Family psychiatric history a risk factor for PCS (6/13/19 newsletter)
We are pleased to have students from Carleton College interning with Concussion Alliance. Intern contributors this week:
Editor: Galen Moller
Contributors: Eloïse Cowan, Micalie Hunt, Hannah Kennicott, and Julian Szieff.
A video presentation by the Harborview Injury Prevention & Research Center (HIPRC), about school-based Return to Learn programs, is now available online. Monica Vavilala, MD, Director of HIRPC, describes her center’s collaborative effort to create the first evidence-based RTL protocols, focused on Washington State, with the goal to make it a national program. All 50 states have Return to Play (RTP) Laws, but only 12 states have Return to Learn (RTL) guidelines, as of June 2017. Across the United States, 47-77% of school districts don’t have RTL protocols. Laura Widdice, BSN, RN, NCSN, Director of Health Services for the Renton School District, is also a presenter in the video.
HIRPC is looking for Washington State high schools to pilot their Return to Learn (RTL) toolkit for the upcoming 2019-2020 school year. The RTL toolkit is an outgrowth of the RTL protocols being developed by the Harborview Injury Prevention & Research Center (HIPRC). The toolkit will “guide schools through defining an RTL policy that fits their local needs and is in alignment with current medical recommendations.” Designed by HIRPC, the tool kit will “include school staff education and clearly define the roles and responsibilities of school staff within each school when responding to and supporting a student with a concussion.”
A study published in PLOS ONE details some of the first efforts to collect data on sports-related injuries in 5-11 year-olds. In an interview for the University of South Florida, the head of the study, Dr. Karen Liller, explained that “For child athletes, many sports/recreational activities are not organized for reporting injuries, so almost no data for this group have been collected.” Liller and her researchers are taking the necessary first step to prevent injuries in young athletes by understanding the most common mechanisms of injuries in this demographic. Injuries occurred most frequently from colliding with other players, and contact with the playing apparatus or playing surfaces. Although the total injury rate was low, 46% of the injuries were concussions.
A study published in Health Affairs (Millwood) by Kevin F. Boehnke et al. examined comprehensive data regarding the reasons for medical cannabis usage in the United States. Trends showed that chronic pain was consistently, and historically the most prevalent qualifying condition for 67% of medical cannabis patients as of 2016. Their evidence indicates that cannabis is an effective therapy for 85.5% of the qualifying conditions reported by patients. However, the researchers also warn that they are using patient-reported data, their results likely underestimate the true usage among patients.
A study published in The Journal of Neurology, Neurosurgery, and Psychiatry by Lorenzo Gaetani, et al. identified the protein “neurofilament light chain” (NfL) as a biomarker that could be used for diagnostics. NfL levels in cerebrospinal fluid and blood directly correlate to axonal damage for many neurological disorders, including those caused by physical trauma, making it a promising means for assessing the severity of a TBI.
Mohammad N. Haider et al., from the State University of New York at Buffalo, sought to uncover a connection between performance on the Buffalo Concussion Treadmill Test (BCTT) and duration of recovery from sports-related concussion. The BCTT is used to identify the amount of aerobic exercise that a patient can safely perform before they reach their “heart rate threshold” (HRt), or the point where exercise makes their symptoms worse. In patients who were prescribed relative rest or a stretching program, the difference between their HRt and resting heart rate correlated with their duration of clinical recovery. However, this correlation did not occur in patients who were prescribed sub-threshold aerobic exercise. The researchers postulate that the BCTT could not predict recovery time for the exercise group since aerobic exercise treatment reduced their recovery time. Their study was published in Frontiers in Neurology.
The University of Oregon has seen considerable success in treating and supporting youth concussions with its six-member interdisciplinary Youth Concussion Management Team. This team was created three years ago and includes a neuropsychologist, a sports medicine specialist, a psychologist, a physical therapist with a balance and dizziness specialization, a doctoral student, and a team leader from the Concussion Clinic at the University of Oregon. In addition to appropriately treating different concussion symptoms, the team’s multidisciplinary expertise allows them to support children through the social pressures of school, family, and extracurriculars. As a patient recovers, the team reaches out to the school and works with them to support return to school, sports, etc, according to an article in Medical Express.
A recent study published in the journal JAMA Neurology found that use of a cholesterol-reducing statin can reduce the risk of developing post-concussion dementia in older adults (median age 76 years). The authors Donald A. Redelmeier, MD, MSHSR, et al. found that if a statin was prescribed within 90 days of sustaining a concussion, dementia risk was lowered by 13%.
In a video of her presentation at UW Medicine/Gonzaga University, researcher Christine MacDonald Ph.D. shares several important discoveries about the impact of combat concussions on mental health. The EVOLVE study, for which she is the lead researcher, found that those who suffer combat concussions worsen over the course of their 1-year and 5-year follow-ups; 80% seek mental health assistance by the 5-year follow-up, and only 19% achieve a “sustained resolution of their symptoms.” The service members had blast or non-blast related concussions, but none had more complex or severe brain injuries. READ MORE ON OUR BLOG POST.
In a recent study, Legarreta, A. D., et al. examined the role of family and personal psychiatric history in the risk of developing post-concussion syndrome (PCS). Using a retrospective study of 154 high school athletes, the authors found that concussed high school athletes with family psychiatric history (FPH) and personal psychiatric history (PPH) were greater than 5 times more likely to develop PCS than controls. Athletes with only FPH were over 2.5 times more likely to develop PCS than controls. Those with an FPH of anxiety or bipolar disorder are specifically at increased risk of PCS. The study suggests the importance of taking psychiatric history into account when undergoing treatment for, or managing, a concussion. It was published in the Journal of Neurosurgery.
The Center for Disease Control and Prevention recently updated the statistics regarding TBI-related emergency department visits, hospitalizations, and deaths (abbreviated EDHDs). There were 2.87 million TBI-related EDHDs in 2014, a 53% increase from 2006. Around 837,000 of these EDHDs occurred among children.
Concussion Alliance co-founder Malayka Gormally