Chapter 6 - Sport-related Concussive Convulsions

Summary

Sports-related concussive (SRC) convulsions are defined as episodes of transient, abnormal movements, occurring immediately following a head injury and after which an individual returns to a normal or only mildly altered level of consciousness (GCS 13-15). These episodes do not recur in the absence of a repeat head injury. While SRC-convulsions were once assumed to be early manifestations of post-traumatic epilepsy (PTE), they are now recognized as a distinct clinical entity. The pathophysiology of this clinical entity is largely unknown, with hypotheses suggesting either hypoxia-related functional decerebration or functional decerebration from shear forces on the ascending reticular activating formation. Due to the relative dearth of studies on SRC-convulsions, robust epidemiologic data are lacking, and the exact incidence is unknown. The diagnosis of SRC-convulsions is largely clinical, relying on detailed history and observed convulsion semiology. Electroencephalography (EEG) and neuroimaging studies, including computed tomography (CT) and magnetic resonance imaging (MRI), are of limited utility in the work-up of SRC-convulsions. Management with anti-epileptic drugs (AEDs) appears to be unnecessary, and follow-up should occur similarly to any concussed patient. Ultimately, more research is needed to better understand SRC-convulsions.