McCrory P R, Bladin P F, Berkovic S F
Department of Medicine (Neurology), University of Melbourne, Austin, Australia.
BMJ. 1997 Jan 18;314(7075):171-4. doi: 10.1136/bmj.314.7075.171.
To study the ictal phenomenology, aetiology, and outcome of convulsions occurring within seconds of impact in violent collision sport.
Retrospective identification of convulsions associated with concussive brain injury from case records from medical officers of football clubs over a 15 year period.
Elite Australian rules and rugby league footballers.
Neuroimaging studies, electroencephalography, neuropsychological test data, and statistics on performance in matches to determine presence of structural or functional brain injury. Clinical follow up and electroencephalography for evidence of epilepsy.
Twenty two cases of concussive convulsions were identified with four events documented on television videotape. Convulsions began within 2 seconds of impact and comprised an initial period of tonic stiffening followed by myoclonic jerks of all limbs lasting up to 150 seconds. Some asymmetry in the convulsive manifestations was common, and recovery of consciousness was rapid. No structural or permanent brain injury was present on clinical assessment, neuropsychological testing, or neuroimaging studies. All players returned to elite competition within two weeks of the incident. Epilepsy did not develop in any player over a mean (range) follow up of 3.5 (1-13) years.
These concussive or impact convulsions are probably a non-epileptic phenomenon, somewhat akin to convulsive syncope. The mechanism may be a transient traumatic functional decerebration. In concussive convulsions the outcome is universally good, antiepileptic treatment is not indicated, and prolonged absence from sport is unwarranted.
研究在激烈碰撞性运动中，撞击后数秒内发生惊厥的发作现象、病因及预后。
通过回顾性分析15年间足球俱乐部医务人员的病例记录，识别与脑震荡性脑损伤相关的惊厥。
澳大利亚精英澳式橄榄球和橄榄球联盟球员。
神经影像学检查、脑电图、神经心理学测试数据以及比赛表现统计数据，以确定是否存在结构性或功能性脑损伤。进行临床随访和脑电图检查，以寻找癫痫证据。
共识别出22例脑震荡性惊厥病例，其中4例事件有电视录像记录。惊厥在撞击后2秒内开始，最初为强直性僵硬期，随后是四肢的肌阵挛性抽搐，持续长达150秒。惊厥表现存在一些不对称较为常见，意识恢复迅速。临床评估、神经心理学测试或神经影像学检查均未发现结构性或永久性脑损伤。所有球员在事件发生后两周内重返精英比赛。在平均（范围）3.5（1 - 13）年的随访中，没有任何球员发展为癫痫。
这些脑震荡性或撞击性惊厥可能是一种非癫痫现象，有点类似于惊厥性晕厥。其机制可能是短暂的创伤性功能性去大脑状态。在脑震荡性惊厥中，预后普遍良好，无需进行抗癫痫治疗，也无需长时间禁赛。
