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Cause neurological-structural
Cause #22 High - CDC/ONF guidelines

Pcs and Brain Fog

22 min read Updated Our evidence standards Editorial policy

Guideline: CDC HEADS UP clinical guidance (updated 2025); Ontario Neurotrauma Foundation guidelines

Medically reviewed by Dr. Alexandru-Theodor Amarfei, M.D.

First published

Quick Answer

Pcs can contribute to brain fog. The most useful clues are the symptom pattern, nearby overlaps, and whether the mechanism described here matches your story: Post-concussion syndrome - persistent cognitive symptoms after head injury.

Mechanism overlap

Mechanisms this cause often overlaps with

These are explanation lenses, not diagnosis certainty. If this cause fits, these mechanisms can help explain why the pattern looks the way it does.

structural vestibular load

Structural or Vestibular Load

Cervical strain, vestibular dysfunction, post-concussion effects, or positional head/neck load can distort clarity, orientation, and stamina.

What would weaken it: No positional or motion sensitivity.

⏱️

When to expect improvement

2-4 weeks

If no improvement after this timeframe, it's worth exploring other possibilities.

Is Pcs Brain Fog Reversible?

Post-concussion brain fog is reversible in most cases. The vast majority of concussions resolve within 2-4 weeks. Persistent post-concussion syndrome (>3 months) affects 10-30% and often responds to targeted rehabilitation. Early aerobic exercise accelerates recovery.

Cause Visual

PCS Pattern Map

Pattern-focused visual for PCS with mechanism, timing, action, and clinician discussion cues.

PCS Pattern Map Community-informed pattern guide with clinical framing PCS Pattern Map Community-informed pattern guide with clinical framing Mechanism Cue Mechanism path: PCS can reduce mental clarity through repeatable ph… Timing Pattern Timing strip: track whether symptoms cluster in mornings, after mea… This Week Action Start graded aerobic exercise using the Buffalo Concussion Treadmil… Clinician Discussion Cue Discuss post-concussion follow-up and whether findings support PCS… Use repeated patterns, not single episodes, to guide next steps.
Subtle motion Updated: 2026-02-25 Evidence-linked visual

How Pcs Disrupts Clear Thinking

PCS-related fog often feels stimulus-sensitive, head-pressure-sensitive, and effort-limited after concussion rather than like a general unexplained decline.

What this pattern often feels like

These community-grounded clues are here to help you recognize the shape of the pattern. They are not a diagnosis.

PCS-related fog usually presents as a post-injury, stimulus-sensitive pattern with head pressure, vestibular, visual, or effort-limited features.

The pattern clearly changed after a concussion or head injury. Screens, busy environments, motion, or head movement can make the fog much worse. Head pressure, dizziness, or visual strain rise with the cognitive symptoms. If I push too hard cognitively or physically, I pay for it later.

Differentiator question: Did the fog begin after head injury and worsen with screens, motion, visual load, or overdoing it?

PCS may be central, but cervical strain, migraine, vestibular dysfunction, sleep loss, and autonomic symptoms often maintain the same pattern.

Pcs Brain Fog Symptoms: How It Usually Shows Up

These are pattern signals, not proof by themselves. Use them to guide what to measure, compare, and discuss next.

Common Updated 2026-02-25

Pcs can present with morning-heavy fog when sleep or overnight physiology is relevant.

Common Updated 2026-02-25

Post-meal worsening can strengthen Pcs when metabolic or inflammatory triggers are involved.

Common Updated 2026-02-25

Post-exertional worsening can increase confidence for Pcs when recovery capacity is reduced.

Less common Updated 2026-02-25

Normal or near-normal average labs can coexist with high variability; do not conclude from one number alone.

What to Try This Week for Pcs

  1. 1

    Start graded aerobic exercise using the Buffalo Concussion Treadmill Test protocol: walk on treadmill increasing 1mph every 2 minutes until symptoms increase. Your symptom-free threshold is your exercise prescription. Stay below it. Increase by 5-10% weekly. A 2019 Lancet Child & Adolescent Health RCT confirmed early aerobic exercise ACCELERATES recovery from concussion.

    Start with one high-yield change before adding complexity.

  2. 2

    20-minute walk outside today. Evidence supports this for virtually every cause of brain fog. Start with 10 if that's all you can do.

