Zalneraitis Brian H, Yengo-Kahn Aaron M, Pawlukiewicz Alec J, Solomon Gary S
a Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , TN , USA.
b Department of Neurological Surgery , Vanderbilt University School of Medicine , Nashville , TN , USA.
Phys Sportsmed. 2017 Nov;45(4):470-474. doi: 10.1080/00913847.2017.1372035. Epub 2017 Sep 1.
Baseline neurocognitive assessment data can be critical in return to play (RTP) decision-making following a sport-related concussion (SRC). The literature indicates that many modifying factors of SRC have been studied empirically; however, there has been little investigation into the effect of a self-reported history of seizure(s) on baseline neurocognitive test data. The objective of this investigation was to determine whether a self-reported history of seizure(s) is associated with differences in baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance.
A retrospective analysis of 18,245 adolescent and young adult athletes' ImPACT scores was performed. After application of inclusion and exclusion criteria, 7,391 participants were dichotomized into groups based on the presence or absence of a self-reported history of seizure. Participants reporting a history of seizure (n = 60) were matched on multiple variables in a 1:3 ratio with controls (n = 180) without a history of self-reported seizure. Baseline ImPACT composite scores were then compared between groups using either a 2-tailed t-test or a Mann-Whitney U-Test.
A significant between-group difference was observed in ImPACT visual motor speed composite scores (35.28 vs. 37.64, p = 0.029, Hedge's g = 0.327), with the group self-reporting a history of seizure performing at inferior average scores. No significant between-group differences were detected in verbal memory, visual memory, reaction time, impulse control, or total symptom scores.
Athletes with a history of self-reported seizure scored significantly lower on ImPACT visual motor speed compared to matched controls. As a solitary finding with a small effect size, the clinical significance of this difference is unclear. Apart from the decrease in visual-motor speed, this preliminary analysis suggests that athletes with a history of seizure might not have significantly different neurocognitive baseline test scores when compared with matched controls. Further empirical investigation is warranted to determine if a history of seizure is a modifying factor for SRC.
在与运动相关的脑震荡（SRC）后恢复比赛（RTP）的决策过程中，基线神经认知评估数据可能至关重要。文献表明，许多SRC的修正因素已得到实证研究；然而，关于自我报告的癫痫发作史对基线神经认知测试数据的影响却鲜有研究。本研究的目的是确定自我报告的癫痫发作史是否与基线脑震荡后即刻评估和认知测试（ImPACT）表现的差异相关。
对18245名青少年和年轻成年运动员的ImPACT分数进行回顾性分析。在应用纳入和排除标准后，根据是否有自我报告的癫痫发作史，将7391名参与者分为两组。报告有癫痫发作史的参与者（n = 60）与无自我报告癫痫发作史的对照组（n = 180）按1:3的比例在多个变量上进行匹配。然后使用双尾t检验或曼-惠特尼U检验比较两组之间的基线ImPACT综合分数。
在ImPACT视觉运动速度综合分数方面观察到显著的组间差异（35.28对37.64，p = 0.029，Hedge's g = 0.327），自我报告有癫痫发作史的组平均得分较低。在言语记忆、视觉记忆、反应时间、冲动控制或总症状评分方面未检测到显著的组间差异。
与匹配的对照组相比，有自我报告癫痫发作史的运动员在ImPACT视觉运动速度上得分显著更低。作为一个效应量较小的单独发现，这种差异的临床意义尚不清楚。除了视觉运动速度下降外，这项初步分析表明，有癫痫发作史的运动员与匹配的对照组相比，神经认知基线测试分数可能没有显著差异。有必要进行进一步的实证研究以确定癫痫发作史是否是SRC的一个修正因素。
