When we experience any kind of injury, inflammation naturally follows. As part of the body’s healing response, we need inflammation to help protect the injured area, clear out damaged cells, and signal the immune system to begin the repair process.
When the injury involves the brain (as in a physical or chemical concussion), this inflammatory response involves specialized immune cells called microglia. The microglia act as a cleanup crew, removing cellular debris and supporting recovery. But when inflammation persists and becomes chronic, it can turn from a protective mechanism into a source of ongoing damage. It can disrupt healthy brain function and prolong symptoms.
“With a concussion, you have the immediate inflammatory response, which is appropriate, but then in some individuals that response keeps going—and it can keep going for years,” says Jeremy Schmoe, DC, DACNB, director of The Functional Neurology Center.
Some of the symptoms of neuroinflammation include brain fog, dizziness, headaches, fatigue, and visual disturbances. The specific symptoms often depend on which region of the brain is affected. For instance, inflammation in the cerebellum can lead to dizziness and problems integrating vestibular and visual information, while inflammation in the frontal lobe might impact cognition and emotional regulation.
A functional neurological approach, which combines neurological rehabilitation with functional medicine, can offer relief for patients who haven’t found it through standard treatments.
Addressing both the brain’s immune response and impaired neuronal function can help to calm inflammation, restore healthy signaling, and support the brain’s natural healing processes.
The brain’s immune system
Because the blood-brain barrier (BBB) separates the brain from the rest of the body, the brain needs its own specialized immune system. Microglia are the brain’s resident immune cells—sentinels that monitor the environment and respond to signs of damage or infection.
To help microglial cells differentiate between healthy and damaged neurons, neurons themselves send out signals. “On” signals are produced by neurons that are damaged or dying, letting microglia know to come and clear them away. “Off” signals are sent by healthy, functioning neurons that should be left alone. In a healthy brain, this communication system allows microglial cells to repair tissue without causing unnecessary damage.
But when the brain is inflamed or has undergone trauma, this signaling system can go awry.
Low neuronal firing or metabolic dysfunction can reduce the production of off signals, sending microglial cells into a “primed” or overactive state. “They’re basically going on a spree of eating up bad, dying neurons, but also healthy tissue,” Schmoe explains. This can result in ongoing neuroinflammation and symptoms like brain fog, headaches, dizziness, and cognitive decline.
The good news is that the brain has remarkable capacity for healing and repair, especially with interventions aimed at reducing inflammation, supporting metabolism, and enhancing neuroplasticity.
Identifying underlying sources of inflammation
The brain relies on a tightly regulated environment to function properly, and the BBB is its primary line of defense. When intact, the BBB shields the brain from the systemic turmoil of chronic infections, autoimmune diseases, or metabolic disorders. But when the BBB is compromised—whether from trauma, chronic stress, or persistent inflammation—it can become leaky and allow peripheral inflammatory signals to enter the brain.
This means that pre-existing sources of inflammation in the body can contribute to neuroinflammation if the BBB is disturbed. “All the things you had going on prior to your concussion can now affect your brain,” says Schmoe. “If you had an underlying parasitic infection in your gut, or a lot of GI inflammation, when the BBB becomes leaky and permeable, that inflammation leaks into the brain and perpetuates the inflammatory response.”
Even in the absence of direct inflammatory molecules, microglia can be primed by dysregulated signaling from the vagus nerve and hypothalamic-pituitary-adrenal (HPA) axis. The gut-brain axis further complicates the picture, particularly when gut health is compromised. An imbalance in gut bacteria can lead to increased intestinal permeability, or leaky gut. When both the gut barrier and BBB are leaky, bacterial endotoxins can go from the gut to the brain and wreak havoc.
“You can have an underlying infection and be pretty much fine until you get a head injury,” says Schmoe. “That’s when things that were being managed by the immune system become unmanageable.”
This is why it’s crucial to look for underlying sources of ongoing inflammation in the body when dealing with neuroinflammation, in addition to addressing the integrity of the BBB and proper signaling by the vagus nerve and HPA axis.
Here are some of the potential underlying conditions that might need to be addressed in order to relieve persistent neuroinflammation and post-concussion symptoms:
- Gut dysbiosis and increased intestinal permeability (leaky gut)
- Oral dysbiosis and infections (e.g., periodontal disease)
- Chronic infections (e.g., Lyme disease, Epstein-Barr virus)
- Autoimmune disorders (e.g., rheumatoid arthritis, lupus)
- Metabolic syndrome (e.g., insulin resistance, type 2 diabetes)
- Thyroid dysfunction (e.g., hypothyroidism, Hashimoto’s thyroiditis)
- Hormonal imbalances (e.g., low cortisol, estrogen dominance)
- Mold toxicity or chronic inflammatory response syndrome (CIRS)
- Heavy metal toxicity (e.g., mercury, lead)
- Sleep disorders (e.g., sleep apnea, chronic insomnia)
- Chronic stress or HPA axis dysfunction
- Nutrient deficiencies (e.g., vitamin D, omega-3 fatty acids, magnesium)
- Persistent oxidative stress and mitochondrial dysfunction
- Food sensitivities or allergies (e.g., gluten, dairy)
- Poor vascular health or reduced cerebral blood flow
Comprehensive functional neurological treatment
The comprehensive approach we use at The FNC to treat persistent neuroinflammation blends functional medicine, neurological rehabilitation, and cutting-edge diagnostic tools to target the root causes of inflammation, repair the blood-brain barrier, and support overall brain health.
