Introduction: The incidence of sport-related concussion (SRC) continues to rise with the presentation of concussed athletes ranging from subtle symptoms to dramatic signs. The most recent Concussion in Sport Group guidelines suggest concussive convulsions as a modifying factor, but do not advise altering medical management. To date, considerable research has been performed regarding post-traumatic epilepsy, but convulsions following SRC are relatively understudied. There is no clear consensus on the prevalence of convulsions, seizures or the management of these entities following SRC. The aim of this review was to assess the state of the literature and describe the management trends of concussive convulsions and post-traumatic epilepsy in the SRC population in order to provide evidence and guidance for the management of these athletes.
Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, English-language titles and abstracts published prior to July 2016 were searched systematically across four electronic databases. Primary peer-reviewed journal articles were included if they reported individuals of any age or gender who suffered a concussion or mild traumatic brain injury that was associated with seizure activity during a sports/recreational event.
Results: Of 830 records screened for review, 58 full-text articles were assessed for eligibility. Eight studies with 130 athletes total met the inclusion criteria. Of these individuals, 0.8% received antiepileptic medications, 24.6% received electroencephalograms, and 30.8% underwent imaging. The mean time until the participant returned to play was 14.8 days. Only 6.9% developed long-term sequelae over a mean follow-up time of 3.3 years.
Conclusions: The current literature describing concussive convulsions in sports is limited. The medical community lacks primary literature concerning the management of patients with concussive convulsions or seizures and the long-term sequelae among this population. However, the evidence suggests that concussive convulsions should not be a modifying factor in the management of SRC.
Patient Care: A significant amount of research has been performed regarding post-traumatic epilepsy, but sport-related concussive convulsions are relatively understudied. Clinicians often extrapolate management guidelines from post-traumatic epilepsy to concussive convulsions. However, based on this systematic review, we propose that concussive convulsions should not be modifying factors in the management of a sport-related concussion (i.e., there should be no changes in the work-up or follow-up of patients in this population) given the low incidence of long-term sequelae, electroencephalograms with abnormal features, imaging studies with positive findings, and the use or need for anti epileptic drugs.
Learning Objectives: 1.Discuss whether concussive convulsions should remain a modifying factor in the management of sport-related concussions.
2.Appreciate the lack of current literature concerning both the acute and long-term management of sport-related concussive convulsions.
3.Describe the appropriate clinical approach to sport-related concussive convulsions.
References: See accompanying figures for studies included for review