Author Topic: Does concussion in adolescence increase MS risk?  (Read 43 times)

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Offline agate

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Does concussion in adolescence increase MS risk?
« on: October 09, 2017, 07:55:36 am »
I had two head injuries in adolescence that may have been concussions. They were severe enough to knock me out and leave me with scars that are still noticeable, and one led to an infection that needed treatment by a doctor. So this research interests me.

From the MS International Federation (October 6, 2017):

Quote
Does concussion increase the risk of MS?

What’s behind the media reports on concussion and MS?


Last week we saw the media pick up on a study just published about a potential link between head injuries and the risk of developing MS.

Previous studies have looked for any potential connection between head injury and the risk of later developing MS. Some of these studies have found evidence for a link, but others found no connection. A combined analysis of the data from several good quality studies ultimately concluded that there was no strong evidence that head injuries increased the risk of MS.

Now a Swedish group have used the data from the Swedish MS Registry which has been collecting data on every person with a diagnosis of MS in Sweden since 1964, to try to provide a clearer answer on this topic.

Their research suggests a connection between concussion in adolescence and a later risk of developing MS. However, one of the most important things to note from this study, is that 97% of people with MS had no history of concussion. This means that it is likely to be a contributing factor only in a very small portion of MS cases, and for most people, other environmental and genetic risk factors (reviewed here) are likely to have a stronger influence.

In this study, published in the journal Annals of Neurology, researchers looked at the medical records of 7292 people with MS and 72920 people without MS. They looked at how many in the MS group had had a previous diagnosis of concussion compared to those in the non-MS group and at what age did the concussion occur. To rule out the possibility that any physical general trauma might lead to MS, they also compared broken limb bones between the groups.

There was no connection between either concussion or a broken limb sustained in childhood (age 0 to 10 years) and a later diagnosis of MS. However, when they looked at concussion that occurred during adolescence (ages 11-20 years) they found a small but statistically significant increase in the risk of later developing MS. The increased risk was only modest for one episode of concussion, but was much clearer for two or more episodes of concussion.

The researchers acknowledged that an underlying, un-diagnosed MS could have increased the risk of a person having a traumatic injury, for example through an effect on mobility, coordination and balance – a phenomenon known in science as ‘reverse causation’. However, because there was no association between broken limb bones and a later diagnosis of MS, they conclude that this could not be the case.

A strength of this study was that it used hospital records rather than relying on people’s recollection of past trauma and injury. However, as the number of people having two or more concussions in the study was a relatively rare event it makes the interpretation of the statistical analysis challenging.

The authors of the study discuss a number of reasons why severe head injuries may increase the risk of developing MS. This includes damage to the nervous tissue itself, which may lead to an inappropriate immune response, as well as the possibility that the head trauma sets off a state of inflammation in the brain that predisposes the person to MS.

While the proportion of people with MS in this study who have a clear history of a severe head injury is very small, the researchers do suggest that the study provides further impetus to protect adolescents from head injuries in sport and other physical activities. However, preventing MS will require a much broader approach to tackle the other known risk factors that are more strongly connected to MS.


https://www.msif.org/news/2017/10/06/does-concussion-increase-the-risk-of-ms/







« Last Edit: October 17, 2017, 03:53:40 pm by agate »
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Offline agate

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Re: Does concussion in adolescence increase MS risk?
« Reply #1 on: October 17, 2017, 03:57:08 pm »
From the "Summary and Comment" section of NEJM Journal Watch Neurology, October 17, 2017:

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Is Concussion During Adolescence a Risk Factor for Multiple Sclerosis?

Jaime Toro, MD reviewing Montgomery S et al. Ann Neurol 2017 Sep 25.

Yes, among adolescents but not younger children, according to a large population-based study in Sweden.

Although its etiology is still poorly understood, multiple sclerosis (MS) is a multifactorial disease that results from the interaction between genetic and environmental factors. Whether physical trauma could play a role in the etiology of this disease has been debated. Some scientists argue that physical trauma involving the spinal cord and/or the brain could cause disruption of the blood-brain barrier, causing development of MS plaques in individuals genetically at risk.

To examine whether concussion in childhood or adolescence is associated with risk for MS, researchers identified approximately 7300 patients with MS using Swedish national registers of prospectively recorded MS diagnoses between 1964 and 2012. Each patient with MS was matched with 10 patients without MS by sex, year of birth, age and vital status at diagnosis, and region of residence (approximately 73,000 controls). Concussion incidence during childhood (birth to age 10 years) and adolescence (ages 11–20 years) was compared between cases and controls.

Using multivariate modeling, concussion diagnosis during adolescence, but not childhood, was significantly associated with risk for MS (adjusted odds ratio, 1.2). A dose-response relationship between number of concussions and MS risk was observed among adolescents (AOR for ≥2 concussions, 2.3). A control diagnosis of broken limb trauma was not associated with MS risk in either age group.

COMMENT

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This is one of the largest studies reported to date in which a significant association was shown between concussion in adolescence and risk for MS. To guide our counseling of patients and families, further studies are needed to clarify and explore the mechanisms that account for these findings.
MS Speaks--online for 13 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010.

 

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