    Weekly focus: Body.

  3. 3

    Eat a proper meal with protein, vegetables, and good fat (olive oil, nuts, avocado). Skip the ultra-processed snack. One meal upgrade today.

    Weekly focus: Food.

  4. 4

    Drink a glass of water now. Keep a bottle visible. Aim for pale yellow urine. Don't overthink it - just drink regularly.

    Weekly focus: Hydration.

  5. 5

    Open a window for 15 minutes. Fresh air exchange reduces indoor pollutants. If outdoors is bad (pollution, pollen), use a HEPA filter.

    Weekly focus: Environment.

  6. 6

    Reach out to one person today. Text, call, walk together. Isolation worsens every cause of brain fog. Connection is a biological need, not a luxury.

    Weekly focus: Connection.

  7. 7

    Rate your brain fog 1-10 each morning for 7 days. Note sleep quality, food, exercise, stress. Patterns emerge within a week.

    Weekly focus: Tracking.

Is Pcs Brain Fog Reversible?

Post-concussion brain fog is reversible in most cases. The vast majority of concussions resolve within 2-4 weeks. Persistent post-concussion syndrome (>3 months) affects 10-30% and often responds to targeted rehabilitation. Early aerobic exercise accelerates recovery.

Typical timeline: Most concussions: 80% recover within 2-4 weeks. Persistent PCS: may take 3-12 months with active rehabilitation. Very prolonged cases (years): often have treatable components (vestibular, cervical, autonomic, psychological).

Factors that affect recovery:

  • Time to initiation of aerobic exercise (earlier = better outcomes)
  • Identification of specific deficits (vestibular, cervical, oculomotor)
  • Prior concussion history (increases recovery time)
  • Psychological factors (anxiety, depression, fear-avoidance)
  • Sleep quality (poor sleep delays recovery)

Source: Leddy et al., Lancet Child Adolesc Health, 2019; Schneider et al., BMJ, 2014

Food Approach

Primary Option

Mediterranean / MIND Pattern

The most evidence-backed eating pattern for brain health. Not a diet - a way of eating.

Leafy greens daily, berries 3-5x/week, fatty fish 2-3x/week, olive oil as main fat, nuts/seeds daily, legumes 3-4x/week, whole grains. Minimal ultra-processed food, refined sugar, and seed oils.

Omega-3 (fatty fish 2-3x/week) supports neuronal membrane repair. Adequate protein for brain tissue recovery. Anti-inflammatory pattern. Don't restrict calories during brain recovery. Hydrate well - dehydration worsens post-concussion symptoms.

Open primary diet pattern →

Alternative Options

Gentle Anti-Inflammatory (Recovery-Adapted)

For people who are too fatigued, nauseous, or overwhelmed for complex dietary changes. The minimum effective dose.

Small, frequent, simple meals. Broth/soup if appetite is poor. Add ONE portion of oily fish per week. Add berries when tolerable. Reduce (don't eliminate) ultra-processed food. Hydrate. Don't force large meals.

Open this option →

Iron-Repletion Focus

For confirmed or suspected iron deficiency. Pair iron-rich foods with vitamin C. Separate from tea/coffee/dairy.

Iron-rich foods: red meat 2-3x/week, liver 1x/week (if tolerated), lentils, spinach, fortified cereals. ALWAYS pair with vitamin C (bell pepper, orange, kiwi, strawberry). Avoid tea/coffee within 1hr of iron-rich meals. Continue prenatal vitamins if postpartum.

Open this option →

How to Talk to Your Doctor About Pcs and Brain Fog

Suggested Script

"I want to systematically evaluate whether Pcs is contributing to my brain fog and compare it against close alternatives."

Tests To Discuss

  • Post-Concussion Investigation

Differentiator Questions

  • Does your pattern fit Pcs more consistently than Anxiety when timing, triggers, and recovery are compared side-by-side?
  • Does your pattern fit Pcs more consistently than Migraine when timing, triggers, and recovery are compared side-by-side?
  • Does your pattern fit Pcs more consistently than Pain when timing, triggers, and recovery are compared side-by-side?
  • When symptoms flare, do they reliably occur 1-3 hours after meals and improve when meal composition changes?

Quiet next step

Get the doctor handout for this pattern

Get the printable doctor handout for this pattern and keep the next steps in one place. No funnel, just the handout and a quiet email reminder if you want it.

