Longitudinal Study Finds that Post-Concussion Syndrome (PCS) May Be Permanent
University of Toronto researchers have just published an important longitudinal study in the peer-reviewed Journal of Neurotrauma following patients with Post-Concussion Syndrome (PCS) based on a diagnosis of concussion in conformity with the international sport concussion criteria. This was the first longitudinal study that specifically excluded patients with contusions and hemorrhages identified by imaging (so-called “complicated” concussions), patients who tested positive on so-called “malingering” tests (the TOMM) and patients involved in litigation.
Insurers in litigated cases typically rely on experts who claim that “all” patients recover from concussion and that patients with persistent symptoms are motivated, consciously or unconsciously, by “secondary gain.” The results of this study contradict this defense.
The researchers reached out to a cohort of 285 patients diagnosed with concussion and received 141 responses. All of these patients had been seen by a neurosurgeon with a special interest in concussion and PCS between 1997 and 2013. Of the 141 patients who responded, 44 had recovered within 3 months and 97 had not recovered. After applying the exclusions for complicated concussions, litigation and failed malingering tests, the researchers were left with 30 patients who had recovered within 3 months and 80 who had not (a total study population of 110 patients).
The most common symptoms among the group that had not recovered were headaches (68.8%), difficulty concentrating (67.5%) and fatigue (52.5%). Not surprising, patients with the greatest total number of symptoms reported the longest recovery time. Of the total study population of 110 patients only 27% eventually recovered. One of the most significant findings in the study was that none of the patients with PCS symptoms lasting longer than 3 years had recovered. Of the 27% of patients in the study population who recovered, 67% did so in the first year.
The results of this study, the researchers note, highlight the importance of treating patients with persistent concussion symptoms in the early stages before these symptoms become chronic.