated as a result of, you know, kidney function or a loss of kidney function. So again, it's also taking into account the age of the patient pre existing conditions. So sometimes these markers can be elevated for other reasons too.

Dr. Mavroudis  24:58

Exactly, exactly. So. Yes, so yeah, to my knowledge, the in some countries, I think in France, I'm not sure. I think that in the States as well, but you might know better. There are some panels of biomarkers that are used in the emergency setting. Mainly, I think it's mainly, it's three, three biomarkers that the problem is that can only be used in the first seven to two hour 72 hours in the in the acute phase, and these biomarkers can help you. Can help us with the diagnosis, but cannot help us are not predictive of the outcome. Cannot help us yet with the prognosis of these patients. Yeah.

Dr. Ayla Wolf  25:38

Which brings me to my next question, because you also are researching a lot in the world of just neurodegenerative disease. And so you're also studying biomarkers in that context of trying to understand, is there a way where we can get a better handle on does somebody have a neurodegenerative condition? And so fill me in on kind of where the research is on that in terms of the biomarkers,

Dr. Mavroudis  26:03

yes. So the main question in the neurodegenerative conditions is whether a patient with mild symptoms will develop the full condition. For example, if we have a patient with mild cognitive impairment, some of these patients will develop Alzheimer's or other types of dementia, but others will not, will never develop dementia. It's really important. It's really crucial. Now, in the era of these new therapeutic methods, you know, the monoclonal antibodies that we develop these biomarkers, there are some biomarkers that are very sensitive, and we can use them to differentiate these patients and to stratify the patients that will most likely develop a condition, and on the balance of probabilities, will not develop the condition, and to treat them differently.

Dr. Ayla Wolf  26:57

Yeah, that sounds very cutting edge, and that would you, would you say at this point is very much still in the realm of research. It's not yet being kind of implemented,

Dr. Mavroudis  27:07

unfortunately, unfortunately, all these are still in the very first steps, the very first stages. But there are some, some of these biomarkers that can help us. For example, this is how we developed all this theory about the alpha beta peptide and about the tau protein in Alzheimer's disease, and this has helped us to understand the pathophysiology of the disease. We're currently working on a project on neurograining. Neurograining is a very sensitive biomarker. It's a substance that can help us to understand the synaptic function. We did a study a few years back that showed us that it's a very sensitive biomarker for Alzheimer's disease, and using that, we can tell whether a patient will develop or will not develop Alzheimer's and now we're working on this biomarker on as a prognostic marker for prolonged severe post concussion syndrome after a concussion. And the results so far are promising, but they're still we are in the very early stages. If you look at the basics, if you go that's how I approach my research. I go back to the basics. I go back to my medical school books. I'll go back to physiology, back to biochemistry, and looking into the details. This is how I approach my research, and how we design or design our projects.

Dr. Ayla Wolf  28:39

And I know that the microglia are involved in synaptic pruning. So going back to this idea of the the importance of the microglia, and this idea that they're they have different functions. You know that we're all talking about how they can create a lot of in pro inflammatory situations, but they also play these very important roles of surveillance and synaptic pruning and taking away synapses we don't need, but if that gets upregulated, all of a sudden, all these synapses are dying, and so are you also studying the microglia in The context of blood sugar management, and just this idea of, you know, we call type three diabetes in the brain, where the the ability to regulate glucose is affected, and then that throws everything else off, and kind of creates a state where these synapses are perhaps dying at a greater rate than we want them to.

Dr. Mavroudis  29:39

Yeah, this is, this is an excellent idea. This is an excellent question. Unfortunately, I don't do this type of research myself, but a colleague of mine is a very big fan of this theory, and he's trying to establish a research project on this, which is very important and sounds very promising. So hopefully this will be something that we'll be able to talk about. Maybe in a couple of years.

Dr. Ayla Wolf  30:02

Okay, and then what about this paper that you recently published on the microglial exosomes, talk a little bit about what an exosome is and what this study is looking at.

Dr. Mavroudis  30:14

Yeah, the exosomes and the endosomes are small vesicles that are released by the neurons, and these can contain different substances. So in the exosomes, we can find, if we test the exosomes in the saliva, for example, we can find different markers, different substances that will help us to have a better understanding of what's going on into the body and more specifically, into the brain. And studying the exosumes in patients with post traumatic post concussion syndrome and traumatic brain injuries, were able to identify a couple of substances, some of them are the micro RNAs, small parts of RNAs that we can study, and in the exosomes, you can also find some other substances, like some pieces of tau protein and other biomarkers that you can also study. And these are very important.

Dr. Ayla Wolf  31:25

So these are kind of messengers that are being released that can create kind of a cascade of events. Is that fair to say?

Dr. Mavroudis  31:33

Exactly that's fair to say. And some small portions of them will also be released into the bloodstream and into the saliva, and this is how we can capture them and can study them.