Open the doctor handout nowNo sign-in required.

Quick Summary: Pcs Brain Fog Key Points

Informative
  1. 1

    PCS-related fog often feels stimulus-sensitive, head-pressure-sensitive, and effort-limited after concussion rather than like a general unexplained decline.

  2. 2

    Worse in the morning: Pcs can present with morning-heavy fog when sleep or overnight physiology is relevant.

  3. 3

    After-meal worsening: Post-meal worsening can strengthen Pcs when metabolic or inflammatory triggers are involved.

  4. 4

    Worse after exertion: Post-exertional worsening can increase confidence for Pcs when recovery capacity is reduced.

  5. 5

    Story language directly matches a recurring Pcs pattern rather than broad fatigue alone.

  6. 6

    Symptoms recur with a repeatable trigger/timing pattern that is physiologically plausible for Pcs.

  7. 7

    Context clues (history, exposures, or coexisting conditions) support Pcs as a priority hypothesis.

  8. 8

    At least two independent signals point in the same direction without strong contradiction.

  9. 9

    Response to relevant interventions tracks closer with Pcs than with Anxiety.

  10. 10

    A competing cause (Anxiety) has stronger direct evidence in the story.

Metabolic Lens

Secondary overlap

This cause can overlap with metabolic-pattern brain fog. Distinguish by timing, trigger profile, and objective context before narrowing to one explanation.

  • Fog episodes that cluster in repeatable timing windows (meal, exertion, posture, or sleep-pattern linked).
  • Energy or clarity drops that feel abrupt rather than uniformly low all day.
  • Symptom overlap with sleep, autonomic, anxiety, or medication factors.

These pattern clues can raise suspicion but are not diagnostic on their own; confirmation requires clinician-guided evaluation and objective data.

13 Evidence-Based Insights About Pcs and Brain Fog

Your MRI is normal but you can't think. That's because concussions are FUNCTIONAL injuries, not structural ones - they don't show on standard imaging. The old advice was 'rest until better.' The new evidence says controlled exercise SPEEDS recovery. There's almost always something treatable.

Evidence grades: A = strong human evidence, B = moderate evidence, C = preliminary or small-study evidence. Full grading guide

1

THE SYMPTOM-FREE HEART RATE TEST: Buffalo Treadmill Protocol - walk on treadmill increasing 1mph every 2 minutes until symptoms worsen.

The heart rate just before symptoms is your threshold. Exercise at 80-90% of this HR daily. This is now standard of care.

Leddy et al., JAMA Pediatr 2019 DOI

2

A normal MRI does NOT mean a normal brain.

Concussions don't show on standard imaging because they're functional injuries - the wiring is disrupted, not the structure. If you've been dismissed because 'your MRI is fine,' that's expected.

CDC HEADS UP guidelines

3

THE VESTIBULAR SCREEN: Stand with feet together, arms crossed, eyes closed for 30 seconds.

Significant swaying? Can't maintain position? This suggests vestibular involvement - 60% of persistent post-concussion has a vestibular component. Request vestibular physiotherapy.

Schneider et al., BMJ 2014 DOI

4

Early aerobic exercise ACCELERATES recovery.

The old 'rest until symptoms resolve' is outdated. A 2019 RCT proved controlled exercise within days of concussion leads to faster recovery. Rest beyond 48-72 hours is now discouraged.

Leddy et al., JAMA Pediatr 2019

5

THE NECK CHECK: Did you have neck pain or whiplash with your concussion?

Half of 'post-concussion' symptoms may actually be cervical. Press gently along your neck muscles. Tender? Request cervical spine physiotherapy assessment.

Cervicogenic headache research

View all 13 citations ▼
  1. Leddy et al., JAMA Pediatr 2019 doi:10.1001/jamapediatrics.2018.4397
  2. CDC HEADS UP guidelines
  3. Schneider et al., BMJ 2014 doi:10.1136/bjsports-2013-093267
  4. Leddy et al., JAMA Pediatr 2019
  5. Cervicogenic headache research
  6. Tanriverdi et al., Nat Rev Endocrinol 2015
  7. Vision therapy research
  8. Clinical pacing guidance
  9. CDC HEADS UP guidelines
  10. Mills et al., Neurosurgery 2011
  11. Persistent post-concussion research
  12. Ontario Neurotrauma Foundation guidelines
  13. Ontario Neurotrauma Foundation guidelines

Common Questions About Pcs Brain Fog

Based on clinical evidence and community insights. Use these as discussion prompts with your doctor, not self-diagnosis.

