The Effects of Sex Differences and Hormonal Contraception on Outcomes after Collegiate Sports-Related Concussion

Gallagher, Virginia T.; Kramer, Natalie A.; Abbott, Kristin; Alexander, John T.; Breiter, Hans C.; Herrold, Amy A.; Lindley, Tory; Mjaanes, Jeffrey M.; Reilly, James L.

doi:10.1089/neu.2017.5453

Cited by 76 publications

(64 citation statements)

References 44 publications

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“…Previous studies commonly report increased SRC incidence in female contact sports when compared to males, which was not supported by our present data. In addition, females typically fare worse than males after SRC . Both initial symptoms and duration of symptom are commonly worse, findings supported by our present study.…”

Section: Discussionsupporting

confidence: 89%

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Concussion incidence and recovery in Swedish elite soccer — Prolonged recovery in female players

Vedung

Hänni

Tegner

et al. 2020

Scandinavian Med Sci Sports

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Objectives Sport‐related concussions are an increasingly recognized health problem. Soccer is the most popular sport in the world although recent studies on concussion incidence are scarce. Here, a nationwide prospective study on concussion incidence, symptom severity, risk factors, gender differences, and return‐to‐play after concussion was performed in 51 Swedish elite soccer teams during the 2017 season. Methods In the 1st and 2nd soccer leagues for men and women, a Sport Concussion Assessment Tool (SCAT)‐based questionnaire study was performed at preseason (baseline) and from 48 hours to 3 months post‐concussion. Results We followed 959 players (389 women, 570 men) for 25 146 player game hours (9867 hours for women, 15 279 hours for men). Concussion incidence (n = 36 concussions during the season) was 1.19/1000 player game hours (females 1.22/1000 hours, males 1.18/1000 hours; P = .85). Twenty‐seven percent of all players (8% of females, 40% of males) continued to play immediately after the concussion. When compared to male players, female players had worse initial symptom severity scores (median and IQR 30 (17‐50.5) vs 11 (4‐26.25), P = .02) on SCAT and longer return‐to‐play (P = .02). Risk factors for concussion were baseline symptoms and previous concussion. Conclusion In Swedish elite soccer, the concussion incidence was 1.19/1000 without gender differences. Most players recovered to play within 4 weeks post‐injury. Almost one third of players continued to play at time of concussion. Female players had worse initial symptoms and longer return‐to‐play time than males, and a prolonged recovery beyond 3 months was only observed among female players.

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Section: Discussionsupporting

confidence: 89%

“…In addition, females typically fare worse than males after SRC. [36][37][38] Both initial symptoms and duration of symptom are commonly worse, 36 findings supported by our present study. The reasons for this gender difference are not established, although less neck muscle strength or biomechanical factors have been suggested.…”

supporting

confidence: 87%

Concussion incidence and recovery in Swedish elite soccer — Prolonged recovery in female players

Vedung

Hänni

Tegner

et al. 2020

Scandinavian Med Sci Sports

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“…However, a meta‐analysis of animal neuroscience research concluded that female mice displayed no more variability than males, and emphasized the suitability of their inclusion (Prendergast, Onishi, & Zucker, ). Using only male animals disregards the diverse response in outcome of mTBI in males and females (Gallagher et al, ). In the reviewed studies comparing sex differences in mTBI, differences were seen in male and female prefrontal cortex atrophy; white matter integrity in the corpus callosum; microglial activation; brain mRNA expression of GFAP, MBP, and tau; short‐term working memory; depressive‐like behavior; and social interaction (Hehar, Yu, Ma, & Mychasiuk, ; Mychasiuk, Hehar, et al, ; Wright, O'Brien, Shultz, & Mychasiuk, ; Yamakawa, Lengkeek, et al, ).…”

Section: Discussionmentioning

confidence: 99%

Modeling sports‐related mild traumatic brain injury in animals—A systematic review