Functional medicine focuses on addressing systemic inflammation and metabolic dysfunction. Nutrients such as omega-3 fatty acids, polyphenols, and antioxidants (e.g., from fish, berries, turmeric, and leafy greens) can help reduce oxidative stress and calm microglial activation.
Nutritional deficiencies, such as low levels of vitamin D, magnesium, and B vitamins, should be identified and corrected, as these nutrients are vital for brain health and mitochondrial function.
Probiotics, prebiotics, and specific gut-healing protocols that include supplements like glutamine can help resolve dysbiosis and leaky gut, removing a key source of inflammation.
Glutathione, the body’s master antioxidant, is critical for protecting neurons from oxidative stress. Nearly 50% of people have genetic variations that can impair their ability to produce and recycle glutathione effectively. Genetic testing can identify this issue and guide personalized interventions, such as supplementation with glutathione precursors (e.g., N-acetylcysteine, alpha-lipoic acid, and glycine) or liposomal glutathione to boost antioxidant capacity. GABA precursors can also help calm neuroinflammation and set the stage for rehabilitation.
At The FNC, we use panels from Cyrex Laboratories that can detect autoimmune reactivity, environmental toxins, and food sensitivities. Cyrex’s Array 2 (intestinal permeability), Array 3
(gluten sensitivity), and Array 5 (multiple autoimmune reactivity) provide valuable insights into systemic triggers, and Array 20 can reveal permeability of the BBB.
We may also assess for chronic infections (e.g., Epstein-Barr virus, Lyme disease), hormonal imbalances, and heavy metal toxicity, which can be significant sources of systemic inflammation. Addressing these root causes through targeted therapies, such as antimicrobial treatments, hormone regulation, or chelation for heavy metal detoxification, can significantly reduce the inflammatory burden on the brain.
Neurological rehabilitation: The missing piece
While identifying and treating underlying sources of inflammation is important, we see many patients whose symptoms weren’t fully resolved by working solely with functional medicine practitioners. “Often, activating and rehabilitating neurological pathways is the missing piece,” says Schmoe. “Nobody has done that rehabilitation piece to drive those pathways and make them more functional.”
Neurological rehabilitation techniques, such as gait retraining, balance work, tilt table therapy, and eye movement exercises, can help stimulate underactive brain regions, promote neurogenesis, and improve neuronal communication. Targeted and personalized brain exercises can help enhance brain function and support neural rewiring. And techniques like vagus nerve stimulation can help reduce inflammation and calm an over-sensitized nervous system, so people are better able to tolerate supplements or rehab exercises.
“It’s kind of an art form to figure out how much we can dose their therapy without taking them past the limits of their neuronal fatigue,” says Schmoe. By combining nutritional support, gut healing, genetic insights, metabolic optimization, neurological rehabilitation, immune modulation, and vagus nerve stimulation, a comprehensive treatment plan targets the root causes of neuroinflammation and supports the brain’s natural ability to heal and adapt.
The FNC approach in action
Recently, The FNC team worked with a young, highly talented hockey player who had been drafted for the NHL and was competing at a Big 10 university. Despite repeated chiropractic treatment and functional neurology from other providers, his post-concussion symptoms (headaches, brain fog, fatigue, and balance issues) were persistent and debilitating. His routine to maintain even basic functionality required regular contrast therapy and leg compression.
Upon our initial evaluation, we ran a Cyrex Array 20 test to assess blood-brain barrier (BBB) permeability, which came back out of range. This indicated that his BBB was compromised, making his brain more susceptible to systemic inflammation and toxins.
We explored potential underlying infections, as research suggests chronic infections often underlie persistent post-concussion symptoms. Testing for chronic Lyme disease and co- infections revealed high antibody levels for Lyme, Bartonella, Babesia, and Ehrlichia. The patient had a history of symptoms going back to age 12, including skin issues, unexplained fatigue, and reduced stamina during workouts, suggesting a long-standing, undiagnosed infection.
We also conducted a mycotoxin panel, which showed very high levels of ochratoxin A and citrinin, indicating significant mold exposure. The likely source was a damp dorm environment, correlating with a worsening of symptoms after he moved away from home.
The mycotoxins identified are known to cause neurotoxicity, oxidative stress, and immune dysregulation, contributing to his systemic inflammation and BBB compromise. We initiated a detoxification protocol using CellCore binders to address the mycotoxin load while also increasing his glutathione levels to support detoxification.
Further testing revealed significant gut dysbiosis, including salmonella levels seven times above the normal range. Inflammatory markers were six times higher than expected, and eosinophil activation protein was elevated by 50%, suggesting a strong immune response in the gut. We implemented a GI repair protocol using Apex products, including RepairVite SE and GI Synergy, along with a high-quality probiotic (SymbioticA) to restore gut health and reduce systemic inflammation.
At the same time, we started a comprehensive brain inflammation protocol using curcuminoids, resveratrol, glutathione, and a glutathione recycler, alongside OptiMag Neuro from Xymogen to support neurological health. We also corrected his low vitamin D levels, which play a critical role in immune modulation and brain function.
“Within two weeks of this approach, nearly all of his symptoms were gone,” says Schmoe. Over the next few months, the team incorporated brain exercises to enhance his neural connectivity and vestibular function. By the end of the summer, he saw a dramatic turnaround. After dealing with persistent symptoms for three years and facing the possibility of early retirement at just 20 years old, he was finally able to return to training and competition without the debilitating effects that had plagued him.
By identifying and treating underlying infections, supporting detoxification, restoring gut health, and engaging specific brain pathways, it’s possible to facilitate a full recovery, even after years of persistent symptoms.
To schedule a free phone consultation with the expert team at The FNC, click here.