1. Can pcs cause brain fog?

Pcs can contribute to brain fog. The most useful clues are the symptom pattern, nearby overlaps, and whether the mechanism described here matches your story: Post-concussion syndrome - persistent cognitive symptoms after head injury.

2. What does pcs brain fog usually feel like?

Post-concussion syndrome - persistent cognitive symptoms after head injury.

3. What should I try first if I think pcs is involved?

Start graded aerobic exercise using the Buffalo Concussion Treadmill Test protocol: walk on treadmill increasing 1mph every 2 minutes until symptoms increase. Your symptom-free threshold is your exercise prescription. Stay below it. Increase by 5-10% weekly. A 2019 Lancet Child & Adolescent Health RCT confirmed early aerobic exercise ACCELERATES recovery from concussion. Start with one high-yield change before adding complexity.

4. What tests should I discuss for pcs brain fog?

The most useful next tests depend on the pattern, but common discussion points include post-concussion follow-up. Use the timing of your fog and the closest competing causes to narrow the first step.

5. When should I bring pcs brain fog to a clinician?

STOP - Seek urgent medical evaluation if: sudden onset of cognitive symptoms (hours/days), new focal neurological symptoms (weakness, numbness, vision or speech changes), seizures, fever with confusion, or rapidly progressive decline. These may indicate a medical emergency requiring immediate care, not lifestyle modification.

6. How is pcs brain fog different from anxiety?

Does your pattern fit Pcs more consistently than Anxiety when timing, triggers, and recovery are compared side-by-side?

7. How quickly can I tell whether this path is helping?

Improvement timing depends on the root driver. Track the pattern for 1 to 2 weeks before deciding whether this path is helping, unless the story includes urgent escalation features.

8. When should I take this to a clinician instead of self-tracking?

Escalate when fog stays stable or worse after a focused 1-2 week trial, function keeps dropping, or your story includes red-flag features. Bring your trigger/timing log, medication list, and prior test results to save appointment time.

9. Could this be Anxiety instead of Pcs?

Yes, overlap is common in community stories. The key separator is: Does your pattern fit Pcs more consistently than Anxiety when timing, triggers, and recovery are compared side-by-side? Use a 7-day log of timing, triggers, and function impact before deciding between similar causes.

10. What do people usually try first when they suspect Pcs?

A common first step from related community patterns is: Start graded aerobic exercise using the Buffalo Concussion Treadmill Test protocol: walk on treadmill increasing 1mph every 2 minutes until symptoms increase. Your symptom-free threshold is your exercise prescription. Stay below it. Increase by 5-10% weekly. A 2019 RCT showed this approach accelerates recovery compared to rest.

Source: Community pattern analysis (50 analyzed stories)

📖 Glossary of Terms (3 terms)

Pcs

Pcs can contribute to brain fog.

vestibular

Relating to the inner ear balance system.

VOMS

vestibular screening.

See full glossary →

Related Articles

When to Seek Urgent Help

STOP - Seek urgent medical evaluation if: sudden onset of cognitive symptoms (hours/days), new focal neurological symptoms (weakness, numbness, vision or speech changes), seizures, fever with confusion, or rapidly progressive decline. These may indicate a medical emergency requiring immediate care, not lifestyle modification.

Deep Dive

Clinical Fit + Advanced Detail

How This Cause Is Evaluated

The analyzer ranks all 66 causes, but this page shows the exact clues that strengthen or weaken Pcs so your next steps stay logical.

Direct Evidence Needed

  • Story language directly matches a recurring Pcs pattern rather than broad fatigue alone.
  • Symptoms recur with a repeatable trigger/timing pattern that is physiologically plausible for Pcs.

Supporting Clues

  • + Context clues (history, exposures, or coexisting conditions) support Pcs as a priority hypothesis. (weight 7/10)
  • + At least two independent signals point in the same direction without strong contradiction. (weight 6/10)
  • + Response to relevant interventions tracks closer with Pcs than with Anxiety. (weight 5/10)

What Lowers Confidence

  • A competing cause (Anxiety) has stronger direct evidence in the story.
  • Core expected signals for Pcs are missing across history, timing, and triggers.

