DOI 10.1212/WNL.0b013e31828d9c13; Published online before print March 18, 2013;Neurology

Anthony G. Alessi, Thom Mayer and DeMaurice SmithProtecting the brain in sports : What do we really know?

 March 22, 2013This information is current as of

 

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Neurology. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.since 1951, it is now a weekly with 48 issues per year. Copyright © 2013 American Academy of

® is the official journal of the American Academy of Neurology. Published continuouslyNeurology

EDITORIAL

Anthony G. Alessi, MD,FAAN

Thom Mayer, MD,FACEP

DeMaurice Smith, JD

Correspondence toDr. Alessi:agalessi@cxcare.com

Neurology® 2013;��:��

See page XXX

Protecting the brain in sportsWhat do we really know?

Guidelines for the diagnosis and treatment of concus-sion were last published 15 years ago.1 Over the courseof those years, much has changed, not only in ourknowledge of this clinical syndrome, but also in theneurologist’s role in the field of sports.

In 1997, it was rare to see a neurologist on the side-lines or at ringside. In fact, the American Academy ofNeurology (AAN) supported a position statement call-ing for boxing to be banned.2 That policy has beenreplaced by a call to arms for neurologists to becomemore involved in all sports as advocates for the safety ofparticipants.3

Sports neurology is now on its way to becoming arecognized subspecialty of neurology. The Sports Neu-rology section of the AAN now has 465 members inaddition to an active online community. The first SportsNeurology fellowship has been established at the Univer-sity of Michigan.

The growth of sports neurology has also increased thevisibility of neurologists who now serve in key positionson the health and safety committees of the NationalFootball League Players Association (NFLPA), NationalFootball League (NFL), National Hockey League,National Basketball Association, United States TennisAssociation, and National Collegiate Athletic Associa-tion. Neurologists now even serve on multiple state box-ing commissions.

TheNFLPA has taken a central role in advocating forthe health and safety of its players and accelerating thecreation and adoption of guidelines for the care ofNFL players with concussions. In October 2009, underthe direction of the Executive Director, DeMauriceSmith, theMackey-White Traumatic Brain Injury Com-mittee of the NFLPA held its first meeting. Chaired bythen-active player Sean Morey and the NFLPA MedicalDirector, Dr. Thom Mayer, this group comprised morethan 25 eminent scientists with expertise in neurologicinjuries, including neurologists, neurosurgeons, emer-gency physicians, and neuropathologists. Most impor-tantly, it also included current and former players,representing, for the first time, the voice of the “playeras person and patient.” In November 2009, at thedirection of Mr. Smith and following a rash of

concussions during that season, the NFLPA asked theNFL to develop immediately and then implement con-cussion guidelines to protect the players, which were inplace within 30 days. Following the season, the Mackey-White Return to Play Subcommittee developed guide-lines to ensure that NFL players sustaining concussionswere evaluated and cleared by independent neurologicconsultants prior to returning to play. While a detailedSideline Concussion Evaluation was implemented by theNFL in 2011, its use was not mandated until 2012. TheNFLPA supports the AAN guidelines published hereand will continue to advocate in every possible way toensure its players have the best clinical care provided byneurologic experts with appropriate credentials, includ-ing sideline concussion experts at each game.

In this issue of Neurology®,4 the guideline authorsreport on a literature review extending back to 1955.They approach the problem of concussion in sports byattempting to answer 4 broad questions:

1. For athletes, what factors increase or decrease con-cussion risk?

2. For athletes suspected of having a concussion, whatdiagnostic tools are useful in identifying those withconcussion?

3. For athletes with a concussion, what clinical factorsare useful in identifying those at increased risk forsevere or prolonged early postconcussion impair-ments, neurologic catastrophe, recurrent concussions,or late neurobehavioral impairment?

4. For athletes with a concussion, what interventionsenhance recovery, reduce the risk of recurrent concus-sion, or diminish late neurobehavioral impairment?

While attempting to answer these questions, the au-thors were able to provide crucial information regardingthe most vulnerable sports and positions within thosesports. They also answer many questions regarding pro-tective equipment, sex differences, and medical factorsthat predispose to concussion.

The information in this guideline is the culminationof years of work, but instead of being the end of a longroad, it is a foundation from which to build. As Churchillnotably said, “This is not the end; it is not even the

From the Departments of Neurology and Kinesiology (A.G.A.), University of Connecticut, Farmington; and National Football League PlayersAssociation (T.M., D.S.), Washington, DC.

Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.

© 2013 American Academy of Neurology 1

ª 2013 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.

Published Ahead of Print on March 18, 2013 as 10.1212/WNL.0b013e31828d9c13

beginning of the end. But it may, perhaps, be the end ofthe beginning.5” Like any public health problem, themost important element in future endeavors regardingconcussion in sports will be educating athletes. It is re-assuring to know that neurologists will be an essentialpart of that effort.

AUTHOR CONTRIBUTIONSA. Alessi: drafting/revising the manuscript, analysis or interpretation of data.

T. Mayer: study concept or design, analysis or interpretation of data, con-

tribution of vital reagents/tools/patients, statistical analysis, study supervi-

sion. D. Smith: analysis or interpretation of data, acquisition of data,

statistical analysis.

STUDY FUNDINGNo targeted funding reported.

DISCLOSUREA. Alessi is a consultant to the National Football League Players Association

and a member of the NFL/NFLPA Accountability and Care Committee.

T. Mayer and D. Smith report no disclosures. Go to Neurology.org for

full disclosures.

REFERENCES1. American Academy of Neurology. The Management of Con-

cussion in Sports. March 1997. Available at: www.neurology.

org/content/48/3/581.full.pdf. Accessed January 12, 2013.

2. American Academy of Neurology, 1983–1985 Membership

Directory. Minneapolis, MN: American Academy of Neurol-

ogy; XIV, XX; 1984.

3. American Academy of Neurology. Position Statement on

Sports Concussion. October 2010. Available at: www.aan.

com/globals/axon/assets/7913.pdf. Accessed January 12, 2013.

4. Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-

based guideline update: evaluation and management of concus-

sion in sports: report of the Guideline Development Subcom-

mittee of the American Academy of Neurology. Neurology

Epub 2013 March 18.

5. Churchill WS. Speech at Mansion House, London, November

10, 1942. Quoted in: Shapiro FR. The Yale Book of Quota-

tions. New Haven, IN: Yale Press; 2006.

2 Neurology ���ª 2013 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.

DOI 10.1212/WNL.0b013e31828d9c13; Published online before print March 18, 2013;Neurology

Anthony G. Alessi, Thom Mayer and DeMaurice SmithProtecting the brain in sports : What do we really know?

 March 22, 2013This information is current as of

 

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