Best therapies for post-concussion syndrome in children and adolescents (8/29/19 newsletter)

Aug 30

We are pleased to have Carleton College students and alumni interning with Concussion Alliance. Intern contributors this week:

Editor: Galen Moller
Contributors: Julian Szieff

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Education

2019 Concussion Education Video a good summary of current concussion management

The 13-minute 2019 Concussion Education Video, produced by the NHL and NHLPA, is a well-done and up-to-date overview of concussion management, recovery, and potential long-term effects. It is made for a hockey audience but is applicable for youth and adult athletes, parents, coaches, and team medical staff in all sports. The video features pro hockey stars talking about their experience with concussion, and well as information provided by medical experts including Sport Neurologist Dr. Jeffrey Kutcher, “member and co-author of the International Consensus Conference on Concussion in Sport in Zurich (2012) and Berlin (2016)”.

Sports

More parents are preventing their children from playing contact sports

The Barrow Neurological Institute in Arizona released their findings a week ago that more parents than ever are preventing their children from playing contact sports. In 2017, 82% of parents allowed their children to play contact sports such as football, soccer, and basketball and in 2019 that number has dropped to 65%--a 17% decrease. This represents a growing concern for concussion risks, which isn’t just isolated to parents; since 2017, there has been a 50% increase in teens who say they’re either afraid of getting a concussion or of getting another concussion (40% report a recent concussion).

Additionally, parents feel that they lack access to adequate information on concussions--especially in club sports settings where there is a perceived “lack of oversight to diagnose/treat concussions”. This shift in perception is crucial to having a health-first response to concussions in our society. The increased focus on concussions hopefully will yield a safer future.

Cannabis

CBD and CBDA restore blood-brain barrier integrity (in mice with stroke); blood-brain barrier dysfunction in patients with persistent concussion symptoms

Researchers at the University of Nottingham presented evidence that “CBD and CBDA (cannabidiolic acid) restore blood-brain barrier (BBB) integrity by activating the 5-HT1a serotonin receptor.” Although their study was an analysis of CBD and ischemic stroke in animal models, we find it potentially relevant because another study using specialized MRI techniques found “widespread blood-brain barrier disruption in mild traumatic brain injury patients with post-concussion syndrome.”

Project CBD discusses the University of Nottingham presentation of their meta-analysis at the 29th annual International Cannabinoid Research Society (ICRS) symposium in Bethesda, Maryland in June. Our Diagnostics category covers the research about BBB disruption in mTBI patients with persistent symptoms.

Diagnostics

The blood-brain barrier may be disrupted in patients with post-concussion syndrome

We are a big fan of Dr. Chris Giza’s twitter feed, which often features his photographs of slide presentations at conferences. A recent tweet was a slide entitled “Further evidence for physiogenesis,” referencing physical rather than psychological causes for persistent post-concussion symptoms. This slide alerted us to a study by Roh-Eul Yoo et al., published in European Radiology. The study found that the blood-brain barrier, important for keeping toxins out of the brain, may be disrupted in patients with PCS and these patients may also be at greater risk for white matter disruptions which impact the connectivity of the brain.

Therapies

Best therapies for a child with post-concussion syndrome

Mitul Kapadia et al. at UC San Francisco have done an extensive review of cases involving children and adolescents with post-concussion syndrome (PCS) to establish what treatments are most applicable for different symptoms. They found that the best way to organize treatment was a breakdown of therapies by four symptom groups: vestibular-ocular, autonomic (or physical), emotional, and cognitive. Vestibular-ocular symptoms are often the most difficult to treat, but after screening from a physician, new therapies have shown a potential to treat these issues. Check out the Concussion Alliance pages on Vestibular Therapy, Vision Therapy, and Physical Therapy to find out more.

The authors recommend cognitive behavioral therapy (CBT) to address emotional symptoms; CBT also can address some physical symptoms, as it is shown to “reduce pain frequency and severity,” including post-traumatic headache. CBT is a type of psychological therapy based on changing thought patterns to help patients improve their own situation or at least cope with it better. The researchers describe how these three symptom groups can feed off each other to the detriment of the patient. The study was published in Current Reviews of Musculoskeletal Medicine. Check the blog post by Julian Szieff for the full breakdown of this research article.

Veterans

University of Illinois hosts symposium for veterans with traumatic brain injury

"Making the Invisible Visible: A Dialogue on Veteran Traumatic Brain Injury" will be held on November 1st at the University of Illinois, and registration opens September 1st. This event will “foster dialogue between military service members, veterans, caregivers, Illinois experts, and providers about traumatic brain injury.”

Mental Health

Online concussion toolkit for psychologists

The Concussion Toolkit for Psychologists is a useful resource sponsored by the American Psychological Association. Some of the key points in the section on Treatment/Management section are as follows: early psychoeducation to prevent long-term symptoms, and for persistent post-concussion symptoms, a “12-session framework for CBT with post-concussive patients”. Research trials show the therapy to be effective.

Statistics

CARE Consortium to begin studying the cumulative effects of concussions

The CARE Consortium is preparing to follow coast guard cadets and student-athletes for up to four years after graduation, according to the website Military. The NCAA-DoD Concussion Assessment, Research, and Education (CARE) Consortium is moving into a new phase which will study the cumulative effects of concussions. Participants will be given periodic cognitive assessments, and their psychological health will be tracked “to determine what role, if any, concussions and repetitive head impacts may have on depression, anxiety and emotional control.”

The CARE Consortium is currently the world’s largest concussion study. It has collected data on 40,000 student-athletes and cadets from 30 colleges and military service academies. Previously the consortium had focused on the short-term implications of the 3,300 concussions that have occurred to date, but after a combined $22.5 billion grant from the NCAA and the Pentagon, they are now able to look more at the long-term effects of concussions. Another aspect of the CARE Consortium was covered in last week’s newsletter.

Women's Health

Women with concussion have a 70% greater chance of sexual dysfunction

A study found that women who went to the emergency room for a concussion had a 70% greater chance of sexual dysfunction, compared to women who went to the ER for an injured extremity. Concussed women with sexual dysfunction also reported more post-concussion symptoms as well as more anxiety and depression. The authors M. Anto-Ocrah et al. point out that women of reproductive age are “one of the fastest-growing subgroups of TBI” and that more research and interventions are needed. The study was published in Brain Injury.

Culture

Kiesza’s return to pop music after a concussion

Pop singer-songwriter Kiesza, known for her hit song “Hideaway”, is returning to music after a 2-year hiatus to recover from an mTBI. Part of her recovery included spending six months in a dark room, and she alludes to that experience in the music video for her song “Sweet Love." At certain points in the music video, you can see Kiesza moving in a black mesh suit that represents the confinement she felt in her recovery. In her interview with The Star, she discusses how it relates to her feelings over the past two years by saying, “I’ve been in this black hole which has become my den and my safe space but has also been my jail."

The isolation embodied by the mesh suit also feels familiar, as she explains, “There’s been this feeling of being alone through this whole journey because there’s only so much I can say what I’m going through that people can relate to. The rest of it, I’m on my own. Every brain injury is unique.” In the interview, Kiesza describes many of the emotions that can occur when returning to the life you had before a concussion.

Concussion Alliance would like to point out that "cocooning" in a dark room is no longer recommended for concussions, and that "prolonged rest time may even delay healing and recovery."