‘Direct Impact’ of Concussions on Future Health

March 16, 2015


“Brain injuries from multiple concussions can ultimately lead to death,” says Dr. Harry Kerasidis, the go-to concussion expert with the answers every athlete, parent, coach, athletic director and league official needs to know on how to successfully prevent, detect and protect athletes from concussion-related brain trauma. With 300,000 sports related concussions, reported each year among people who are 15 to 24 years old, sports are second only to motor vehicle crashes as the leading cause of traumatic brain injury.Dr. Harry Kerasidis

Dr. Harry Kerasidis, M.D. is one of only a few neurologists in the world specializing in the impairment of cognitive and emotional performance resulting from concussions. After 25 years treating hundreds of concussions, Dr. Kerasidis noticed existing concussion management options were limited or incomplete. So he created his own protocol, called XLNTbrain LLC.

A regular contributor to Psychology Today, Dr. Kerasidis also founded Chesapeake Neurology Associates, based in Prince Frederick, Maryland, helping patients with cognitive and behavioral disorders including memory loss, sleep deprivation, ADD, dementia, Alzheimer’s, and traumatic brain injury. At Calvert Memorial Hospital, he serves as the Medical Director for the ‘Center for Neuroscience’, the hospital’s ‘Sleep Disorders Center’ and ‘Stroke Center.’

Salonpas sat down with Dr. Kerasidis to learn about more how to prevent this dangerous injury:

What is a concussion and how serious is it, and how do you know you have one?

Concussions are a very serious brain injury. I sometimes refer to concussions as a “brain sprain.” Like muscle sprains, concussions have temporary symptoms that vary in severity, from mild to moderate to severe. However, if the concussion isn’t treated properly, there is a potential for long-term consequences. Considered a mild traumatic brain injury, a concussion can last hours, days, or even weeks. If the symptoms of a concussion continue beyond a week or two, the severity may then be classified as Post-Concussion Syndrome or even brain damage.

The most important factor about signs and symptoms of concussions to know is that they may not materialize until several minutes, hours or days after the injury occurs. If you have experienced any of the following:

1. Head to head contact
2. Head to ground contact
3. Head to body contact
4. Non-head contact due to a sudden change in direction, like a whiplash
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If you start to exhibit any of the following symptoms; you should seek medical attention immediately!  Symptoms include:

Loss of Consciousness — This is the most obvious, and scariest, sign of a concussion.

Confusion — The most common symptom is temporary confusion, often associated with a “dazed” look or vacant stare. A confused, concussed individual probably won’t talk much. If the individual does talk, the words may be jumbled, rapid, or generally non-sensical and irrelevant.

Amnesia — Amnesia is temporary memory loss that can be divided into two types:

Retrograde: Forgetting things that happened before the incident.

Anterograde: Inability to remember facts after the concussion.

Disorientation — A concussion can affect your ability to know where you are, what day it is, and what you were doing at the time of the injury.

Delayed Verbal/Motor Response — Slow, slurred or incoherent speech as well as inability to move or walk normally can be associated with concussion.

Inability to Focus — A concussion may be evident if you have trouble paying attention, focusing on the conversation or game situation.

Headache — When due to concussion, headaches are very similar to migraine and may be accompanied by nausea, vomiting, and sensory sensitivity.

Disequilibrium — Experiencing a problem with balance, and feelings of dizziness.

Visual Disturbances – Your vision may become blurred, doubled or overly sensitive to light.

Nausea/Vomiting — May occur in the absence of headache.

Emotional Lability (mood swings) — When hits occur to the sides of the head, or temporal lobes, you may notice anger outbursts, inappropriate laughing, extreme sadness or overt stubbornness not typical of the individual.

Sleep Disruption — Excessive drowsiness or inability to sleep are usually delayed symptoms of a concussion presumably due to disruption of the sleep pathways rising up through the brainstem, and imbalance of the neurotransmitters.

Tell us about your XLNTbrain LLC protocol.

After 25 years treating hundreds of concussions, I noticed existing concussion management tools, modalities and options for the sports world were limited or incomplete. Despite all the awareness lately about concussions, most sports programs still do not have a clinical-caliber protocol, and even many medical professional cannot adequately outline a valid concussion program. So, I created the first all-in-one platform that any sports team or league can implement to give them a “virtual neurologist” on the team.

XLNTbrain.com is a website and mobile app that integrates education which is compliant with statewide laws, baseline testing (measuring, cognitive and emotional scores), sideline assessment, recovery, symptom tracker and reporting tool. It follows my outline of “The Four R’s” which include:

Recognize

Provide proper education that complies with state laws about how to recognize and recover from concussions, as well as the potential short- and long-term impairments. Next, recognize athletes’ current condition with pre-season baseline testing that measures the full spectrum of cognitive and emotional performance tasks.

Report

Gain the ability to immediately assess, document and report results of concussion symptoms to necessary parties including the athlete, parents, coaching and training staff, athletic trainers and athletic directors, medical professionals, and if necessary, league officials.

Recovery

Guide the athlete and training staff through a progressive exertion protocol that helps determine when the athlete can be cleared to “return to play,” as well as “return to learn” academic activities.

Responsibility

It takes a “team effort” to apply concussion management involving the athlete, parents, coach, training staff, medical professionals, referees, and league officials. The health of the athlete’s short- and long-term future should weigh heavier than the desire to return to the field or the classroom.

