MINNEAPOLIS – With more than one million athletes now experiencing a concussion each year in the United States, the American Academy of Neurology (AAN) has released an evidence-based guideline for evaluating and managing athletes with concussion. This new guideline replaces the 1997 AAN guideline on the same topic. The new guideline is published in the March 18, 2013, online issue ofNeurology®, the medical journal of the American Academy of Neurology, was developed through an objective evidence-based review of the literature by a multidisciplinary committee of experts and has been endorsed by a broad range of athletic, medical and patient groups.
“Among the most important recommendations the Academy is making is that any athlete suspected of experiencing a concussion immediately be removed from play,” said co-lead guideline author Christopher C. Giza, MD, with the David Geffen School of Medicine and Mattel Children’s Hospital at UCLA and a member of the AAN. “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.”
The updated guideline recommends athletes with suspected concussion be immediately taken out of the game and not returned until assessed by a licensed health care professional trained in concussion, return to play slowly and only after all acute symptoms are gone. Athletes of high school age and younger with a concussion should be managed more conservatively in regard to return to play, as evidence shows that they take longer to recover than college athletes.
The guideline was developed reviewing all available evidence published through June 2012. These practice recommendations are based on an evaluation of the best available research. In recognition that scientific study and clinical care for sports concussions involves multiple specialties, a broad range of expertise was incorporated in the author panel. To develop this document, the authors spent thousands of work hours locating and analyzing scientific studies. The authors excluded studies that did not provide enough evidence to make recommendations, such as reports on individual patients or expert opinion. At least two authors independently analyzed and graded each study.
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 guideline is endorsed by the National Football League Players Association, the American Football Coaches Association, the Child Neurology Society, the National Association of Emergency Medical Service Physicians, the National Association of School Psychologists, the National Athletic Trainers Association and the Neurocritical Care Society.
To learn more about concussion, visit http://www.aan.com/concussion or download the Academy’s new app, Concussion Quick Check, to quickly help coaches and athletic trainers recognize the signs of concussion.
The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
For more information about the American Academy of Neurology, visit http://www.aan.com or find us onFacebook, Twitter, Google+ and YouTube.
Editor’s Note on Press Conference:
Drs. Giza and Kutcher will be available for media questions during a press conference at 2:00 p.m., ET/11:00 a.m., PT, on Monday, March 18, 2013, in Room 14B of the San Diego Convention Center in San Diego. To join the press conference remotely, please call (866) 740-1260/Passcode: 6952738.Space is limited.
Drs. Giza and Kutcher are also available for advance media interviews ahead of the press conference. Please contact Rachel Seroka, firstname.lastname@example.org, to schedule an advance interview.
Mar 11, 6:39 PM EDT
BY HOWARD FENDRICH
AP PRO FOOTBALL WRITER
NEW YORK (AP) — NFL Commissioner Roger Goodell imagines a day in the not-too-distant future when players could be checked to determine whether their genetic makeup leaves them more likely to develop brain disease.
They then might be told to switch to a less dangerous position – or give up football entirely.
“In talking to the medical experts over several years, I think there’s a predisposition to most injuries, particularly to the brain, or to brain disease,” Goodell said in an interview with The Associated Press on Monday. “So we do want to know what those biomarkers are.”
Goodell also envisions players being required – with the union’s OK, of course – to wear helmets containing sensors to detect hits that cause concussions. Those helmets might be lighter and “less of a weapon” than today’s, he said.
Those are the kinds of advances the NFL and General Electric are hoping to produce in a partnership that could funnel up to $60 million over four years to research on head injuries and possible improvements to helmets.
“Imaging of the brain, studying the brain, is still pretty far behind the study of cancer, heart disease, things like that,” GE Chairman and CEO Jeff Immelt said. “I look at this as a catalyst in terms of where the technology will go. … I would say you’re going to start seeing really strong activities almost immediately.”
Goodell, who spoke to the AP after a news conference at a GE office building, agreed about the importance of quick progress.
“We weren’t looking at a long timetable,” he said. “We wanted to see results quickly.”
Not long after Goodell was forced to defend the league’s concussion policies at a congressional hearing in October 2009, the NFL began making changes. Among them: new return-to-play guidelines; changing the co-chairmen of the NFL’s committee on concussions; and, expected for next season, putting independent neurological experts on sidelines during games.
Thousands of former players are suing the league and its teams, saying that for years the NFL did not do enough to protect players from concussions. Next month, a federal judge is scheduled to hear oral arguments on the league’s motion to dismiss.
Such scrutiny “has no impact” on projects like the one with GE, Goodell said.
“This is about looking forward,” he said. “This is about the future. This is about changing the way all of our lives are led, whether it’s riding a bicycle or playing football or being a member of the military.”
In September, the NFL announced a donation of $30 million for medical research to the Foundation for the National Institutes of Health, the NIH’s fundraising arm.
One influential NFL owner, Robert Kraft of the New England Patriots, is pleased to see these kinds of projects now.
“I wish it had happened sooner. The evolution, the issue has been coming to the forefront and … a lot of times we didn’t talk about it, or talk about it enough. But we need to talk about it and do something about it,” Kraft said.
“Everyone has been spending money in bits and pieces, but now it will be concentrated and this will become a tremendous resource,” he added. “I don’t think anyone has the answers, how to treat it, whether to continue to play – there haven’t been answers, and we need to find the answers.”
The Head Health Initiative described Monday, which also includes sports apparel and equipment maker Under Armour, involves a four-year, $40 million research and development program to find ways to detect and diagnose brain injuries, and a two-year “innovation challenge” that would put up to $20 million toward research to protect against those injuries.
Goodell thinks helmets can be improved.
“The better protection the helmet provides, sometimes the more likely (players) are to use their head, and that’s a dilemma that we have to change, in part through rules,” Goodell said. “But I also see that we could potentially change the helmet by making it lighter. (That) would make it less of a weapon.”
AP Pro Football Writer Barry Wilner and AP Science Writer Malcolm Ritter contributed to this report.
Published: March 18, 2013
The American Academy of Neurology said Monday that it had revised its guidelines for handling concussions to emphasize treating athletes case by case rather than according to a predetermined scale.
The move brings the group more in line with best practices followed by the N.F.L. and other leagues and associations, and it essentially acknowledges that concussions are too idiosyncratic to be categorized neatly.
“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,” said Christopher C. Giza, a doctor at the David Geffen School of Medicine and Mattel Children’s Hospital at U.C.L.A. and one of the lead authors of the new guidelines. “There is no set timeline for safe return to play.”
Concussions, Giza and other authors of the report said, are clinical diagnoses. “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.”
The revised recommendations were announced at the academy’s annual meeting in San Diego on Monday, and they have been published in Neurology, the medical journal of the academy, which includes more than 25,000 neurologists and neuroscience professionals.
In noting that more than a million American athletes experienced concussions each year, the authors of the study noted that the risk of concussion was greatest in football and rugby, followed by hockey and soccer, and that the risk of concussion for young women and girls was greatest in soccer and basketball.
Critically, the authors found “no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet.”
Signs and symptoms of a concussion include headaches; sensitivity to light and sound; changes in reaction time, balance and coordination; changes in memory, judgment, speech and sleep; and loss of consciousness or blackouts. The guidelines recommend that athletes suspected of having a concussion should be immediately removed from play.
“If in doubt, sit it out,” said Jeffrey S. Kutcher, a doctor at the University of Michigan Medical School in Ann Arbor and a member of the academy. “You only get one brain; treat it well.”