Effects of repetitive head trauma on symptomatology of subsequent sport-related concussion

Abstract

OBJECTIVE Adolescent participation in athletics continues to grow, leading to an increasing incidence of sports-related concussion (SRC). The current literature suggests that a greater number of prior concussions positively correlates with a greater number of total symptoms, but the specific concussion-related symptoms are not as well defined. The current study investigated the effects of prior recurrent head injury on the symptom profiles of student-athletes after another suspected concussion. METHODS A multicenter database consisting of 25,815 Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) results was filtered for student-athletes aged 12–22 years old who competed in 21 different sports. Patients were separated into 2 cohorts: athletes reporting a single prior concussion (SRC1) and athletes reporting 2 or more prior concussions (SRC2+). Comparisons were assessed for differences in 22 symptoms and 4 symptom clusters at baseline, first postinjury test (PI1), and second postinjury test (PI2) by using univariate and multivariate analyses. RESULTS No differences were seen between SRC1 (n = 2253) and SRC2+ (n = 976) at baseline. At PI1, the SRC2+ group (n = 286) had lower severity of headaches (p = 0.04) but increased nervousness (p = 0.042), irritability (p = 0.028), sadness (p = 0.028), visual problems (p = 0.04), and neuropsychiatric symptoms (p = 0.009) compared with SRC1 (n = 529). Multivariate analysis revealed decreased headache severity with increased prior concussion (β = −0.27,95% CI −0.45 to −0.09, p = 0.003). Multivariate analysis at PI2 demonstrated the SRC2+ cohort (n = 130) had increased cognitive (β = 1.22, 95% CI 0.27–2.18, p = 0.012), sleep (β = 0.63, 95% CI 0.17–1.08, p = 0.007), and neuropsychiatric (β = 0.67,95% CI 0.14–1.2,0.014) symptoms compared with SRC1 (n = 292). CONCLUSIONS At longitudinal follow-up, patients with a history of recurrent concussions reported greater symptom burden in cognitive, sleep, and neuropsychiatric symptom clusters but not migraine symptoms. This is an important distinction because migraine symptoms are often more easily distinguishable to patients, parents, and physicians. Careful assessment of specific symptoms should be considered in patients with a history of recurrent head injury prior to return to play.

Recent insights from non-mammalian models of brain injuries: an emerging literature

“…Recent studies underscored the accumulating nature of symptoms in adolescents with repeated concussions, with higher symptom scores observed after the second concussion compared to the initial one ( 72 ). Following a second concussion, patients reported an increased burden of neuropsychiatric symptoms, particularly in cognitive, sleep, and neuropsychiatric domains ( 73 ). Collectively, these studies emphasize the importance of considering the cumulative effects of repeated head injuries , with potential long-term consequences on brain structure, function, and behavior.…”

Maximizing the Clinical Value of Blood-Based Biomarkers for Mild Traumatic Brain Injury

“…These symptoms as well as the neuropsychological assessments previously mentioned are used for clinical management, while physiological change after sports-related concussion can be analyzed in a research context using the neuroimaging techniques previously discussed. Also warranting attention is the increased risk of longterm consequences with a history of repetitive trauma to the head, which is seen in athletes who compete over the years and thus put themselves at risk of multiple concussions [54].…”

Neurite orientation dispersion and density imaging reveals abnormal white matter and glymphatic function in active young boxers

“…However, these events have a cumulative impact that defies quantification and are believed to contribute to the development of chronic traumatic encephalopathy (Gallo et al., 2020; Pearce et al., 2020). Consequently, SRC frequently results in severe sequelae such as somatic symptoms (e.g., headache, dizziness, vestibular and oculomotor dysfunction, and fatigue) (Harris et al., 2022; Quinones et al., 2023), cognitive deficits (Teng et al., 2022), and psychomotor impairment (Ellis et al., 2015). Although most cases resolve within a few weeks of injury onset, some athletes may experience persistent symptoms lasting for months or even years.…”