NEWS

American Acad. of Neurology updates concussion guidelines

UPI reported on evidence-based guidelines for managing concussions that were published Monday in the journal Neurology that it said affect more than 1 million Americans each year.

Co-lead guidelines author Dr. Christopher C. Giza of the David Geffen School of Medicine and Mattel Children's Hospital at University of California, Los Angeles, said the new guidelines replaced the 1997 American Academy of Neurology guidelines on concussions.

"Among the most important recommendations the academy is making is that any athlete suspected of experiencing a concussion immediately be removed from play," Giza said in a statement.

"We've moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually. There is no set timeline for safe return to play."

Athletes of high school age and younger with a concussion should be managed more conservatively in regard to return to play, because they take longer to recover than college athletes.

PRNewswire published the full guidelines.

According to the guidelines:

* 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).

NBC News also wrote about the new guidelines, looking at how they might have affected one prep athlete.

Olivia Brandy and her family certainly wish that those guidelines had been in effect when she suffered her first concussion. It happened back when Olivia was a high school freshman soccer player.

"The problem started when I hit heads with a girl going up for a ball in a game," said Olivia, now 19. "I remember feeling totally different when I got up, like somebody had tied a rope around my waist and was holding me back as I ran. I had no idea what the problem was. I just pushed through it and at the end of the game I was in severe pain."

It took a week before anyone diagnosed the Pittsburgh-area teen with a concussion and that delay cost her six months of school and playing time -- which came as a shock to her parents.

"My husband's a physician and I'm a nurse and though we knew about concussions, we didn't appreciate how serious they were, or how much they could affect a young person's life," said Trina Brandy, 50. "We had our eyes opened by this."

USA Today reported on the guidelines by looking at the grades the AAN did away with.


Treatment of sports concussions is a work in progress. New guidelines issued by the American Academy of Neurology show the evolution that has occurred since the guidelines it last put forth in 1997 recommending grading concussions on a scale of 1, 2 and 3.

The grading scale is out under the guidelines published Monday in online issue of the medical journal Neurology. The medical experts now know it's not as simple as 1-2-3.

"That's no longer a part of this. We're taking much more of a patient specific approach to diagnosis and return to play," says Geoffrey Manley, chief of neurosurgery at San Francisco General Hospital.

-- Bill Bradley, contributing editor

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