Chronic concussion-related issues can persist in children for many months – study

Persistent Post-concussion Syndrome (PPCS) is often misdiagnosed as attention deficit disorders, sleep disorders and depression.

One in four children evaluated for a mild traumatic head injury in an emergency room is liable to suffer from chronic post-concussion syndrome, study findings suggest.

The researchers suggest the long-term consequences of mild head injuries in children are underdiagnosed.

The researchers in Israel, reporting in the journal Scientific Reportsfound that 25.3% of children who come to the emergency room with a mild head injury go on to suffer from Persistent Post-concussion Syndrome (PPCS).

Persistent PPCS can continue for many years. It can include chronic symptoms such as forgetfulness, memory problems, sensitivity to light and noise, attention deficit problems, and even psychological problems. Instead of receiving treatment for the syndrome, they can be mistakenly diagnosed as suffering from the likes of attention disorders, sleep disorders and depression.

Misdiagnosis can lead to treatments unsuited to the problem, thus causing the youngsters prolonged suffering.

Professor Shai Efrati. Photo: Shamir Medical Center (Assaf Harofeh)

The research was led by Professor Shai Efrati, of the Sagol Center for Hyperbaric Medicine and Research at Tel Aviv University and Shamir Medical Center (Assaf Harofeh), which is a hospital in Be’er Ya’akov.

The study also involved Dr Uri Bella and Dr Eli Fried, of Kaplan Medical Center; and Professor Eran Kotzer, of the Shamir Medical Center.

The authors said the consequences of brain damage during childhood continue throughout life and may prevent those affected from realizing their potential in education and in social life.

“The objective of our study was to determine how many children in Israel suffer from persistent post-concussion syndrome,” Fried said.

“The children participating in the study arrived at the emergency room with mild head trauma and, after staying overnight for observation or being sent for a CAT scan of the head, they were discharged to go home.”

A similar number of controls were also followed.

Efrati said PPCS is a chronic syndrome that results from micro-damage to the small blood vessels and nerves, which may appear several months after the head injury, and therefore is often misdiagnosed as attention deficit disorder, sleep disorder or depression.

“There are cases where children report headaches and are diagnosed as suffering from migraines or, for example, children who report difficulty concentrating and the doctor prescribes Ritalin.

“Unfortunately, these children continue to suffer for many years from various disorders and, instead of treating the real problem, which is the syndrome, they receive treatments that usually do not solve the problem.”

The researchers tracked the subjects for six months to three years from their date of discharge, which revealed one in four were affected by the chronic syndrome.

“It should be understood that the consequences of brain injury during childhood continue throughout life,” says Bella, who directs the Pediatric Emergency Room at the Kaplan Medical Center. “Loss of any brain function will prevent the child from realizing his or her potential in education and in social life.”

Unlike damage to large arteries and noticeable damage to brain tissue, with a minor head injury, the damage is to the small blood vessels and neurons – and it is not detected on CAT scans of the head or on regular MRIs.

Diagnosis of the syndrome requires long-term monitoring of the manifestations of symptoms as well as the use of imaging and functional tests of the brain.

According to the researchers, the alarming findings demonstrate that changes in approach are needed for monitoring and treating these children.

“The purpose of an emergency room diagnosis is to determine whether the child suffers from a severe brain injury that requires immediate medical intervention,” added Kotzer, who directs the emergency rooms at the Shamir Medical Center.

“Unfortunately, the way most medical systems operate today, we miss long-term effects and do not continue to monitor those children who leave the emergency room without visible motor impairment.”

Efrati said proper diagnosis of the cause is the first and most important step in providing appropriate treatment for the problem.

Fried, E., Balla, U., Catalogna, M. et al. Persistent post-concussive syndrome in children after mild traumatic brain injury is prevalent and vastly underdiagnosed. Sci Rep 12, 4364 (2022). https://doi.org/10.1038/s41598-022-08302-0

The study, published under a Creative Commons Licensecan be read here.

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