Only a doctor can determine when an athlete can return post-concussion

This article claims that only doctors can help determine when a player returns to play post-concussion.

An editorial published today in The Lancet Neurology calls for sports authorities to take into consideration the long term neurological problems that repeated concussions can cause.

Cerebral concussion is the most common form of sports-related traumatic brain injury (TBI), and the long-term effects of repeated concussions may include dementia, amyotrophic lateral sclerosis, and other neurological disorders, say the journal editors.

However, what is perhaps more concerning, is that even when the symptoms of concussion are delayed, or if they come and go quickly, neurological damage can remain without detection. This can lead to footballers, such as Uruguayan defender Álvaro Pereira during the 2014 FIFA World Cup, overruling doctors' advice to be substituted and returning to play after sustaining a head injury.

The journal editors argue that the decision for players to return to a game after sustaining a concussion should be made only by healthcare professionals, and "should surely be taken out of the hands of those with a vested interest in the player's performance."

According to the journal editors, "Many sporting organisations now acknowledge the potentially serious consequences of mild TBI and have drawn up new protocols to protect athletes who sustain a head injury'. However FIFPro, the world players' union, has called for an investigation of concussion protocols and return-to-play standards following Pereira's injury."

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Do doctors have an obligation to protect athletes from concussions?

This article discusses if doctors have an ethical obligation to teach and protect athletes from concussions.

The American Academy of Neurology (AAN), the largest professional association of neurologists and a leading authority on sports concussion, is releasing a new position paper that states doctors have an ethical obligation to educate and protect athletes from sports concussion and clear them to play only when the athlete is medically ready, standing firm against objections from players, parents or coaches. The statement is published in the July 9, 2014, online issue of Neurology®, the medical journal of the AAN, and is being released ahead of The Sports Concussion Conference, July 11-13, 2014, in Chicago, where the AAN will share the latest scientific advances in diagnosing and treating sports concussion.

The AAN position statement calls for doctors to safeguard the future mental and physical health of athletes as a top priority, especially regarding return-to-play decision-making. Physicians also must educate patients and their families about the dangers of concussion in all relevant sports, according to the statement.

The Academy has spent several years analyzing all of the available research and ethical issues to develop this official position paper, which corresponds with the AAN's guideline on sports concussion.

"With nearly four million sports-related concussions in the US each year, it is imperative doctors are educated and protect these athletes who may have sustained a concussion," said lead author Matthew P. Kirschen, MD, PhD, a neurologist with The Children's Hospital of Philadelphia and a member of the American Academy of Neurology. "Concussions can have devastating effects such as short-term impairments in athletes' cognitive and athletic performance. Repeat concussions have been linked to long-term impairments in brain function, such as problems with learning, memory and behavior."

The statement also:

• Supports wider use of baseline cognitive testing

• Recommends that concussion evaluation and management training be added to neurology residency programs

• Suggests the development of a national concussion registry with mandatory reporting, which may help to document more rigorously the incidence and recurrence of concussion at all levels of play

Ethically, the statement concludes that physicians caring for athletes during and after a sports-related concussion should have adequate training and experience in the recognition and evaluation of both the existence and severity of potential brain injury.

"These strategies could help identify the threshold at which the number and severity of head injuries leads to irreversible brain injury. They may also help to clarify how concussion risk varies with factors like age, gender, puberty stage and ethnicity so athletes and parents can make informed decisions about playing contact sports," said Kirschen.

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Tips for living with epilepsy

This article discusses five tips that are helpful for those living with epilepsy.

For people with epilepsy, the onset of recurring seizures can be frightening. While many people with the condition live full and active lives, including driving a vehicle, working outside the home and playing sports, it may be necessary to make some lifestyle changes.

“The goal is to make sure the patient is seizure free with minimal side effects,” says Shaila Gowda, M.D., director, Epilepsy Program, Beaumont Hospital, Royal Oak. “Avoiding seizure triggers such as lack of sleep, alcohol and stress will help.”

In addition to following a supervised treatment plan with medication, it’s just as important to establish good habits to manage or avoid seizures. Once triggers have been identified, exposure can be limited.

According to the Epilepsy Foundation, epilepsy and seizures affect more than 2 million Americans of all ages. Nearly 200,000 new cases occur each year.

Epilepsy is a brain disorder. When clusters of brain nerve cells, or neurons, signal abnormally they can cause unusual sensations, emotions and behavior; or convulsions, muscle spasms, seizures and loss of consciousness. Epilepsy can have many causes including illness, brain damage and abnormal brain development.

Dr. Gowda provides 5 helpful tips to follow when living with epilepsy:

Keep a healthy diet

A balanced diet should consist of a wide variety of carbohydrates, fats and proteins. Yet, there are some foods and beverages that should be avoided as they may trigger or worsen seizures. Foods with monosodium glutamate, the food additive commonly known as MSG, is an “excitatory neurotransmitter” meaning it is a brain stimulant which can increase the severity of the seizure. Other foods and beverages with stimulants, like caffeine, should also be avoided. Dr. Gowda explains that an occasional drink will not cause a seizure, but prolonged alcohol consumption should be avoided. “Studies suggest that alcohol withdrawal seizures most often occur seven hours after heavy drinking has stopped,” explains Dr. Gowda.

Get to bed

Poor sleep habits can lead to increased frequency of seizures. It’s important to get seven to nine hours of restful sleep each night. But, getting too much sleep is not good either. If you are feeling drowsy and not feeling energized during the day, make sure you’re not experiencing side effects of the medication. Discuss the dosage with your physician. “Sometimes, if not diagnosed properly, sleep issues get dismissed as part of epilepsy,” says Dr. Gowda.

Exercise regularly

Those with epilepsy can experience fatigue and symptoms of depression. Getting regular, moderate amounts of exercise will improve overall physical health and fitness. An added benefit of exercise is that it indirectly boosts self-esteem – keeping mood disorders and depression at bay.

Manage your stress

While it’s important to learn how to handle stress on a regular basis, excessive stress in never a good thing. Undue stress increases hormones which have been shown to cause seizures. “To avoid getting overwhelmed, create an agenda of daily activities and prioritize tasks. It is important to keep some time aside for relaxation at the end of each day,” advises Dr. Gowda.

Choose the right doctor 

Find a doctor who specializes in epilepsy. Those with epilepsy should be able to discuss any concerns freely, and work together with an expert to find a treatment program that works for them. People with epilepsy who understand their condition will be able to make informed decisions about lifestyle changes that are needed.

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