Dr. Ayla Wolf  31:47

Got it so that sounds like the future is promising in terms of being able to, hopefully, in the near future, have some better testing methods to understand where somebody is at on the scale of, say, neuroinflammation, or if they're having symptoms, how worried do we need to be that this might progress into something more serious down the line?

Dr. Mavroudis  32:10

Exactly, exactly, I believe that in the near future, we'll be able to offer personalized medicine to understand the patient and to offer tailored treatments and tailor strategies for each one of them based on their needs and based on these biomarkers, and potentially more biomarkers that will rise in the future. Yeah.

Dr. Ayla Wolf  32:30

Well, how exciting to be at the cutting edge of all of that. The other question I wanted to ask you was on this, when we talk about the brain, much like we do with with medicine, we everything kind of becomes siloed, and so we often talk about the brain as this separate entity from the rest of the body, but in my practice, I pay a lot of attention to the the health of the liver and the kidneys and the role of healthy liver and kidney function on healthy brain function. But I think this is something that I don't really hear anybody else talking about. And so I'm curious if you have anything to say in terms of how you look at the you know, the totality of

Dr. Mavroudis  33:12

it, absolutely, absolutely. Yeah. So the brain doesn't exist in isolation. The brain always works and collaborates with the other organs. The brain is the center, but the other organs are also vital. We all know from our own experience that the liver function, the kidney function, even the intestinal function and the stomach are really important for the brain. When I was a student at 6/6, year of medical school last year, I was involved in a research that widened my horizons on the understanding of what you're talking about, because it was a PhD project, and the guy that did that. He worked on how some substances that we now understand as auric sins from the stomach, can affect the brain, can affect the hypothalamus, in this way, can affect the whole brain function. So, yeah, all these organs are very important. Are crucial. So we know that we have the condition, which is called hepatic encephalopathy. If there is dysfunction to the to the liver and the energy that will go to the brain is not enough, then we'll have dysfunction of the brain, and the patient will develop a kind of, you know, dementia, like presentation,

Dr. Ayla Wolf  34:40

yeah, I remember when my my grandmother ended up in the hospital and she had a urinary tract infection, but before they had diagnosed it, she it was affecting her cognition. She couldn't she didn't know her own son's name, and so there was this brief moment in time where we all thought, Oh no, like she's going. Downhill really fast. And, you know, cognitively, she was completely delirious, and all of a sudden they said, Oh no, she just has a urinary tract infection. And once they fixed that, all of a sudden her cognitive faculties returned. And it was such an acute thing to to have, like, okay, a urinary tract infection can cause this severe type of dementia, symptoms that come on like that. It just makes you realize that this connection is is vital, and even if we don't have, like, an extreme kidney failure, what happens if the kidneys, I feel like in in our modern medicine, the kidneys have to be like, practically failing before things start to show up on blood work, or before we start to pay attention to them. And yet, in our current day and age, our kidneys are assaulted with so many environmental toxins and chemicals and things in the environment that I feel like they're having to work overtime. And yet, we just don't really pay attention to them as much as we as we should, especially with covid, we learned that the that can create a lot of inflammation in the kidneys and cause all kinds of problems, and then you've got downstream consequences from that. So I just be with my background in Chinese medicine. We we always pay very close attention to kidney function. And so I just see that that being another kind of avenue of you know this idea of integration, and we talk about the gut brain axis, but I think we also need to talk a lot more about that role of liver health and kidney health and those impacts on the brain, if those aren't working optimally or subpar.

Dr. Mavroudis  36:34

Absolutely, I could not agree more. Yeah, yeah, as the ancient Greek used to say, it's the golden men, moderation.

Dr. Ayla Wolf  36:42

Yes, absolutely. Well, what are the next projects that you're working on?

Dr. Mavroudis  36:48

Yeah, so the the main study that we've just recently started is to work on this cloud application and this machine learning algorithm on the diagnosis of post concussion syndrome and traumatic brain injuries, mainly the concussions. We try to standardize the panel that we will use, so we've identified through the literature six or seven biomarkers to begin with. Interestingly, cortisol is one of them. Cortisone is very versatile biomarker and can be raised in different conditions, but we found that it's very sensitive and can help in the prognosis of different symptoms, mainly psychological symptoms, in these patients. Then we have the CGRP biomarker. The CGRP is the biomarker that can help us on the prognosis of post traumatic headaches. So we've identified these biomarkers, and we're trying to do a clinical trial now, and this is the main project that I'm very enthusiastic about,

Dr. Ayla Wolf  38:02

yeah, absolutely. I see lots of patients with chronic post traumatic headaches, and many of them are given migraine medications, but not the CGRP antagonists. Again, I think because of money and because of the insurance model saying, well, let's give them all these other medications first, and we have to prove that these don't work before you get the better, more expensive drugs.

Dr. Mavroudis  38:29

Exactly, exactly. This is how the symptoms systems work, but they need to be sustainable, so it's something we need to follow.

