The Agenda with Steve Paikin (Audio) - What Should You Know About Concussions?

Episode Date: January 23, 2025

How much do we really know about concussions? And what are the long-term effects? We get some fast facts and bust some myths with Dr. Carmela Tartaglia.See omnystudio.com/listener for privacy information.

I'm Matt Nethersole. And I'm Tiff Lam. From TVO Podcasts, this is Queries. This season, we're asking, when it comes to defending your beliefs, how far is too far? We follow one story from the boardroom to the courtroom. And seek to understand what happens when beliefs collide. Where does freedom of religion end and freedom from discrimination begin? That's this season on Queries in Good Faith,

a TVO original podcast. Follow and listen wherever you get your podcasts. How much do we really know about concussions and what are the long-term effects? We're going to get some fast facts and bust some myths as we do 10 questions with Dr. Carmela Tartaglia, clinician scientist at the Canadian Concussion Centre and professor of medicine at the University of Toronto.

And it's good to have you in that chair. Here we go, question one, what is a concussion? Well, a concussion is a brain injury. And I think it's important to recognize that, that it is, that all the symptoms that you end up with after a concussion come because something has happened to the brain. And so when you think about that, I think you can recognize that it's serious.

And I think that actually that concussions have not really received the attention they deserved. Question two, how do you get a concussion? Well, one of the myths is that you actually have to be hit in the head for a concussion, but actually a blow to the body as well as a head can lead to a concussion. And so a hard blow to the body can exert enough force that is transmitted to the brain. And so you can end up with a concussion and the concussion symptoms. Question three. When you experience a concussion, brain hitting skull, what does that actually feel like? Well, it probably feels different for different people, but you don't actually feel your brain hitting the skull, right? You just feel the hit to the head, or it could actually even

be like a whiplash injury, which is just basically your head being propelled forward. And that's what you feel. Nothing about the brain itself, really. Question four, are the symptoms the same for everyone? No. It's very, very heterogeneous. What does that mean?

And that means that, you know what? No two people suffer the same after a concussion. And so there's a myriad of symptoms that people can end up with from headache, which is very, very common, to difficulty concentrating, poor sleep, mood disorders, dizziness, vertigo, ringing in your ears, all kinds of things, balance problems, fatigue. And so it's difficult because when you're trying to treat somebody, you have to really think holistically about the person and, you know,

use a multidisciplinary team, have, you know, different people helping out with the treatment, the treating of the patients. Yeah. How do you diagnose a concussion? So that's a really important question, because actually, the diagnosis of concussion is a clinical diagnosis, which means a clinician is required.

Right now, that is physicians or nurse practitioners. In some provinces, neuropsychologists are also able to diagnose a concussion. No other specialty is allowed to diagnose a concussion. And so sometimes we do see that people are going to other types of practitioners who can help you with some of the symptoms, but they aren't really supposed to be making a diagnosis of concussion. You should see your family doctor, your nurse practitioner, or a psychologist. Let me do a 5A here. Why not? Why only that select group?

Well, you know, firstly, I think it goes back to this is a brain problem. And so there's only certain people who are trained to be able to detect brain issues. And the thing that's important is that, you know, because we don't have a test, I don't have a blood test to give you an MRI, nothing, you know, I have to actually make sure that you didn't have something else. It's not so easy sometimes, and so we do have to make sure that people haven't had a more severe brain injury, and you actually need somebody with medical expertise to do that.

Question six, what are the long-term risks of sustaining a concussion? So in the recent years what has been recognized is that even one concussion can put you at increased risk of dementia, which is what I think scares many of us. And so how you go from one concussion to dementia is obviously, you know, we're gonna need a lot more research. We don't understand that. But the fact that it has been recognized

that having concussions throughout your life puts you at higher risk of having dementia later on in life and all cause dementia, not from one specific cause, which is different than the chronic traumatic encephalopathy that people do worry about, that disease that has been described in those professional athletes or high level athletes, but that's a very, very small portion. The other people actually have different causes of dementia like Alzheimer's or Parkinson's.

Question seven, what does concussion recovery look like? Well, just as the symptoms are varied across the population, so is recovery. So some people, most people actually recover very quickly within a few days, you know, weeks. We allow adults to take two weeks to recover. In children, we expect recovery within a month. And if you fall outside of those ranges, that means you're in a prolonged recovery state.

