LETTER RE: Medical retirement from sport after concussions: A practical guide for a difficult discussion
Nitin K.Sethi, Associate Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY U.S.A.
Published March 15, 2018
I read with interest Davis-Hayes et al. suggested algorithm to help guide medical retirement from sport discussion after an athlete suffers a single or multiple sports-related concussions (SRC). [1] The authors are to be lauded for attempting to standardize this decision-making process. The decision to medically disqualify and retire a professional athlete from his or her chosen sport is not to be made lightly for it threatens the livelihood of not just the athlete but the entire family. Both the physician and the athlete have to make tough decisions about the athlete’s future brain health in the absence of any validated biofluid (blood, CSF) or imaging biomarker for concussion and late-life neuropsychiatric sequelae of brain injury such as chronic traumatic encephalopathy (CTE), dementia pugilistica, chronic post-concussion syndrome, chronic neurocognitive impairment, posttraumatic dementia, posttraumatic cognitive impairment, posttraumatic Parkinsonism and persistent posttraumatic headaches. One size does not fit all. Risk stratification is the process of identifying the individual athlete’s risk of suffering from the above mentioned late-life neuropsychiatric sequelae of brain injury after careful review of history and other clinical and imaging tests. Some professional athletes may warrant medical disqualification or denial of licensure (if combat sports) and others may be medically cleared to return to sport (RTS) under supervision. Lastly the authors use the terms of “immediate epilepsy” interchangeably with “impact seizures”. This should be avoided since impact seizures differ in their pathophysiology and prognosis from immediate epilepsy/early post-traumatic epilepsy. It would also be helpful to the readers if the authors define how they differentiate “impact seizures” from “concussive convulsions” (including fencing and other tonic postures).
Reference
1. Davis-Hayes C, Baker DR, Bottiglieri TS, Levine WN, Desai N, Gossett JD, Noble JM. Medical retirement from sport after concussions: A practical guide for a difficult discussion. Neurol Clin Pract. 2018; 8:40-47.
I read with interest Davis-Hayes et al. suggested algorithm to help guide medical retirement from sport discussion after an athlete suffers a single or multiple sports-related concussions (SRC). [1] The authors are to be lauded for attempting to standardize this decision-making process. The decision to medically disqualify and retire a professional athlete from his or her chosen sport is not to be made lightly for it threatens the livelihood of not just the athlete but the entire family. Both the physician and the athlete have to make tough decisions about the athlete’s future brain health in the absence of any validated biofluid (blood, CSF) or imaging biomarker for concussion and late-life neuropsychiatric sequelae of brain injury such as chronic traumatic encephalopathy (CTE), dementia pugilistica, chronic post-concussion syndrome, chronic neurocognitive impairment, posttraumatic dementia, posttraumatic cognitive impairment, posttraumatic Parkinsonism and persistent posttraumatic headaches. One size does not fit all. Risk stratification is the process of identifying the individual athlete’s risk of suffering from the above mentioned late-life neuropsychiatric sequelae of brain injury after careful review of history and other clinical and imaging tests. Some professional athletes may warrant medical disqualification or denial of licensure (if combat sports) and others may be medically cleared to return to sport (RTS) under supervision. Lastly the authors use the terms of “immediate epilepsy” interchangeably with “impact seizures”. This should be avoided since impact seizures differ in their pathophysiology and prognosis from immediate epilepsy/early post-traumatic epilepsy. It would also be helpful to the readers if the authors define how they differentiate “impact seizures” from “concussive convulsions” (including fencing and other tonic postures).
Reference
1. Davis-Hayes C, Baker DR, Bottiglieri TS, Levine WN, Desai N, Gossett JD, Noble JM. Medical retirement from sport after concussions: A practical guide for a difficult discussion. Neurol Clin Pract. 2018; 8:40-47.