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Sport-Related Concussion: “How many is too many?”

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Abstract

The long-term effects of multiple sport-related concussions are currently at the center of debate in the popular press and scientific community. The question, “How many concussions are too many,” is frequently asked in the competitive sport environment by parents, athletes, and coaches. While research suggests that a history of concussion influences the risk and recovery from subsequent concussion, studies investigating the long-term effects of multiple concussions are less conclusive. This paper reviews the literature on multiple concussions and the potential long-term consequences of these injuries. Furthermore, this paper addresses how concussion history can inform clinical and return-to-play decisions. Recent studies incorporating novel brain imaging and electrophysiological technology for assessing residual impairment from multiple concussions are reviewed and the clinical implications of this work are discussed.

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References

  1. Guskiewicz KM, McCrea M, Marshall SW, Cantu RC, Randolph C, Barr W, et al. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003;290(19):2549–55.

    Article  PubMed  CAS  Google Scholar 

  2. Covassin T, Stearne D, Elbin R. Concussion history and postconcussion neurocognitive performance and symptoms in collegiate athletes. J Athl Train. 2008;43(2):119–24.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gavett BE, Stern RA, McKee AC. Chronic traumatic encephalopathy: a potential late effect of sport-related concussive and subconcussive head trauma. Clin Sports Med. 2011;30(1):179–88. xi.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Center for Disease Control. Heads up and sports concussion. Center for Disease Control; 2006

  5. McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, et al. Consensus statement on concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Clin J Sport Med. 2009;19(3):185–200.

    Article  PubMed  Google Scholar 

  6. Giza C, Hovda D. Ionic and metabolic consequences of concussion. In: Cantu RC, Cantu RJ, editors. Neurologic athletic and spine injuries. Philadelphia: WB Saunders; 2000. p. 80–100.

    Google Scholar 

  7. Giza C, Hovda D. The neurometabolic cascade of concussion. J Athl Train. 2001;36(3):228–35.

    PubMed  PubMed Central  Google Scholar 

  8. Field M, Collins MW, Lovell MR, Maroon J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr. 2003;142(5):546–53.

    Article  PubMed  Google Scholar 

  9. Willer B, Leddy JJ. Management of concussion and post-concussion syndrome. Curr Treat Options Neurol. 2006;8(5):415–26.

    Article  PubMed  Google Scholar 

  10. Covassin T, Swanik CB, Sachs M, Kendrick Z, Schatz P, Zillmer E, et al. Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes. Br J Sports Med. 2006;40(11):923–7. discussion 7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  11. Mihalik JP, Stump JE, Collins MW, Lovell MR, Field M, Maroon JC. Posttraumatic migraine characteristics in athletes following sports-related concussion. J Neurosurg. 2005;102(5):850–5.

    Article  PubMed  Google Scholar 

  12. Gaetz M, Goodman D, Weinberg H. Electrophysiological evidence for the cumulative effects of concussion. Brain Inj. 2000;14(12):1077–88.

    Article  PubMed  CAS  Google Scholar 

  13. Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M. Cumulative effects of concussion in high school athletes. Neurosurgery. 2002;51(5):1175–9. discussion 80–1.

    Article  PubMed  Google Scholar 

  14. Zemper ED. Two-year prospective study of relative risk of a second cerebral concussion. Am J Phys Med Rehabil. 2003;82(9):653–9.

    Article  PubMed  Google Scholar 

  15. Iverson GL, Gaetz M, Lovell MR, Collins MW. Cumulative effects of concussion in amateur athletes. Brain Inj. 2004;18(5):433–43.

    Article  PubMed  Google Scholar 

  16. Macciocchi SN, Barth JT, Littlefield L, Cantu RC. Multiple concussions and neuropsychological functioning in collegiate football players. J Athl Train. 2001;36(3):303–6.

    PubMed  PubMed Central  Google Scholar 

  17. Colvin AC, Mullen J, Lovell MR, West RV, Collins MW, Groh M. The role of concussion history and gender in recovery from soccer-related concussion. Am J Sports Med. 2009;37(9):1699–704.

    Article  PubMed  Google Scholar 

  18. Collins MW, Grindel SH, Lovell MR, Dede DE, Moser DJ, Phalin BR, et al. Relationship between concussion and neuropsychological performance in college football players. JAMA. 1999;282(10):964–70.

    Article  PubMed  CAS  Google Scholar 

  19. Killam C, Cautin RL, Santucci AC. Assessing the enduring residual neuropsychological effects of head trauma in college athletes who participate in contact sports. Arch Clin Neuropsychol. 2005;20(5):599–611.

    Article  PubMed  Google Scholar 

  20. Iverson GL, Echemendia RJ, Lamarre AK, Brooks BL, Gaetz MB. Possible lingering effects of multiple past concussions. Rehabil Res Pract. 2012;2012:316575.

    PubMed  PubMed Central  Google Scholar 

  21. Schatz P, Moser RS, Covassin T, Karpf R. Early indicators of enduring symptoms in high school athletes with multiple previous concussions. Neurosurgery. 2011;68(6):1562–7. discussion 7.

    Article  PubMed  Google Scholar 

  22. Register-Mihalik JK, Mihalik JP, Guskiewicz KM. Association between previous concussion history and symptom endorsement during preseason baseline testing in high school and collegiate athletes. Sports health. 2009;1(1):61–5.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Moser RS, Schatz P, Jordan BD. Prolonged effects of concussion in high school athletes. Neurosurgery. 2005;57(2):300–6. discussion −6.

