By Ronnie Cohen
NEW YORK (Reuters Health) - Youths who suffer concussions may continue to have emotional problems after their physical symptoms wane, a new study suggests.
“The physical symptoms tend to start early and fade with time, while the emotional symptoms frequently have a delayed onset,” the study’s lead author, Dr. Matthew Eisenberg, told Reuters Health.
“Everyone thinks of headache, dizziness, nausea as concussive symptoms, but they’re not necessarily thinking of depression, frustration and these emotional symptoms,” he said. “It’s important to understand that it’s part of the normal healing process to have sleeping issues, irritability, changes in mood as well as difficulty concentrating and focusing.”
Eisenberg, an emergency physician at Boston Children’s Hospital, and his Harvard Medical School research team studied the course of concussions over three months in 235 patients between the ages of 11 and 22.
Lingering symptoms - from headaches and dizziness to difficulty thinking, irritability and frustration - persisted in 15 percent of those studied at the end of three months.
The research highlights the emotional as well as physical toll of blows to the head, researchers said.
U.S. emergency rooms treat more than 100,000 sports-related concussions a year in kids ages 19 and under, according to the Centers for Disease Control and Prevention.
Between 2005 and 2012, concussions among high school athletes became more common with every passing academic year, a previous study found (see Reuters Health story of May 7, 2014 here: http://reut.rs/QGpQIl).
Other studies also show a spike in high school concussions over the last decade, though researchers cannot tell if the hike reflects a real increase or an uptick in the count as a result of a growing awareness about concussions.
In the current study, when kids first arrived at the emergency room, they most frequently complained of headaches, fatigue, dizziness and taking longer to think. But emotional and cognitive symptoms, including disturbed sleep, frustration and forgetfulness, were the most likely to develop over the next three months.
One month after the injury, nearly one-quarter still suffered headaches, more than 20 percent experienced fatigue and almost 20 percent reported taking longer to think. Forgetfulness continued to affect 14 percent, and 17 percent complained of trouble concentrating, the authors write in Pediatrics.
Nearly 38 percent of those studied reported feeling frustrated one week after the concussion, and nearly 15 percent reported frustration one month after.
Eisenberg said he believes the findings offer guidance to patients, families, coaches, teachers and healthcare providers.
“It really hit home how big a burden a concussion can be on patients and on families,” he said. “I would certainly emphasize to families to watch out for the emotional symptoms - not sleeping, rapid mood swings or personality changes, irritability, depression and being deeply frustrated.”
The researchers could not tell whether the late-emerging emotional and cognitive symptoms resulted from the concussions themselves or from consequences stemming from the injury, like missing school or sports, Eisenberg said.
The findings may signal a need for some athletes to wait longer to return to their sports and regular school activities, Dr. Heidi Blume told Reuters Health. They should also help guide doctors in developing a recovery course following concussions.
Blume, a pediatric neurologist from Seattle Children’s Hospital and Research Institute in Washington, was not involved in the current research but has studied concussion symptoms. Though most U.S. states have passed laws to try to identify and bench students who have suffered concussions, athletes do play with symptoms, she said.
One recent study found more than half of high school athletes with concussions return to their sports despite symptoms (see Reuters Health story of March 14, 2014 here: http://reut.rs/1jYP5kR).
“There still are schools and teams and parents who say, ‘Just suck it up; I don’t understand why you’re still having problems,’” Blume said. “Some kids may need school accommodations, changes in school expectations, not taking tests as they’re recovering (or) altered school days.”
The study showed that 85 percent of concussion patients appeared to have fully recovered three months after their injuries, Blume noted. “The good news is that most kids do get better with time,” she said.
“But we are still struggling with trying to figure out which kids are going to have the most problems and what to do about it,” she said. “Certainly, sitting on the couch and doing nothing is not the answer, but going right back to all your activities is usually not the answer either. You need to give your brain time to recover.”
SOURCE: http://bit.ly/1or8Bth Pediatrics, online May 12, 2014.