Concussion - Treatment

Treatment

After checking for signs of neck injury, the patient should be watched for several hours. Taking the patient to the emergency room is warranted for any of the following: repeated vomiting, worsening headache, dizziness, seizure activity, excessive drowiness, double vision, slurred speech, unsteady walk, or weakness or numbness in arms or legs, or signs of basilar skull fracture. After this initial danger period has passed, there is debate whether it is necessary to awaken the patient several times during the first night as has traditionally been done, or whether the patient would benefit more from uninterrupted sleep.

The 2008 Zurich Consensus Statement on Concussion in Sport states, "The cornerstone of concussion management is physical and cognitive rest until symptoms resolve." Most (80–90%) concussions resolve in a seven to ten days, although the recovery time may be longer in children and adolescents. Cognitive rest includes going easy on activities which require concentration and attention such as school work, video games, and text messaging. A 2010 Pediatrics article on sports-related concussions in children and adolescents stated that reading, even leisure reading, can commonly worsen symptoms. This article suggested such methods as time off from school and attending partial days. And since the student may physically appear fine, teachers and other school personnel may need to be educated regarding concussions.

Concussion sufferers are generally prescribed rest, including plenty of sleep at night plus rest during the day. Rest includes both physical and cognitive rest until symptoms clear. Health care providers recommend a gradual return to normal activities at a pace that does not cause symptoms to worsen. Education about symptoms, how to manage them, and their normal time course can lead to an improved outcome.

For persons participating in athletics, the 2008 Zurich Consensus Statement on Concussion in Sport recommends persons be symptom free before restarting and then, not all at once, but rather through a series of graded steps. These steps include: complete physical and cognitive rest, light aerobic activity (less than 70% of maximum heart rate), sport-specific activities such as running drills and skating drills, non-contact training drills (exercise, coordination, and cognitive load), full-contact practice, and full-contact games. Only if a person is symptom free for 24 hours, should he or she proceed to the next step. If symptoms occur, the person should drop back to the previous asymptomatic level for at least another 24 hours. This is not a race. The person should go easy and take his or her time. The emphasis is on remaining symptom free and taking it in medium steps, not on the steps themselves.

Medications may be prescribed to treat symptoms such as sleep problems and depression. Analgesics such as ibuprofen can be taken for the headaches that frequently occur after concussion, but paracetamol (acetaminophen) is preferred to minimize the risk for complications such as intracranial hemorrhage. Concussed individuals are advised not to drink alcohol or take drugs that have not been approved by a doctor as they can impede healing. There has been one treatment intervention that has shown to be particularly effective. It is called activation database guided EEG biofeedback. and has been shown to return the memory abilities of the concussed individual to levels better than the control group.

About one percent of people who receive treatment for MTBI need surgery for a brain injury. Observation to monitor for worsening condition is an important part of treatment. Health care providers recommend that those suffering from concussion return for further medical care and evaluation 24 to 72 hours after the concussive event if the symptoms worsen. Athletes, especially intercollegiate or professional athletes, are typically followed closely by team athletic trainers during this period. But others may not have access to this level of health care and may be sent home with no medical person monitoring them unless the situation gets worse.

Patients may be released from the hospital to the care of a trusted person with orders to return if they display worsening symptoms or those that might indicate an emergent condition, like unconsciousness or altered mental status; convulsions; severe, persistent headache; extremity weakness; vomiting; or new bleeding or deafness in either or both ears.