Pre-Existing Conditions May Lengthen Concussion Recovery (Part One of Two)

A concussion can often worsen symptoms in an adult or child who has pre-existing conditions that affect the brain, such as learning disorders, attention deficit, depression, anxiety and migraines.

Dr. Nathan Cook, Pediatric Neuropsychologist, Sports Concussion Program, Massachusetts General Hospital for Children, is part of the Virginia Concussion Initiative and works primarily with “outlier” cases, which he describes as children and young people who take longer than the usual four weeks to recover from a concussion.

These are children and young people who are suffering persistent, chronic headaches, oculomotor dysfunction or difficulty with eyes, vision, balance and other issues.

One of the robust predictors of prolonged recovery from sports-related concussion is a pre-existing mental health history, says Dr. Cook.

In the absence of pre-existing conditions, individuals recover from concussion within two to four weeks and treatment consists of scaling back on activities and finding that “sweet spot” between rest, recovery and gradually increasing activity.

But the situation can be quite different for complex cases. For example, children and teens with ADHD often have challenges with balance testing, in the absence of a head injury. The data available through the Virginia Concussion Initiative, specifically through collaborating with Dr. Caswell at George Mason, allowed for the collection of a huge amount of information on pre-existing conditions among Virginia students.

“We were able to match students with ADHD to basically same age teammates, in other words, students on the same team from the same school, same age, very strong similarities so that we could isolate the ADHD factor. And in fact, the research bears this out, that those students with ADHD did perform differently. Specifically, they had more errors on the balance test that is commonly used in concussion called The Modified Balance Error Scoring System.”

This was in the absence of head injury and represented a preseason baseline testing. It’s critical to have this sort of baseline testing so that months later, if an injury occurs, health providers can be aware of what might be related to the student’s pre-existing health condition versus what might reflect continued dysfunction related to concussion or neurotrauma. And sometimes when it’s too difficult to tell, the focus must simply be on treatment, says Dr. Cook.

Part Two will discuss other pre-existing conditions and concussion treatment.