If you play a contact sport, are you truly trading cognitive function for the thrill of the game-and playing Russian Roulette with your future?

The risk of long-term cognitive and emotional impairment exists with any brain injury, including those sustained from contact sport. The risk varies by person as well. Every athlete’s brain has a different threshold or margin for absorbing hits. For example, every athlete’s level of brain health varies based on heredity and genetic factors, gender differences, pre-natal health, history of prior brain trauma, nutrition, exercise, sleep, toxicity from alcohol and use and abuse, tobacco smoking, and presence of environmental toxins from drinking water, air they breathe, and chemicals from foods.

So, the risk is greater for athletes with a lower threshold of brain health. Most people don’t realize the actual concussion injury may be the result of numerous “sub-concussive” hits that have added up and finally tripped the brain into a concussion. Every hit counts, and avoiding them altogether would be in the best interest of the athletes’ futures.

The most dangerous concussion injury is referred to as “Second-Impact Syndrome,” in which a second concussion occurs before the first concussion has had a chance to heal. This comes with a 50% fatality rate, and 100% chance of long-term brain damage.

So, when I see an athlete taken out of a game from a big hit, and then is returned to the game without proper diagnosis, I fear the athlete’s life is in danger.

If you choose to participate in a contact sport, what does your team need to have in place for concussion protocol?

Every team needs to have a concussion management protocol, which is a plan for preventing and detecting concussions, and then protecting the athletes who sustain one. I would start with having an individual be responsible as the “concussion coordinator,” who oversees and implements the protocol. On the high school, college and professional levels, this is usually an athletic trainer. But in youth sports, a parent may need to volunteer with full acknowledgement of the coaches.

The concussion protocol starts with education that meets or exceeds the state concussion laws. Then, every athlete should take pre-season “baseline test” measuring cognitive and emotional scores prior to injury. These scores should be saved for future reference. The concussion coordinator should have every athlete’s telephone number and email address for their parents and doctors. During the season, the concussion coordinator should have a “sideline assessment” tool that helps identify the risk and severity of a concussion. I recommend XLNTbrain Mobile App. If a concussion is present, the athlete should be put in to a recovery protocol, with daily tracking of symptoms. After 5-7 days, if the athlete’s symptoms are not present, seek medical clearance to return to game play.

This is a brief outline, and there are nuances with every step. I’ve created a protocol based on the “best-practices” of some of the most respected organizations in the field: NATA, the American Academy of Sports Medicine, American Academy of Neurology, American Academy of Pediatrics and the International Conference on Concussion in Sport.

Would you let your own children play contact sports?

I personally would not. The brain continues developing through the age of 25 years old. So any injury during this growth can advance the onset of Alzheimer’s and other brain-related diseases. Many other sports provide the excitement, education and physical fitness we all enjoy from the game.

What is the connection between concussions and Parkinson’s disease or other major diseases?

There are wide ranges of cognitive, behavioral and emotional impairments that can result from concussions, or repeated sub-concussive hits to the head. Scientists studying the brains of NFL players found presence of degenerative brain and neurological damage resulting from the brain injuries. When looking at the brains of NFL players had died, nearly all of them at chronic traumatic encephalopathy (CTE) which may have been the reason for many of their cognitive, behavior and emotional problems.

The following conditions can be connected to concussions, sub-concussive hits and CTE (in alphabetical order):

Alzheimer’s disease
Anxiety
Attention Deficit Disorder
Balance and equilibrium problem
Changes in Behavior
Bipolar Disorder
Brain Fog
Chronic Fatigue
Depression
Language and Speech Difficulties
Memory and Learning Impairment
Parkinson’s disease
Sleep Disorders

Is one concussion enough to cause serious current or future injury?

Yes it is possible. However, typically one concussion can be healed in 7-10 days. It really depends on the overall health of the individual. The risk varies by individual because every individual’s brain has a different threshold or margin for absorbing hits. For example the following factors can increase or decrease the threshold for concussion: Heredity and genetic factors, gender differences, pre-natal health, history of prior brain trauma, nutrition, exercise, sleep, toxicity from alcohol and use and abuse, tobacco smoking, and presence of environmental toxins from drinking water, air they breathe, and chemicals from foods.

What is the average number of concussions that professional football players have during their career?  

We don’t know the answer to this question. But we do know that most athletes do NOT report the concussion. While the Center for Disease Control (CDC) estimates about three million concussions occur every year, based on reports from emergency rooms, millions more probably occur. The professional football player is more likely to sustain a concussion due to years of sub-concussive hits that have been sustained. Also, the speed and strength of the athletes can apply much greater force, which the human brain was not design to sustain.

On the other hand, one of the most exciting discoveries in medicine is that brain damage can be reversed! I write about several studies and techniques that can be applied to re-build the brain in my new book, “Concussionology,” which comes out in April, 2015.

Tell us about your new book, “Concussionology: Redefining Sports Concussion Management” 

It’s a comprehensive, yet concise look at everything every parent, athlete, coach, athletic trainer — even medical personnel — needs to know about concussions, and how to implement a clinical-caliber concussion protocol on every level. I feel concussion management is emerging as a new medical field, somewhere between sports medicine and neurology. So in the book, I give enough brain anatomy and neurological detail for my medical colleagues, and break it down in simple terms for every parent, coach and athlete out there who want to protect their futures. The book will be available on amazon.com

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