Concussion concern: Researchers convene at UPMC

When UPMC organized a conference to discuss concussion treatment, its leaders had no idea what to expect from the experts.

“It was very unclear to us what the response was going to be among these 37 experts in the field,” David Okonkwo, a neurosurgeon and the clinical director of the Brain Trauma Research Center at Pitt’s School of Medicine, said.

It soon became clear, however, that all the doctors and researchers there agreed on two key points, concussions are treatable, and rest — the traditional treatment for concussion patients — is ineffective or even harmful, according to Okonkwo and Michael Collins, executive director of the UPMC Sports Medicine Concussion Program.

Using this information, the 37 clinicians and researchers, as well as others in the field, will move forward with concussion research using points from the panel discussion to guide their questions. The group will publish a report detailing the philosphy of the conference.

According to UPMC, other concussion summits and conferences abroad have settled on definitions, evaluations and on-field protocols, but Friday’s meeting marked the first ever U.S. meeting focused strictly on active therapies, treatments and best clinical practices for concussions.

“There has been a hunger in the field for experts to stand shoulder to shoulder and say that concussion is treatable,” Okonkwo said.

On Oct. 15 and 16, UPMC hosted the Targeted Evaluation and Active Management conference, a meeting of 37 clinicians and researchers who shared their opinions and experiences with treating concussions, in Pittsburgh.

“This is paradigm-shifting,” Okonkwo said. “This meeting will change the conversation.”

The TEAM conference came amid growing public awareness of the damage concussions can cause, in part due to publicity surrounding the debilitating effects of chronic traumatic encephalopathy on some NFL players and other athletes with repetitive brain trauma.

Representatives from the NFL, U.S. Soccer, the Department of Defense and the Department of Health, among other organizations, attended the conference to hear experts’ recommendations.

After the conference, UPMC held a press event at which four of the participants, including Collins and Okonkwo, discussed the conclusions they reached. Collins said all 37 attendees agreed that, instead of rest, concussion patients need active treatment.

Collins listed a few options which the group thinks work better as treatments, including exercise, medication and physical therapy.

“It’s got to be done the right way,” Collins said, specifying that no matter what treatment works best, a doctor must prescribe and supervise its use.

Javier Cardenas, director of the Barrow Concussion and Brain Injury Center at Barrow Neurological Institute in Phoenix, said there are several treatment options since concussion symptoms are highly variable. He added that one future goal for conference attendees is to determine exactly which treatments work best on each concussion symptom.

“We agree that we should start treatment early,” Cardenas said. “How early is up for debate.”

According to Okonkwo, rest, which he called “the oldest treatment known to man,” became the treatment of choice for concussions simply because it is familiar. However, he said that in his experience rest is either useless or damaging to concussion patients.

“Prolonged, prescribed rest actually worsened the concussion,” Okonkwo said.

Shortly before the TEAM conference, a UPMC-commissioned Harris Poll study discovered that only 29 percent of Americans believe all concussions can be treated. Collins said in an Oct. 1 statement that this study revealed the need for education about concussions.

To begin disseminating this information, the conference attendees will publish a statement in the next few months on their conclusion that active treatment works in the academic journal Neurosurgery. They will also publish other papers on research they conduct in the future and come up with ways to spread awareness to the general public.

“There’s work to be done here, but it’s doable,” Collins said.