Timing Patterns That Strengthen This Fit

Worse in the morning

Pcs can present with morning-heavy fog when sleep or overnight physiology is relevant.

After-meal worsening

Post-meal worsening can strengthen Pcs when metabolic or inflammatory triggers are involved.

Worse after exertion

Post-exertional worsening can increase confidence for Pcs when recovery capacity is reduced.

Differentiate From Similar Causes

Question to ask

Does your pattern fit Pcs more consistently than Anxiety when timing, triggers, and recovery are compared side-by-side?

If yes: Pattern consistency is stronger for Pcs.

If no: Pattern consistency is stronger for Anxiety.

Compare with Anxiety →

Question to ask

Does your pattern fit Pcs more consistently than Migraine when timing, triggers, and recovery are compared side-by-side?

If yes: Pattern consistency is stronger for Pcs.

If no: Pattern consistency is stronger for Migraine.

Compare with Migraine →

Question to ask

Does your pattern fit Pcs more consistently than Pain when timing, triggers, and recovery are compared side-by-side?

If yes: Pattern consistency is stronger for Pcs.

If no: Pattern consistency is stronger for Pain.

Compare with Pain →

How People Describe This Pattern

headaches dizziness light sensitivity sound sensitivity
  • My most prominent issues are headaches and dizziness.
  • I also struggle significantly with light sensitivity.
  • These symptoms feel like a repeatable pattern that affects my cognition.

Often Confused With

Anxiety

Open

Pcs and Anxiety can both present as fatigue + concentration problems when story detail is sparse.

Key question: When timing and trigger details are compared directly, which pattern fits better: Pcs or Anxiety?

Migraine

Open

Pcs and Migraine can both present as fatigue + concentration problems when story detail is sparse.

Key question: When timing and trigger details are compared directly, which pattern fits better: Pcs or Migraine?

Pain

Open

Pcs and Pain can both present as fatigue + concentration problems when story detail is sparse.

Key question: When timing and trigger details are compared directly, which pattern fits better: Pcs or Pain?

Use This Page With the Story Analyzer

Use this starter to run a focused check while still comparing all 66 causes:

"I want to check whether Pcs could explain my brain fog. My most relevant symptoms are headaches, dizziness, and it gets worse with screens, bright lights."

Map My Pattern for Pcs

Biomarkers and Tests

Post-Concussion Investigation

View full test guide →

Doctor Conversation Script

Bring concise evidence, request specific tests, and agree on rule-out criteria.

Initial Visit

"I want to systematically evaluate whether Pcs is contributing to my brain fog and compare it against close alternatives."

Key points to emphasize

  • Please document what findings would confirm this cause versus lower confidence.
  • I want an evidence-first workup with clear follow-up criteria.
  • Please note which competing causes should be checked in parallel if results are inconclusive.
  • Please separate metabolic, sleep, autonomic, and medication overlap before narrowing to one cause.

Tests to discuss

Post-Concussion Investigation

Used to rule in or rule out Pcs.

Healthcare System Navigation

Healthcare Guidance

Loading...

🇺🇸US

CDC HEADS UP Concussion Guidelines; Ontario Neurotrauma Foundation Guidelines (used in US); Berlin Consensus Statement on Concussion in Sport

  • Early aerobic exercise (within 24-48 hours) ACCELERATES recovery - replaces 'rest until symptoms resolve'
  • Buffalo Treadmill Test establishes symptom-free exercise threshold
  • Vestibular and cervical components common in persistent PCS
View official guidelines →

How the United States Healthcare Works for This

Step-by-step pathway for getting diagnosed and treated

Post-concussion syndrome management in the US:

Insurance rules vary by provider. Confirm coverage with your insurer before procedures.

Understanding Your Test Results Results

What each number means and when to ask questions

Key post-concussion assessments:

Lab ranges vary by facility. Your doctor interprets results in context of your symptoms and history. This guide helps you ask informed questions, not self-diagnose.

If Your Insurance Denies Coverage

Tools to appeal denials (US-specific)

⚠️This condition/test typically requires prior authorization. Get approval before scheduling.

