Sports Medicine

, Volume 25, Issue 2, pp 131–136 | Cite as

Concussive Convulsions

Incidence in Sport and Treatment Recommendations
  • Paul R. McCroryEmail author
  • Samuel F. Berkovic
Injury Clinic


Concussive convulsions (CC) are nonepileptic phenomena which are an immediate sequelae of concussive brain injury. Although uncommon, occurring with an approximate incidence of 1 case per 70 concussions, these episodes are often confused with post-traumatic epilepsy which may occur with more severe structural brain injury. The pathophysiological mechanism of CC remains speculative, but may involve a transient traumatic functional decerebration with loss of cortical inhibition and release of brainstem activity. The phenomenology of the CC is somewhat akin to convulsive syncope, with an initial tonic phase occurring within 2 seconds of impact, followed by a clonic or myoclonic phase which may last several minutes. Lateralising features are common during the convulsions. There is no evidence of structural or permanent brain injury on clinical assessment, neuropsychological testing or neuroimaging studies. Long term outcome is universally good with no evidence of long term epilepsy and athletes are usually able to return to sport within 2 weeks. The correct management of these episodes centres on the appropriate management of the associated concussive injury and the exclusion of other cerebral injury by medical assessment. The CC requires no specific management beyond immediate onfield first aid measures such as protection of the airway. Antiepileptic therapy is not indicated and prolonged absence from sport is unwarranted. These episodes, although dramatic, are relatively straightforward to manage and all team physicians and those involved in athlete care need to be aware of this condition.


