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American Academy of Neurology Issues New Report On Evaluation and Management of Concussion in Sports

The American Academy of Neurology’s (AAN) guideline development subcommittee has issued a new report updating and replacing the 1997 AAN practice parameter regarding sports concussion, focusing on four questions:  
  1. What factors increase/decrease concussion risks?
  2. What diagnostic tools identify those with concussion and those that increase risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neuro behavioral or impairment?
  3. What clinical factors identify those that increase risk for severe/prolonged early post concussion impairments, neurologic catastrophe, recurrent concussion, or chronic neuro behavioral impairment?
  4. What interventions enhance recovery, reduce recurrent concussion risks, or diminish long-term sequelae?
 To read the report, Click Here
 
According to the guideline:
 
Among the sports in the studies evaluated, risk of concussion is greatest in football and rugby, followed by hockey and soccer. The risk of concussion for young women and girls is greatest in soccer and basketball.
 
An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion.
 
The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with another concussion.
 
There is no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet. Helmets should fit properly and be well maintained.
 
Licensed health professionals trained in treating concussion should look for ongoing symptoms (especially headache and fogginess), history of concussions and younger age in the athlete. Each of these factors has been linked to a longer recovery after a concussion.
 
Risk factors linked to chronic neurobehavioral impairment in professional athletes include prior concussion, longer exposure to the sport and having the ApoE4 gene.
 
Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.
 
Signs and symptoms of a concussion include:
 
Headache and sensitivity to light and sound Changes to reaction time, balance and coordination Changes in memory, judgment, speech and sleep Loss of consciousness or a “blackout” (happens in less than 10 percent of cases).
 
“If in doubt, sit it out,” said Jeffrey S. Kutcher, MD, with the University of Michigan Medical School in Ann Arbor and a member of the AAN. “Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain; treat it well.”
 
The guideline states that while an athlete should immediately be removed from play following a concussion, there is currently insufficient evidence to support absolute rest after concussion. Activities that do not worsen symptoms and do not pose a risk of repeat concussion may be part of concussion management.
 
The importance from a neuro-legal standpoint is that The American Academy of Neurology said it would emphasize treating concussions on a case-by-case basis, acknowledging they are too idiosyncratic to be neatly categorized.
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