Appeal Script Template

Post-concussion syndrome is a clinical diagnosis that does not require MRI abnormalities (CDC HEADS UP guidelines). Per Berlin Consensus and Ontario Neurotrauma Foundation, vestibular rehabilitation and neuropsychological evaluation are standard of care for persistent post-concussion symptoms. I request reconsideration.

💡Fill in the blanks with your specific scores and symptoms. Customize as needed.

Disclaimer: This is informational guidance, not legal or medical advice. Insurance rules change frequently. Always verify current policies with your insurer. Consider consulting a patient advocate if appeals are denied.

Safety Considerations

🚗

Driving

DVLA: Must not drive until symptoms resolve if they affect driving ability. Sports medicine physician or neurologist can advise on return to driving. Post-concussion cognitive slowing can affect driving safety.

💼

Work & Occupational Safety

Gradual return to work with accommodations often needed. Reduced hours, screen breaks, cognitive pacing. Occupational health can advise. Most return to full function.

🤰

Pregnancy

If pregnant and concussed, follow standard concussion management. Omega-3 supplementation is safe and may aid recovery. Avoid NSAIDs in third trimester.

Medical Treatment Options

Discuss these options with your prescribing physician. This information is educational, not medical advice.

Hormone Replacement (if pituitary damaged)

If testing reveals deficiencies: targeted hormone replacement. Growth hormone deficiency post-TBI is particularly associated with cognitive impairment and fatigue.

Evidence: Moderate - Tanriverdi et al., Nat Rev Endocrinol, 2015

Supplements — What the Evidence Says

Supplements are adjuncts, not replacements for lifestyle changes. Discuss with your healthcare provider.

Omega-3 (DHA-predominant)

Dose: 2,000-4,000mg DHA daily

DHA is the primary structural fat in neuronal membranes. High-dose DHA supports membrane repair post-injury. But exercise and vestibular rehab are the primary treatments - omega-3 is adjunct.

Mills et al., Neurosurgery, 2011

Creatine

Dose: 5g daily

Emerging evidence: creatine supports brain energy metabolism post-TBI. Sakellaris et al. 2006 RCT in children showed improvement. Low-cost, well-tolerated adjunct.

Sakellaris et al., J Trauma, 2006

See the full Supplements Guide →

Psychological Support and Therapy

Neuropsychology for cognitive assessment + rehab. Vestibular rehab if dizziness. CBT for post-concussion anxiety. Vision therapy if convergence insufficiency.

Quick Reference

Quick Win

Start graded aerobic exercise using the Buffalo Concussion Treadmill Test protocol: walk on treadmill increasing 1mph every 2 minutes until symptoms increase. Your symptom-free threshold is your exercise prescription. Stay below it. Increase by 5-10% weekly. A 2019 Lancet Child & Adolescent Health RCT confirmed early aerobic exercise ACCELERATES recovery from concussion.

Cost: Free Time to effect: 2-4 weeks

Leddy et al., Lancet Child Adolesc Health, 2019 - Buffalo Treadmill Protocol RCT

Not sure this is your cause?

Brain fog can have many causes. The story analyzer can help narrow down what pattern fits best for you.

About This Page

Written by

Dr. Alexandru-Theodor Amarfei, M.D.

Medical reviewer and clinical content lead for the What Is Brain Fog cause library

Research methodology

Evidence-based approach using peer-reviewed sources

View our evidence grading standards

Last updated: . We review our content regularly and update when new research emerges.

Important: This content is for educational purposes only and does not replace professional medical advice. Consult a qualified healthcare provider for diagnosis and treatment.

Claim-Level Evidence

  • [C] Pattern-focused visual summary for PCS intended to support structured, non-diagnostic investigation planning. low/validated
  • [B] pcs: Schneider et al., BMJ, 2014 - Vestibular rehabilitation. medium/validated

Key Citations

  • Leddy et al., JAMA Pediatr, 2019 - Early aerobic exercise for concussion [DOI]
  • Schneider et al., BMJ, 2014 - Vestibular rehabilitation [DOI]
  • CDC HEADS UP Clinical Guidance [Link]
  • Azevedo FAC, Herculano-Houzel S et al., J Comp Neurol, 2009 - Cerebellum: 80% of brain neurons [DOI]
  • Pascual-Leone A et al., Annu Rev Neurosci, 2005 - Neuroplasticity in 5 days [DOI]