Proper concussion management is essential for mitigation of long-term affects and ensuring full recovery. Its very important to understand and manage Post-Concussive Syndrome.
Lets talk PCS! So what exactly is Post-Concussive Syndrome?
Post-concussive syndrome, or PCS, describes a constellation of signs and symptoms resulting from a concussion that lasts longer than expected, typically beyond 4-6 weeks. It is also sometimes referred to as “concussion with prolonged symptoms.” These signs and symptoms fall under the categories of physical, cognitive, mood disturbances, and/or sleep disorders, and differ from one patient to the next.
How is it different from a simple concussion?
Post-concussive syndrome has similar symptoms as a simple concussion, including physical symptoms such as dizziness or headache, cognitive symptoms such as feeling “foggy” or “slow,” mood symptoms such as irritability and mood swings, and/or difficulties falling or staying asleep, but they last longer than expected. A simple concussion on average resolves within 10-14 days, but may persist for as long as 4 weeks. In addition, the management of PCS is different than that of a concussion and usually involves a more proactive, multidisciplinary approach.
Who gets PCS?
It is estimated that approximately 10 to 30 percent of people who suffer from a concussion will go onto have PCS. While there is no way to predict who will have prolonged symptoms, there are certain risk factors that put some patients at higher risk than others, especially in the pediatric population. These risk factors include previous concussions or TBI, poor interim care, history of migraine or other chronic headache disorders, history of learning or developmental/behavioral disorders including ADHD, and/or history of psychiatric disorders such as anxiety or depression. Non-athletes also appear to have a higher incidence of PCS than athletes based on current studies.
What is the treatment and long-term management of PCS?
The management of PCS includes a variety of modalities by different health professionals, as well as support from families, teachers, coaches, and counselors. Depending on the types of symptoms affecting the patient, treatment is varied to try to provide the right stimulation to the brain to promote therapy while staying below the symptom threshold. This may include active rehabilitation therapy, which gives the patient controlled “doses” of exercise, or vestibulo-ocular rehab, which treats problems with balance and dizziness. There are multiple evidence based studies supporting both of these rehabilitative measures early on for PCS. Sleep disturbance can be treated with proper sleep routine, nutrition, and sometimes supplemental sleep aids such as melatonin. Cognitive symptoms need to be addressed with proper interpretation of neurocognitive tests and detailed academic support plans for school. A combination of neuropsychological testing, counseling, and/or medication may also be used for cognitive and mood-related symptoms.
How is it different from management of simple concussions?
While certain concussions may be treated in some of the same ways, many “simple” concussions simply resolve in a matter of weeks, given the appropriate trigger avoidance and supports in place. However, PCS requires a more active and multidisciplinary approach, often involving referrals to physical therapy, cognitive therapy, behavioral health, neurology, and/or psychiatry, to help the patient recover. Having a concussion specialist who serves as the “quarterback” coordinating multidisciplinary care is critical to put the pieces together.
What is the timeline for recovery?
Just as every concussion is different from patient to patient and case to case, PCS can vary widely among patients as well. In most patients, symptoms resolve within about 12 weeks, but may persist for as long as 18 months. There is no reliable way to predict how long recovery will take once you PCS. However, recovery can be helped and shortened by proactive measures and management by specialists, as described above.
What are the long-term implications?
After a patient has suffered PCS, his/her risk of having prolonged symptoms with another concussion is substantially higher. Depending on the sport and/or activity, as well as the patient and family’s comfort level, the patient may want to consider changing his/her activity to reduce the risk of additional brain injuries.
By Yuan He and Mo Mortazavi, MD
References:
Hugentobler JA, Vegh M, Janiszewski B, Quatman-Yates C. Physical Therapy Intervention Strategies for Patients with Prolonged Mild Traumatic Brain Injury Symptoms: A Case Series. Int J Sports Phys Ther. 2015; 10(5):676-89.