    Article  PubMed  Google Scholar 

  24. Moser RS, Schatz P. Enduring effects of concussion in youth athletes. Arch Clin Neuropsychol. 2002;17(1):91–100.

    PubMed  Google Scholar 

  25. Guskiewicz KM. No evidence of impaired neurocognitive performance in collegiate soccer players. Am J Sports Med. 2002;30(4):630.

    PubMed  Google Scholar 

  26. Bruce JM, Echemendia RJ. History of multiple self-reported concussions is not associated with reduced cognitive abilities. Neurosurgery. 2009;64(1):100–6. discussion 6.

    Article  PubMed  Google Scholar 

  27. Iverson GL, Brooks BL, Lovell MR, Collins MW. No cumulative effects for one or two previous concussions. Br J Sports Med. 2006;40(1):72–5.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  28. Collie A, McCrory P, Makdissi M. Does history of concussion affect current cognitive status? Br J Sports Med. 2006;40(6):550–1.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  29. Elbin RJ, Covassin T, Hakun J, Kontos AP, Berger K, Pfeiffer K, et al. Do brain activation changes persist in athletes with a history of multiple concussions who are asymptomatic? Brain Inj. 2012;26(10):1217–25.

    Article  PubMed  CAS  Google Scholar 

  30. Gosselin N, Theriault M, Leclerc S, Montplaisir J, Lassonde M. Neurophysiological anomalies in symptomatic and asymptomatic concussed athletes. Neurosurgery. 2006;58(6):1151–61. discussion −61.

    Article  PubMed  Google Scholar 

  31. De Beaumont L, Brisson B, Lassonde M, Jolicoeur P. Long-term electrophysiological changes in athletes with a history of multiple concussions. Brain Inj. 2007;21(6):631–44.

    Article  PubMed  Google Scholar 

  32. Theriault M, De Beaumont L, Tremblay S, Lassonde M, Jolicoeur P. Cumulative effects of concussions in athletes revealed by electrophysiological abnormalities on visual working memory. J Clin Exp Neuropsychol. 2011;33(1):30–41.

    Article  PubMed  Google Scholar 

  33. Pontifex MB, O'Connor PM, Broglio SP, Hillman CH. The association between mild traumatic brain injury history and cognitive control. Neuropsychologia. 2009;47(14):3210–6.

    Article  PubMed  Google Scholar 

  34. McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68(7):709–35.

    Article  PubMed  PubMed Central  Google Scholar 

  35. McKee AC, Gavett BE, Stern RA, Nowinski CJ, Cantu RC, Kowall NW, et al. TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy. J Neuropathol Exp Neurol. 2010;69(9):918–29.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  36. Omalu BI, Fitzsimmons RP, Hammers J, Bailes J. Chronic traumatic encephalopathy in a professional American wrestler. J Forensic Nurs. 2010;6(3):130–6.

    Article  PubMed  Google Scholar 

  37. Omalu BI, Hamilton RL, Kamboh MI, DeKosky ST, Bailes J. Chronic traumatic encephalopathy (CTE) in a National Football League Player: case report and emerging medicolegal practice questions. J Forensic Nurs. 2010;6(1):40–6.

    Article  PubMed  Google Scholar 

  38. Covassin T, Elbin RJ. The female athlete: the role of gender in the assessment and management of sport-related concussion. Clin Sports Med. 2011;30(1):125–31.

    Article  PubMed  Google Scholar 

  39. Covassin T, Elbin RJ, Harris W, Parker T, Kontos A. The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sports Med. 2012;40(6):1303–12.

    Article  PubMed  Google Scholar 

  40. Covassin T, Elbin 3rd RJ, Larson E, Kontos AP. Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms. Clin J Sport Med. 2012;22(2):98–104.

    Article  PubMed  Google Scholar 

  41. Covassin T, Schatz P, Swanik CB. Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes. Neurosurgery. 2007;61(2):345–50. discussion 50–1.

    Article  PubMed  Google Scholar 

  42. Covassin T, Swanik CB, Sachs ML. Epidemiological considerations of concussions among intercollegiate athletes. Appl Neuropsychol. 2003;10(1):12–22.

    Article  PubMed  Google Scholar 

  43. Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–9.

    PubMed  PubMed Central  Google Scholar 

  44. Broshek DK, Kaushik T, Freeman JR, Erlanger D, Webbe F, Barth JT. Sex differences in outcome following sports-related concussion. J Neurosurg. 2005;102(5):856–63.

    Article  PubMed  Google Scholar 

  45. Covassin T, Elbin RJ, Crutcher B, Burkhart S. Should males and females be managed differently when it comes to sport-related concussion? J Transl Stroke Res. 2012 (in press)

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA, 15260, USA

    R. J. Elbin, Luke Henry, Jennine Wedge & Anthony P. Kontos

  2. Department of Kinesiology, Michigan State University, East Lansing, MI, 48824, USA

    Tracey Covassin

  3. Department of Psychology, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Diana J. Whalen

  4. UPMC Center for Sports Medicine, 3200 South Water Street, Pittsburgh, PA, 15203, USA

    R. J. Elbin

Authors
  1. R. J. Elbin
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  2. Tracey Covassin
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  3. Luke Henry
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  4. Diana J. Whalen
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  5. Jennine Wedge
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  6. Anthony P. Kontos
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Correspondence to R. J. Elbin.

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Elbin, R.J., Covassin, T., Henry, L. et al. Sport-Related Concussion: “How many is too many?”. Transl. Stroke Res. 4, 425–431 (2013). https://doi.org/10.1007/s12975-012-0237-y

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  • DOI: https://doi.org/10.1007/s12975-012-0237-y

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