Dr. Ayla Wolf  38:39

Yeah, yeah. Well, I'll be excited to see that research, since CGRP is, you know, one of those things that is well studied in the migraine literature, but we're still really trying to figure out why, why patients with post traumatic headaches don't always respond well to migraine medications, yeah,

Dr. Mavroudis  38:59

because not all post traumatic headaches are migraines in nature. The different mechanisms, about 75% of the post traumatic post traumatic headaches, they have mixed features of tension type headaches, some migraines features as well cervical genic headache, and there is always stress and psychological symptoms. Only 20% can be clearly migraineurs, and this is why just a small percentage of patients with post traumatic headaches will respond well to migraine medication. But CGRP is something that can help in other types of headaches as well, not only in the migraines, excellent.

Dr. Ayla Wolf  39:42

So tell me more about that. You're seeing that even in these mixed types of headaches that CGRP is is elevated.

Dr. Mavroudis  39:51

CGRP can be elevated and can be a very good prognostic factor of developing post traumatic headache independently of the subtype of. Headache. So some patients, they might develop tension type headaches. Others will develop migraineurous headaches. Other patients may develop occipital neuralgia, or even trigeminal neuralgia, or very rare types of headaches. And this is a very, very sensitive biomarker and giving these patients anti CGRP medication can make the difference.

Dr. Ayla Wolf  40:28

Yeah, fascinating. Well, I'm excited to see that research, because we definitely need to help these people more so than we are. There was a study that came out in 2020 that said that 87% of people with post traumatic headaches were dissatisfied with their current medical treatment. So we need to do better for these people,

Dr. Mavroudis  40:49

exactly, exactly. We need to do better and again, we need the holistic approach. Just giving medication will not always help the patient. We need to consider everything, to consider every other element that can trigger the headache to my experience and the literature physiotherapy, neck physiotherapy, will always have a positive impact on these types of headaches, the post traumatic headaches, independently of the subtype of the headache, because most physicians will say that, yeah, but this is a migraine headache. How neck physiotherapy can help? But there is always a cervicogenic element in these types of headaches, because, as I said before, there is always a cervical spine injury when you have a concussion and then managing stress is also very important. And avoiding triggers, this is something that we always forget. We forget to advise patients to avoid triggers. And then most of these patients, because they suffer a lot from the headaches and other symptoms, they tend to overuse medication, and this is something else we need to always look at and to be very careful with these patients, to advise them not to overdo it with medication, because even paracetamol or hebuprofen medications that you can easily buy over the counter, if you take them long term, they can have A very negative impact on these headaches.

Dr. Ayla Wolf  42:21

Yeah, yeah, absolutely. The medication overuse headaches are a real effect, for sure, not to mention their impact on the liver and the kidneys.

Dr. Mavroudis  42:30

If you take absolutely, absolutely, I agree.

Dr. Ayla Wolf  42:33

Yeah, wow. Well, anything else that we haven't talked about that you would like to cover before we wrap up.

Dr. Mavroudis  42:42

No, I don't have anything else. I you know, I could talk for hours about about the brain, about the neuroplasticity, and about these conditions, but I don't have anything else. If you have any other questions, I'm happy to to continue the discussion.

Dr. Ayla Wolf  42:59

Well, what are the things that you do for your own brain health.

Dr. Mavroudis  43:03

Yeah, so I used to be an athlete. I played basketball for many years. I love basketball, so I still try to play basketball with friends at the university, not very successful anymore, and I always try to do some exercise and to follow a good, balanced diet, and I avoid alcohol, I tend to admit that I might enjoy, you know, some spirits now and then, two, three times a year, but that's it. Yeah.

Dr. Ayla Wolf  43:37

So very much in moderation, exactly. Yeah, fabulous. Yeah, having those basic pieces in place, the exercise, the diet, the sleep,

Dr. Mavroudis  43:48

absolutely

Dr. Ayla Wolf  43:49

wonderful. Well, thank you so much for your time, and I'd love to have you back on the show here in a little bit, once you have some of these other research findings published. And love to stay on top of all of this cutting edge work that you're doing, because it's so important.

Dr. Mavroudis  44:05

Thank you. Thank you very much for having me today. I'm honored.

Dr. Ayla Wolf  44:08

Thank you. Where can, where can people find you? I know you've got some YouTube channels out there information, yeah.

Dr. Mavroudis  44:18

So I, unfortunately, I cannot work on my YouTube channels because of my other commitments, but they can find me on LinkedIn, and I'm always happy to respond to any messages or any queries.

Dr. Ayla Wolf  44:30

Okay, fabulous, so I can put that in the show notes there. Wonderful. Well, thank you so much for your time Dr. Mavroudis.

Dr. Mavroudis  44:38

thank you. Thank you very much Ayla.

Dr. Ayla Wolf  44:43

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