A Heads-Up Warning on Concussion

High School Athletes Vulnerable to Cumulative Effects

From the WebMD Archives

Oct. 30, 2002 -- Each year, more than 64,000 high school athletes in the U.S. suffer a concussion while playing sports, including one in five football players. And with each incidence, they may be more susceptible to injuries from even mild future hits, suggests a new study.

Researchers found that concussion appears to have an additive effect on injured high school athletes, with the greatest risk to players who had have at least three jarring injuries to their brains. Those athletes were nine times more likely than other athletes to have symptoms of concussion.

"Preliminary data suggests that the developing brains of high school athletes are more vulnerable to concussion than a more mature brain," says lead researcher Micky Collins, PhD, of the University of Pittsburgh Medical Center's Sports Medicine Concussion Program. "Concussion is a very common injury on the high school level, but the issue is generally given little attention and is not well understood."

For instance, many people don't realize that loss of consciousness is not necessarily the only symptom of a concussion. "Headache, dizziness, personality changes, difficulty with memory, or feeling foggy, distracted, or fatigued are all subtle symptoms," Collins tells WebMD. "Parents need to be aware of these subtle symptoms in the days following a suspected concussion. If a high school athlete who had a concussion is returned to play while still recovering, that's when you're going down a road you don't want to."

Generally, he says, most athletes who suffer an initial concussion can completely recover as long as they don't return to contact sports too soon.

His study examined data on 88 athletes -- most of them football players -- in five states and compared the severity of symptoms after a new concussion in athletes with and without a history of prior concussions. Athletes with three or more prior concussions were 9 times more likely to have at least three of the four symptoms typically associated with concussion. These symptoms include loss of consciousness, inability to recall events that occurred before the injury, inability to recall events after the injury, and confusion.

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"The study indicates for the first time in the high school athlete population that prior concussions may indeed lower the threshold for subsequent concussions injury and increase symptoms severity," Collins says in a news release.

The long-term effects have not been studied, but multiple concussions may increase later risk of Alzheimer's, Parkinson's, and other conditions affecting brain function, Collins says.

Collins' study, which he says is the first published report on the outcomes of concussions among high school athletes, appears in the November issue of the journal Neurosurgery.

"While football poses the greatest risk, concussion also frequently occurs among high school athletes playing soccer, wrestling, and basketball," he tells WebMD.

Several measures are under way to try to reduce risks among young athletes. A new football helmet, specifically designed to protect against concussion, is being evaluated in another study conducted by Collins' team.

His group also has designed a computer program, called ImPACT, that is now used by more than 200 high schools in the nation as well as nine NFL franchises and other professional sports teams. This program, which costs a high school $995, is used to measure aspects of brain function sensitive to concussion both preseason and when a suspected injury occurs.

"If a player sustains a concussion, you can administer a 20-minute test on those functions and compare them to the earlier, preseason results," Collins tells WebMD. "If they fail, they don't go back to play."

Although it's not uncommon for players to have several concussions while in high school, Collins says it is difficult for school officials to issue policies that restrict their play. "We don't know how many concussions in high school are too many, because up until now, the issue hasn't been studied. Until we come up with good data to direct those management directives, policies are very arbitrary." There is no concussion "quota" in the NFL or in other professional sports, either, although several athletes have retired after suffering numerous concussions.

"What it comes down to is if you have a single concussion and the brain is allowed to recover completely, there shouldn't be any long-term effects," he says. "But if you have a concussion and the athlete returns to play before the recovery process has been complete, then the athlete is at increased risk."

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