Part 2 of our 3-part series on player safety in football continues today with discussion from our experts on symptoms and treatment of concussions. Part 1 of our series dealt with the definition of a concussion and debunking some widespread myths about that type of injury.

Once again, our experts Harvard Medical graduate Dr. Jon Lieff and Medical Director for Paradigm Management Services Dr. Elizabeth Sandel will provide answers to our questions below.

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Part 2: Symptoms And Treatment Of Concussions

DSN: What are the symptoms of a concussion?

Dr. Sandel: The most common acute symptoms are headaches, balance problems and dizziness, cognitive problems such as slowed thinking and unreliable memory; behavioral or mood changes; and sleep problems. There can also be many other symptoms, and physicians should use a symptom checklist to identify problems and to follow on whether they have resolved. And while sports injuries don’t carry a high risk of post-traumatic stress disorder (PTSD), this condition may occur as well, so athletes should always be screened for PTSD.

DSN: What is the ideal recovery time and treatment after a brain injury? Should football players return to the game after incurring such an injury? How long should they wait to return to play?

Dr. Sandel: Recovery times vary for each individual and each injury. Researchers and health care professionals can talk about statistical averages, but each person must be thoroughly evaluated after a concussion. Guidelines for evaluation and treatment after a concussion continue to change as we learn more about the brain. For example, an earlier severity grading system for sports concussion has been replaced by a recommendation to use an individualized approach for each person. This means that a medical professional must go beyond the usual 15 to 20-minute visit and take a complete history, check all symptoms, and do a thorough cognitive and physical examination. Then the professional must follow each patient over time to determine when they can return to play or to school. A gradual return to activities and exercise in a protocol-directed manner is crucial. If symptoms persist, the patient should be referred to a multidisciplinary clinic with physicians, neuropsychologists, speech/language therapists, and physical therapists.

Committed athletes may minimize their symptoms in order to be cleared to return to the field, and sometimes parents also push for this clearance, worried about the loss of a scholarship, for example. These are tough situations for all concerned.

DSN: What is the recovery time of concussions? Can an athlete fully recover? What does a full recovery look like? Do the damaged parts of the brain eventually normalize?

Dr. Lieff: Each concussion is different. The assumed time for recovery has been arbitrary. It can only be evaluated on an individual basis. Many people who have concussions have no lasting problems and completely recover. A smaller group have lasting problems from one concussion. Multiple concussions are more likely to cause lasting problems. There is increasing evidence that multiple head hits from high school and college sports can lead to long lasting cognitive and emotional problems in school and careers.

DSN: Please define CTE. What are early symptoms? How much do we really know about this disease?

Dr. Lieff: Chronic traumatic encephalopathy (CTE) is the name given to brain changes that occur after multiple concussions. It is not the same as other degenerative brain damage such as Alzheimer’s, multiple strokes and Parkinson’s. But, like these other dementias, currently it cannot be measured while the person is alive.  It can only be defined and observed by looking at brains of people who have died. Like the other degenerative dementias, it involves abnormal molecules that accumulate along with inflammation. There is reason to believe that through brain imaging, CTE and Alzheimer’s will be able to be measured in live people sometime in the future.

Because it cannot be measured in living people, it is not clear what the very early symptoms are. This is true for other degenerative brain diseases as well. By the time problems of thinking and emotional distress occur, it is late in all of these diseases.

What is clear is that in all of the degenerative brain diseases, immune responses to the specific damage that is occurring can create inflammation in the brain that make matters worse. The damage also has a tendency to spread throughout brain circuits. The mechanisms of this spread are just being discovered. Another factor is that damage from all these different brain diseases can be additive.

Check back tomorrow for Part 3 of our series: Prevention and The Future of Sports