A Survey of Neurologists on Postconcussion Syndrome

Abstract

The majority of respondents agree with the following: PCS is a clearly defined syndrome with a solid basis for determining prognosis with an organic basis; accept the authenticity of patients' reports of symptoms; effective treatment is available for headaches lasting 3 months or more; headaches persist in over 20% 1 year after injury; and cognitive rehabilitation is effective. The majority of the respondents do not agree with the following: symptoms improve in a relatively short period of time and quickly resolve once litigation is settled; effective treatment is available for PCS; and return to play guidelines are strongly evidence based. 68.4% disagree with the following: I would support my son or grandson (or if you do not have one, relative's or friend's) playing football. [Correction added on February 9, 2018, after first online publication: "One year after injury" deleted.] CONCLUSIONS: There has been growing acceptance of the organicity of PCS among neurologists in the last 25 years. There is significant concern over the long-term sequelae of concussion as most respondents would not recommend that their son or grandson play football.

Medico‐Legal Aspects of Concussion

“…The duration of post‐traumatic amnesia may not be accurate. Causes for inaccurate durations include the following: psychogenic amnesia (due to an acute stress disorder or PTSD); the effect of alcohol or drugs (either taken by the patient or administered by paramedics or physicians); and other physical injuries and pain 5 …”

“…In 1674, Boirel suggested that invisible brain damage might occur in concussion 3 . Concussion has been a controversial medico‐legal topic for over 150 years 4,5 …”

Sports and Headaches

“…Three studies in civilians, which involved either monotherapy or combined therapy with propranolol, amitriptyline, or valproate, showed efficacy, although a small study showed no benefit with amitriptyline . In a survey of neurologists, 57% agree that “effective treatment is available for headaches lasting 3 months or more.”…”