Concussion Is Confusing Us All
Concussion Is Confusing Us All
We propose that the terms concussion and postconcussion syndrome are unhelpful and should be 'retired'. Instead, we should use a unified classification of the severity of TBI, coupled with a careful attempt to identify the underlying cause for any persistent post-traumatic symptoms (figure 2B). There are several TBI severity classification systems, but we recommend using the Mayo system (see Box 1). This uses traditional estimates of severity based on loss of consciousness duration, Glasgow coma scale score and post-traumatic amnesia duration, and incorporates neuroimaging measures of injury severity. It separates the large group of patients with mild TBI into two groups, referred to as mild (probable) and symptomatic (possible) TBI. This distinction is useful as it acknowledges the heterogeneity of mild TBI, and makes it explicit that there is wide variation in the likelihood of significant neuropathology across the subgroup. For simplicity we shall refer to these two groups collectively as 'mild TBI' for the remainder of this article.
In the future, additional factors may also help prognostication. Large studies of clinical outcome after TBI are underway, such as Centre TBI (https://www.center-tbi.eu/), which will help to define the key factors determining clinical outcome. The risks of developing Alzheimer's disease and Parkinson's disease are already known to be related to apolipoprotein EACE-R (APOE) and α-synuclein genotypes, respectively, and in the future genetic factors should allow a personalised calculation of the risks of a poor clinical outcome.
What Should Replace Concussion?
We propose that the terms concussion and postconcussion syndrome are unhelpful and should be 'retired'. Instead, we should use a unified classification of the severity of TBI, coupled with a careful attempt to identify the underlying cause for any persistent post-traumatic symptoms (figure 2B). There are several TBI severity classification systems, but we recommend using the Mayo system (see Box 1). This uses traditional estimates of severity based on loss of consciousness duration, Glasgow coma scale score and post-traumatic amnesia duration, and incorporates neuroimaging measures of injury severity. It separates the large group of patients with mild TBI into two groups, referred to as mild (probable) and symptomatic (possible) TBI. This distinction is useful as it acknowledges the heterogeneity of mild TBI, and makes it explicit that there is wide variation in the likelihood of significant neuropathology across the subgroup. For simplicity we shall refer to these two groups collectively as 'mild TBI' for the remainder of this article.
In the future, additional factors may also help prognostication. Large studies of clinical outcome after TBI are underway, such as Centre TBI (https://www.center-tbi.eu/), which will help to define the key factors determining clinical outcome. The risks of developing Alzheimer's disease and Parkinson's disease are already known to be related to apolipoprotein EACE-R (APOE) and α-synuclein genotypes, respectively, and in the future genetic factors should allow a personalised calculation of the risks of a poor clinical outcome.
Source...