Background: There are multiple subtypes identified in patients with Persistent Post Concussion symptoms (PPCS) in young athletes including mood subtype that is traditionally believed to be in higher incidence with PPCS. Although there may be an association of poor mood symptoms with worse PPCS outcomes, empirical analysis of patients’ mood symptoms and the duration of PPCS is scant. By better understanding the incidence of mood symptoms in pediatric PPCS, we may uncover other primary causes of ongoing brain dysfunction. Purpose: To explore the relationship between mood-symptom severity and the duration of PPCS. Methods: A retrospective cohort study of pediatric PPCS patients (age < 18 years) treated at private concussion clinic in Tucson, AZ between 7/2018 to 7/2019. Based on written questionnaires completed by patients at office visits, patients were assigned a mood and anxiety score between 0 and 3, with 0 being the least severe and 1 being the most severe. Patients were also classified into stages 1 through 4 based on PPCS duration (see table). [Table: see text] Results: Data from 59 pediatric patients (ages ranged from 7 to 17 with a mean age of 13.9, 33:26 female to male) were included. ANOVA yielded p-value of 0.94. Average (mean) mood and anxiety scores for each PPCS substage were as follows: 0.9 for stage 1 (n=23); 0.8 for stage 2 (n=18); 0.8 for stage 3 (n=13); 0.6 for stage 4 (n=5). Conclusion: Our review data showed no significance between PPCS stages in regard to average self-reported mood symptoms. Contrary to traditional thinking this preliminary data in pediatric athletes illustrates that mood severity does not increase with increasing PPCS stage. This may suggest that other domains such as migraine or vestibulocular dysfunction may be the primary source of ongoing symptoms.
Background: Persistent post-concussion symptoms (PPCS) encompasses a broad spectrum of mood and cognitive impairments related to traumatic brain injury from sport activities. There has been limited studies conducted on determining the significance of quantitative EEG (qEEG) testing in the pediatric population. Hence, investigations on P300 evoked potential patterns may provide insight on PPCS course, prognosis, and management. Purpose: The purpose of this study is to identify possible P300 evoked potential voltage trends in PPCS pediatric patients. Methods: A retrospective study of pediatric patients with PPCS (defined as symptoms greater than one month) from 7/2018 to 12/2019 at a private concussion clinic in Tucson, AZ. Patients were excluded if they had a history of learning disorders, seizure disorder, or complex concussions with a skull fracture or intracranial hemorrhage, or no qEEG data. Patients were tested between 6-12 weeks post injury using the standard oddball audio P300 EEG protocol and measures extracted included P300 voltage. Patients were further classified into substages of PPCS (1: 1-3 months; 2: 3-6 months; 3: 6-12 months; 4: 12-36 months) to compare mean P300 voltage score among stages. Results: We identified 33 pediatric patients (age 8-21) with available qEEG data. 10 patients were in stage 1; 12 in stage 2; 8 in stage 3; and 3 in stage 4. Stage 1 group had an average P300 voltage of 17.4μV. Stage 2 group had an average of 10.9μV. Stage 3 group had an average of 13μV. Stage 4 group had an average of 10.3μV. There was a significant difference in the average P300 voltage seen in PPCS symptoms duration less than 3 months compared to 3 months or longer (p=0.018). Conclusion: There is a potential trend in declining P300 voltage with progressive PPCS stage. Our data suggests that chronic cognitive dysfunction represented by reduced P300 voltage may be most common in PPCS durations that are beyond 3 months. Future studies are needed to further validate this initial finding and to identify the significance of voltage patterns in concussion prognosis and management.
Background: Oculomotor and visual processing deficits occur commonly after brain injury in young athletes. A subset of these concussed athletes do experience prolonged recoveries or PPCS with ongoing oculomotor deficits and visual symptoms. There have been limited studies conducted to determine the significance of oculomotor tracking (OMT) testing in the pediatric population, and even less investigating the role of microsaccades. Hence, investigations on microsaccades(MS), physiological adjustive micro eye movements critical in visual processing and central/peripheral visual integration, may provide insight on the role of visual dysfunction in PPCS course, prognosis, and management. Purpose: The purpose of this study is to identify possible MS rate trends and differences between early and late stage PPCS pediatric patients. Methods: A retrospective cohort study of 41 pediatric patients with PPCS or symptoms greater than one month from injury. Data was collected from 7/1/2018 to 12/1/2019 and the age group ranged from 8 to 21 years. For each participant, using the OMT device we measured the number of saccades generated, the size and speed of the microsaccades, the area covered and the ratio of vertical-to-horizontal direction component of the fixational eye movements, using a 250 Hz video-eye tracker mounted inside a HTC Vive VR headset. Participants were instructed to fixate on a central dot for 140 seconds, in 20-second intervals. Patients were classified into early or late stages of PPCS (early stage: 1-6 months; late stage: >6 months) to compare MS rate between stages. Exclusion criteria included history of visual disorders, learning disorders, seizure disorder, or intracranial hemorrhage. Results: 27 patients were in the early stage while 14 patients were in the late stage. The early stage group had a mean MS rate of 125 beats/min while the late stage group had a mean MS rate of 116 beats/min. A two sample t-test assuming no difference between early and late stage patients resulted in a p value of 0.51. Conclusion: There is a potential trend in declining MS numbers with progressive PPCS stage. Although the t-test didn’t show statistical significance, this could be due to the small sample size of our study. Future studies are needed to validate this initial finding and to identify the significance of microsaccade patterns in concussion prognosis and management. [Figure: see text]
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