Dear Colleagues and Staff
I am writing from the 65th Annual Meeting of the American Academy of Neurology in San Diego, the biggest neurology conference in the world. It has been a tiring, though markedly educational and rewarding week.
My particular interest area of multiple sclerosis is always a huge topic, addressing issues of diagnosis, prognosis, causation and treatment. Whilst there are no big ticket announcements this year, I will bring back much useful information to the MS Clinic at the Austin, as well as to our private patients. I also have attended a number of courses in more general neurology areas, with particular insights into the management of headache and driving impaired patients that should be of benefit in managing our patients with these very common issues.
Clearly one of the biggest issues this week has been that of concussion, particularly in sport and, the related, though not definitively linked, issues of acute management of concussion (especially with regards to return to play), management of the post-concussive syndrome and, the emerging issue of chronic traumatic encephalopathy. This has been all over the news here in the US (where the latter in particular is of great interest regarding American footballers as well as ice hockey players). I noted from reading The Age online that this issue is making headlines at home as well.
Unfortunately, there is a huge information gap in this area, leading to wild speculation and pretty poor reporting in the lay press, fluctuating between hysteria over an impending epidemic of CTE, to frank denials that it exists. The CTE story needs more study, and we will know more over the next few years. What is more of an issue now will be the acute management of concussion, especially return to play decisions. And this won’t just be AFL professionals – it extends to all levels, especially junior sport, soccer and basketball, particularly for women in these sports.
These decisions will need to be made by GPs and specialists, not Emergency Department physicians who, I suspect, will now recoil from making these calls. The new AAN guidelines will be a great place to start, but we will need a unified Australian approach. Obviously neurologists may need to be involved in management of patients with post-concussive headaches, memory problems. If we have to clear every concussed sports person to play, there will be huge waiting lists, large numbers of athletes out of action awaiting assessment, when they are right to play, as well as no ability to see all the other neurological patients I need to see!
I appreciate any insights or feedback you may have on this issue – GPs, sports doctors, coaches/officials, neurologists, neurosurgeons will need to work collaboratively (and, I suspect, quickly) to practically, but safely deal with concussed athletes. Please email me your thoughts at firstname.lastname@example.org.
Dr Nicholas Crump