Research Reports - Longitudinal study of postconcussion syndrome: Not everyone recovers

J Neurotrauma. 2016 Oct 26. [Epub ahead of print]

Hiploylee C(1), Dufort P(2), Davis H(3), Wennberg R(4,)(5), Tartaglia C(6),
Mikulis D(7), Hazrati LN(8,)(9), Tator C(10).

We examined recovery from postconcussion syndrome (PCS) in a series of 285
patients, diagnosed with concussion based on international sport concussion
criteria, who received a questionnaire regarding recovery . Of 141 respondents,
those with postconcussion symptoms lasting less than 3 months, a positive CT
and/or MRI, litigants, and known Test of Memory Malingering (TOMM)-positive cases
were excluded, leaving 110 eligible respondents. We found that only 27% of our
population eventually recovered, and 67% of those who recovered did so within the
first year. Notably, no eligible respondent recovered from PCS lasting 3 years or
longer. Those who did not recover (n = 80) were more likely to be non-compliant
with a do not return to play recommendation (p = 0.006) , but did not differ from
the recovered group (n = 30) in other demographic variables including age and sex
(p ≥ 0.05). Clustergram analysis revealed that symptoms tended to appear in a
predictable order, such that symptoms later in the order were more likely to be
present if those earlier in the order were already present . Cox proportional
hazards model analysis showed that the more symptoms reported, the longer the
time to recovery (p = 7.4 x 10-6), with each additional symptom reducing the
recovery rate by approximately 20%. This is the first longitudinal PCS study to
focus on PCS defined specifically as a minimum of 3 months of symptoms, negative
CT and/or MRI, negative TOMM test, and no litigation. PCS may be permanent if
recovery has not occurred by 3 years. Symptoms appear in a predictable order, and
each additional PCS symptom reduces recovery rate by 20%. More long-term
follow-up studies are needed to examine recovery from PCS. 

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