In the Journals

Brain injury from concussion can last a year after returning to play

Photo of Nathan W. Churchill
Nathan W. Churchill

Athletes may not be fully recovered from a concussion 1 year after being cleared to return to play, according to a study published in Neurology, the medical journal of the American Academy of Neurology.

“Our study findings tell us that brain recovery after concussion may be a more complex and long-lasting process than originally thought,” Nathan W. Churchill, PhD, post-doctoral fellow at St. Michael's Hospital in Toronto, Canada, told Healio Primary Care. “In particular, brain changes after sport-related concussion appear to last well beyond medical clearance to return to play, even for athletes showing a relatively normal course of recovery.”

To evaluate brain injury after returning to play, researchers conducted an observational study of athletes with concussion. Patients underwent multiple MRI scans for up to 1 year after returning to play. A control group of athletes without concussions were scanned at the start of their sport’s competitive season.

A total of 146 athletes, 24 with concussion, were included in the study.

Concussion Examination 
Athletes may not be fully recovered from a concussion 1 year after being cleared to return to play, according to a study published in Neurology, the medical journal of the American Academy of Neurology.
Source: Shutterstock

Researchers found that patients with concussion who returned to play had significantly reduced blood flow in the brain a year later, with an average decrease of 10 mL per 100 g of blood per minute compared with athletes who did not have concussion. Participants with concussion also showed signs of tissue swelling 1 year after return to play.

However, not all aspects of brain physiology were affected after 1 year — signs of brain connectivity were normal in athletes with concussion a year after return to play.

The long-term effects of concussion on the brain varied depending on the severity of symptoms and how long an athlete took to return to play, according to the researchers. As athletes in the study who had more severe symptoms and took longer to return to play were more likely to have long-term brain injury, Churchill noted that the findings indicate that brain recovery for these athletes could take longer than current guidelines for medical clearance suggest.

Currently, the American Academy of Pediatrics recommends that no athletes should be allowed to return to play on the same day as the injury, and athletes should not be allowed to return to contact, collision or high-risk activities until symptoms of the concussion have resolved. Last year, the CDC also issued new guidelines for physicians in diagnosing, treating and estimating the prognosis of mild traumatic brain injury in children.

Churchill noted that more research is needed to understand the long-term effects of the brain changes identified in the study and whether they could lead to more health issues in athletes who sustain a second concussion before their brain recovers from the first.

“Our findings are part of a growing consensus that the effects of concussion on the brain may be longer-lasting than previously thought, and likely persist beyond symptom resolution,” Churchill said. “As the timeline of biological recovery is still not completely known, we would suggest that some caution is warranted, and individuals should not rush to return to activities if there is some uncertainty regarding recovery.” – by Erin Michael

Disclosures: The authors report no relevant financial disclosures.

Photo of Nathan W. Churchill
Nathan W. Churchill

Athletes may not be fully recovered from a concussion 1 year after being cleared to return to play, according to a study published in Neurology, the medical journal of the American Academy of Neurology.

“Our study findings tell us that brain recovery after concussion may be a more complex and long-lasting process than originally thought,” Nathan W. Churchill, PhD, post-doctoral fellow at St. Michael's Hospital in Toronto, Canada, told Healio Primary Care. “In particular, brain changes after sport-related concussion appear to last well beyond medical clearance to return to play, even for athletes showing a relatively normal course of recovery.”

To evaluate brain injury after returning to play, researchers conducted an observational study of athletes with concussion. Patients underwent multiple MRI scans for up to 1 year after returning to play. A control group of athletes without concussions were scanned at the start of their sport’s competitive season.

A total of 146 athletes, 24 with concussion, were included in the study.

Concussion Examination 
Athletes may not be fully recovered from a concussion 1 year after being cleared to return to play, according to a study published in Neurology, the medical journal of the American Academy of Neurology.
Source: Shutterstock

Researchers found that patients with concussion who returned to play had significantly reduced blood flow in the brain a year later, with an average decrease of 10 mL per 100 g of blood per minute compared with athletes who did not have concussion. Participants with concussion also showed signs of tissue swelling 1 year after return to play.

However, not all aspects of brain physiology were affected after 1 year — signs of brain connectivity were normal in athletes with concussion a year after return to play.

The long-term effects of concussion on the brain varied depending on the severity of symptoms and how long an athlete took to return to play, according to the researchers. As athletes in the study who had more severe symptoms and took longer to return to play were more likely to have long-term brain injury, Churchill noted that the findings indicate that brain recovery for these athletes could take longer than current guidelines for medical clearance suggest.

Currently, the American Academy of Pediatrics recommends that no athletes should be allowed to return to play on the same day as the injury, and athletes should not be allowed to return to contact, collision or high-risk activities until symptoms of the concussion have resolved. Last year, the CDC also issued new guidelines for physicians in diagnosing, treating and estimating the prognosis of mild traumatic brain injury in children.

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Churchill noted that more research is needed to understand the long-term effects of the brain changes identified in the study and whether they could lead to more health issues in athletes who sustain a second concussion before their brain recovers from the first.

“Our findings are part of a growing consensus that the effects of concussion on the brain may be longer-lasting than previously thought, and likely persist beyond symptom resolution,” Churchill said. “As the timeline of biological recovery is still not completely known, we would suggest that some caution is warranted, and individuals should not rush to return to activities if there is some uncertainty regarding recovery.” – by Erin Michael

Disclosures: The authors report no relevant financial disclosures.