Adis International Limited Rugby League Team Physician Australian Football League Collision Sport 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gowers WR. The borderland of epilepsy: faints, vagal attacks, vertigo, migraine, sleep symptoms and their treatment. London: J&A Churchill, 1907: 45–140Google Scholar
  2. 2.
    Gowers WR. Epilepsy and the chronic convulsive diseases: their causes, symptoms and treatment. London: J&A Churchill, 1881: 24Google Scholar
  3. 3.
    McCrory P, Berkovic S, Bladin P. Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology and outcome. BMJ 1997; 314: 171–4PubMedCrossRefGoogle Scholar
  4. 4.
    Jennett B. Epilepsy after non-missile head injuries. 2nd ed. London: Heinemann, 1975: 13–4Google Scholar
  5. 5.
    Phillips G. Traumatic epilepsy after closed head injury. J Neurol Neurosurg Psychiatry 1954; 17: 1–10PubMedCrossRefGoogle Scholar
  6. 6.
    Annegers JF, Grabow JD, Groover RV, et al. Seizures after head trauma: a population study. Neurology 1980; 30: 683–9PubMedCrossRefGoogle Scholar
  7. 7.
    Walker AE, Caveness WF, Critchley M, editors. The late effects of head injury. Springfield (IL): Charles C. Thomas Publishers, 1969: 23–44Google Scholar
  8. 8.
    Seward H, Orchard J, Hazard H, et al. Football injuries in Australia at the elite level. Med J Aust 1993; 159: 298–301PubMedGoogle Scholar
  9. 9.
    Orchard J, Wood T, Seward H. AFL 1995 injury report. Melbourne: Australian Football League, 1995Google Scholar
  10. 10.
    Orchard J, Wood T, Seward H. AFL and VSFL injuries 1994 Report. Melbourne: Australian Football League Medical Officers Association, 1995Google Scholar
  11. 11.
    Chadwick D. Wrong diagnosis may deprive people of their livelihood [letter]. BMJ 1997; 314: 1283PubMedGoogle Scholar
  12. 12.
    Stephenson JBP. Fits and faints. Oxford: Mackeith Press, Blackwell Scientific Publications, 1990: 112–36Google Scholar
  13. 13.
    Gastaut H, Fisher-William M. Electroencephalographic study of syncope: its differentiation from epilepsy. Lancet 1957; II: 1018–25CrossRefGoogle Scholar
  14. 14.
    Gastaut H. Syncope. In: Vincken PJ, Bruyn GW, editors. Handbook of clinical neurology. Amsterdam: Elsevier Press, 1974Google Scholar
  15. 15.
    Lin JT, Zeigler DK, Lai CW, et al. Convulsive syncope in blood donors. Ann Neurol 1982; 11: 525–28PubMedCrossRefGoogle Scholar
  16. 16.
    Howard P, Leathart GL, Dornhurst AC, et al. The mess trick and fainting lark. BMJ 1951; II: 382–4CrossRefGoogle Scholar
  17. 17.
    Duvoisin RC. Convulsive syncope induced by the Weber manoeuvre. Arch Neurol 1962; 7: 219–26PubMedCrossRefGoogle Scholar
  18. 18.
    Aminoff MJ, Scheinmann MM, Griffin JC, et al. Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias. Ann Intern Med 1988; 108: 791–6PubMedGoogle Scholar
  19. 19.
    Lempert T, Bauer M, Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol 1994; 36: 233–7PubMedCrossRefGoogle Scholar
  20. 20.
    Gastaut H, Broughton R. Epileptic seizures: clinical and electrographic features, diagnosis and treatment. Springfield (IL): Charles C. Thomas Publishers, 1972: 186–91Google Scholar
  21. 21.
    Bove AA, Pierce AL, Barrance F, et al. Diving bradycardia as a factor in underwater blackout. Aerospace Med 1973; 44: 245–8PubMedGoogle Scholar
  22. 22.
    Khurana RK, Watabiki S, Hebel JR, et al. Cold face test in the assessment of trigeminal-brainstem-vagal function in humans. Ann Neurol 1980; 7: 144–9PubMedCrossRefGoogle Scholar
  23. 23.
    Whinnery JE. Acceleration-induced loss of consciousness: a review of 500 episodes. Arch Neurol 1990; 47: 764–76PubMedCrossRefGoogle Scholar
  24. 24.
    Denny-Brown D, Russell WR. Experimental cerebral concussion. Brain 1941; 64: 93–163CrossRefGoogle Scholar
  25. 25.
    Westphal CFO. Artificial production of epilepsy in guinea pigs. Berliner Klin Wochenschr [cited in BMJ 1872; I: 399] 1871; 1: 39Google Scholar
  26. 26.
    Maddocks D, Dicker G. An objective measure of recovery from concussion in Australian rules footballers. Sport Health 1989; 7 Suppl.: 6–7Google Scholar
  27. 27.
    Maddocks D, Saling M. Neuropsychological sequelae following concussion in Australian rules footballers. J Clin Exp Neuropsychol 1991; 13: 439Google Scholar
  28. 28.
    Maddocks DL, Dicker GD, Saling MM. The assessment of orientation following concussion in athletes. Clin J Sports Med 1995; 5: 32–5CrossRefGoogle Scholar
  29. 29.
    McCrory P. Were you knocked out? A team physicians approach to initial concussion management. Med Sci Sports Exerc 1997; 29 Suppl.: S207–12PubMedGoogle Scholar
  30. 30.
    Lempert T. Recognising syncope: pitfalls and surprises. J R Soc Med 1996; 89: 372–5PubMedGoogle Scholar
  31. 31.
    Brukner P, Khan KM. Clinical sports medicine. Sydney: McGraw-Hill, 1993: 608–10Google Scholar
  32. 32.
    Cantu RC. Cerebral concussion in sport: management and prevention. Sports Med 1992; 14: 64–74PubMedCrossRefGoogle Scholar
  33. 33.
    Cantu RC. Guidelines for return to contact sports after cerebral concussion. Physician Sports Med 1986; 14: 75–83Google Scholar
  34. 34.
    Cantu R. Head injuries in sport. Br J Sports Med 1996; 30: 289–96PubMedCrossRefGoogle Scholar
  35. 35.
    Roberts W. Who plays? Who sits? Managing concussion on the sidelines. Physician Sports Med 1992; 20: 66–72Google Scholar
  36. 36.
    Roos R. Guidelines for managing concussions in sports. Physician Sports Med 1996: 24: 67–74CrossRefGoogle Scholar
  37. 37.
    Torg JF, editor. Athletic injuries to the head, neck and face. 2nd ed. St Louis: Mosby Year Book, 1991: 270–331Google Scholar

Copyright information

© Adis International Limited 1998

Authors and Affiliations

  1. 1.Department of Medicine (Neurology)The University of Melbourne, Austin and Repatriation Medical CentreHeidelbergAustralia
  2. 2.Olympic Park Sports Medicine CentreMelbourneAustralia

Personalised recommendations