And we should be starting to intervene, to deal with your symptoms more actively, and not just wait for people to get better on their own. And sometimes you see people who've been, you know, unfortunately, dealing with their symptoms for months and months, if not years, without active treatment. And does recovery mean you feel normal again? In most people, sometimes people don't get back to their baseline, you know, but we try to make people understand that, you know, when we think of your cognitive function,

which is one of the reasons I see people the most, they've had a concussion and then they have, you know, mood issues, they have cognitive difficulties, that many things can affect your cognitive function. And so sometimes just fixing the other symptoms like helping you with sleep, helping the anxiety, helping your headache actually improves cognitive function. Because we don't actually know from a brain perspective what happened at the concussion state.

We have many hypotheses of what happens to give you those symptoms. And then we also have many hypotheses of what happens in the recovery. But we don't actually know what that is. But we do know that many things will affect your cognitive function, just like when you don't have a concussion. If you don't sleep well, if you're in a bad mood, well we don't think as well. So we apply the same

principles to concussion. Question eight, if you have a concussion should you at all pains avoid watching television, looking at your iPad, looking at your cell phone, avoid screens in general. Yes or no? No. I think it's very varied. I think the issue with screens and this screen intolerance is really associated with headache.

And so headaches are very common after a concussion. And the problem is that looking at screens sometimes brings on people's headaches or aggravates their headache. So it's on a person by person level. I usually tell people who have terrible headaches and notice that they can't look at screens, well, avoid looking at the screen. Limit as much as possible.

It's hard to do. But if that's not an issue for you, then I have no issue with your screen. There's nothing about a screen that makes your head hurt, really, unless you are predisposed to having these headaches. And then, you know, light will make your headache worse. Lots of noise will do that, and screens too. Question nine, are concussions essentially the same, whether you're a man, a woman, or a child?

So, for males and females, what we do know is that there seems to be a difference in your susceptibility, in your vulnerability. So unfortunately, females seem to be at higher risk of suffering concussions and also at higher risk of persisting or prolonged symptoms of concussion. And so for the same activity, let's say playing soccer, at higher risk of persisting or prolonged symptoms of concussion. And so for the same activity, let's say, you know, playing soccer, it seems that for the

same kind of sort of hit, hits women would have, or females would have a higher incidence of concussion and more prolonged recovery. How come? Well, that's a great question and you know active area of research you know obviously hormones have been implicated, neck muscles have also been implicated, you know the way we report things, the way we deal with our symptoms has been implicated, all kinds of reasons that females and women are different than males and men.

Question 10. If you get a concussion, does that necessarily mean you will have long-term adverse health effects? No, it does not. Most people, luckily, there are hundreds of thousands of concussions. In Ontario alone, there are over 150,000 concussions per year. And most people recover fully. And within a few days, even within the day or within hours. So luckily, most people get better. And so I don't think most of us have long-term effects. But this risk of having a concussion and delayed effects, we don't know if that's pervasive.

Because even though you say, well, that happened to you, and you are at increased risk, there are many things that we can do throughout our lives to mitigate the risk. That happened to us. We cannot change that. But we can practice healthy brain habits to try to mitigate what happened to us.

And that will likely have an effect on the outcome, which will be the delayed effect of decades later, really. Those are my 10 questions, but I want to sneak in one last piece of advice. If you're the parent of a kid watching this or listening to this right now, and the kid's a soccer player, would you let that kid,

I think they call it in soccer, do a header? Would you let them head the ball, exactly? Yeah, no. I think that one of the things that people are recognizing is that if children undergo these repetitive head injuries, because when you think about it, we focus on concussion, but actually, we don't know that that's what we should be focusing on.

These repetitive head injuries are also maybe putting us at increased risk. And really, does heading the ball really have to be part of that game when you're like 10 years old, or 12 years old, or 14 years old? I don't think the game, I think the game could still go on and your child could still have a lot of fun and maybe not put themselves at risk of delayed bad outcome after a concussion.

Thank you. This has been most illuminating. That's Dr. Carmela Tartaglia from the University Health Network. Thanks so much. Thank you.