Doctors' Notes: A new concussion crisis may be upon us
Republished from the Toronto Star's Doctors' Notes
Each year, about 150,000 people in Canada sustain a brain injury. In some cases, such as motor vehicle accidents, these can be life threatening. In most cases, however, there is minimal loss of consciousness, followed by confusion, dizziness, headaches, memory changes, irritability and sensitivity to light or noise, among other symptoms. This kind of brain injury, which is common in sports, is known as a concussion.
Athletes may ignore or under-report symptoms to avoid being taken out of a game. For many years, scientists have warned that not taking concussions seriously is very dangerous. In the past decade, more people have become aware of the risks, in part due to media reports about high-profile athletes who have suffered the consequences of concussion. For the recreational athlete, student or anyone else who has sustained a concussion in daily life, this means that now there is a better chance of getting this injury taken seriously, with recommendations that will help recovery. That is why we now have Rowan’s Law in Ontario, named for Rowan Stringer, a teen rugby player, who died in 2013 following multiple, undiagnosed concussions.
Yet the stories of professional athletes with severe concussion effects, including the neurodegenerative disease known as chronic traumatic encephalopathy or CTE, are leading many to ask if a new concussion crisis is upon us. Many people who have had a concussion are now not only worried about the effects they are experiencing at present, but are afraid that they are going to end up like the football players Mike Webster (depicted in the film Concussion) or Junior Seau (who died of suicide and was found to have CTE).
These fears have led some parents to remove their children from participation in contact sports, even in the absence of concussion. One cannot blame them when Dr. Bennet Omalu, the neuropathologist who discovered CTE in Mike Webster and others, has been quoted by media saying, “Someday there will be a district attorney who will prosecute for child abuse (on the football field), and it will succeed. It is the definition of child abuse.”
As of today, the documented cases of CTE number in the hundreds. The stories of these people need to be told, yet millions of people who have had concussions make good recoveries and resume normal functioning. Even among retired professional athletes at risk for CTE, many thousands of them are leading productive lives.
My research and that of many others is seeking to answer the numerous questions about CTE, such as why some people have the condition, whereas others do not, even with a similar history of concussions, or what are the signs and symptoms of CTE?
At Baycrest, my colleagues and I have been fortunate to do in-depth testing and brain imaging with more than 50 retired professional ice-hockey players. While there are signs of cognitive and emotional problems in some of them, many are healthy and happy. At this time, we do not see evidence of an elevated rate of neurodegenerative diseases relative to the general population.
Protect yourself from concussions
Meanwhile, there are practical steps you can take to help protect you or your loved one from the potentially serious and long-term consequences of concussion.
First and foremost, take measures to control the risks of concussion. Participation in sports, including contact sports, has many benefits to children and to adults. Just as you would not get in a vehicle with a reckless driver, don’t get involved in a sporting or any other activity unless you are confident that all parties, including coaches, parents and other players, are serious about safety and have a concussion protocol in place.
If you suspect you have sustained a concussion, get evaluated by a medical professional as soon as possible. If you have not been diagnosed with additional complications, a process of natural recovery will occur, which could take days, weeks or in some cases, months, before you return to normal.
After a period of rest, gradual return to light activity and exercise is recommended, but let your body guide you and back off if symptoms return. Avoid heavy exercise, stress, recreational drugs and alcohol and use of heavy machinery. Activities that could result in a repeat concussion (e.g., returning to a sport) should be avoided until symptoms have cleared. If there is a history of multiple concussions, extra caution is warranted.
Make sure you are being cared for by a qualified medical professional, preferably at an established concussion clinic or academically affiliated health care facility. For more information, see ConcussionsOntario.org.
Brian Levine is a professor of Psychology and Neurology at the University of Toronto and a senior scientist at Baycrest’s Rotman Research Institute. He is lead investigator on the Baycrest Brain Health in Professional Athletes Study, involving brain and behaviour studies of retired professional ice hockey players. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine.