Hiskens

Angoa‐Pérez

Schneiders

et al. 2019

J of Neuroscience Research

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Sports-related head trauma has emerged as an important public health issue, as mild traumatic brain injuries (mTBIs) may result in neurodegenerative disorders such as chronic traumatic encephalopathy (CTE). Research into mTBI and CTE pathophysiology are difficult to undertake in athletes, with observational trials and post-mortem analysis the current mainstays. Thus, animal models play an important role in the study of mTBI, however, traditional animal models have focused on acute, severe injuries rather than the more typical mTBI's seen in sport injuries. Recently, a number of animal models have been developed that are both appropriately scaled and biomechanically relevant to the forces sustained by athletes. This review aimed to examine the literature for variables included in these animal models, and the resulting neurotrauma as evidenced by pathology and behavioral deficits. A systematic search of the literature was performed in multiple electronic databases. The inclusion criteria required mimicry of athlete mTBI conditions: freedom of head movement, lack of surgical alteration of the skull, and application of direct contact force. Studies were analyzed for variables including apparatus design features (impact force, change in animal head velocity, and kinetic energy transfer to the head), demonstrated pathology (phosphorylated tau, TDP-43 aggregation, diffuse axonal injury, gliosis, cytokine inflammation response, and genetic integrity), and behavioral changes. These studies suggested that appropriate animal models can assist in understanding the pathological and functional outcomes of athlete mTBI, and could be used as a platform for future studies of diagnostic/prognostic markers and in the development of treatment interventions. K E Y W O R D S animal models, chronic traumatic encephalopathy, concussion, neurotrauma | INTRODUC TI ONAthlete head impacts continue to attract significant media and research attention with sports such as soccer, football, ice hockey, lacrosse, and rugby displaying significant rates of head injury in American high school and collegiate athletes O'Connor et al., 2017). These impacts occur across a continuum of severity; from injuries resulting in unconsciousness and requiring the athlete to be assisted on the field, to contact with no immediate observable consequences, such as heading a soccer ball. The nature of many of these sports predicates that head impacts are not sustained in isolation, but are often an intrinsic by-product of the rules of the sport, and as such are repetitively sustained across a match | 1195 HISKENS Et al.

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“…We recently reported that collegiate female athletes on hormonal contraceptives had significantly lower post-concussive symptom severity than females not on hormonal contraceptives 6 . Others have shown that menstrual cycle phase and contraceptive use at time of mTBI differentially affects post-concussive symptoms and quality of life one-month post-injury 13 .…”

Section: Introductionmentioning

confidence: 95%

“…However, this research has been conducted almost entirely among males 5 . Studying female athletes is crucial because evidence suggests adolescent females are more vulnerable to injury, experience a greater number of injuries and longer recovery from mTBI relative to males 6–9 . The limited mTBI studies that have included females, have not examined or controlled for female-specific factors such as contraceptive use, hormonal fluctuations, or menstrual cycle (MC) phase at time of injury or assessment 5,10–12 .…”

Section: Introductionmentioning

confidence: 99%

Implementing an algorithm for controlling for female MC phase for clinical neuroscience

Herrold¹,

Gallagher

Chen

et al. 2020

Preprint

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Background: Recent research suggests that hormones and/or menstrual cycle (MC) phase at time of study may significantly affect clinical neuroscience outcomes of interest.Prior research puts forth sound methods for characterizing MC phase in women not using hormonal contraceptives (HC). However, an estimated 40% of premenopausal women in the United States use some form of HC. We developed an algorithm for characterizing hormone levels and MC phase among women both using and not using HC. We have employed this algorithm among female collegiate athletes post-mild traumatic brain injury (mTBI) as female athletes are understudied in the sports mTBI field, MC phase may have important effects on mTBI-related outcomes and controlling for MC phase has not been employed in this population. Methods: Thirty female collegiate athletes were studied. Fifteen incurred a mTBI 3-10 days prior to assessment and sixteen were age, ethnicity, and menstrual cycle (MC) phase matched to the injured athletes. MC matching was conducted with retrospective and prospective self-report MC tracking, self-report of HC use, and serum progesterone testing. Results: 53% (16/30) of females were on HC and 47% (14/30) were not. Of the non-HC users, seven female pairs were in the follicular and one was in the luteal phase. Among the non-HC users, there was 50% agreement in MC phase identification between self-report and progesterone measures and a κ = 0.138. Of the HC users, eight were in the inactive and six were in the active phase of their medication. Among the HC users, average progesterone levels indicated medication compliance (.58ng/mL). Conclusions: This study provides important methodology and proof-of-concept that MC phase can be used as a control variable for time-sensitive prospective clinical neuroscience studies including those involving brain injury. When studying females, it is important to properly

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The Effects of Sex Differences and Hormonal Contraception on Outcomes after Collegiate Sports-Related Concussion

Cited by 76 publications

References 44 publications

Concussion incidence and recovery in Swedish elite soccer — Prolonged recovery in female players

Concussion incidence and recovery in Swedish elite soccer — Prolonged recovery in female players

Modeling sports‐related mild traumatic brain injury in animals—A systematic review

Implementing an algorithm for controlling for female MC phase for clinical neuroscience

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