Return to Play Seizure Return to Play Process Jeffrey Kutcher MD FAAN National Director The Sports Neurology Clinic Disclosures National Director The Sports Neurology Clinic Team ID: 911616
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2016 Sports Medicine SymposiumReturn to PlaySeizureReturn to Play ProcessJeffrey Kutcher, MD, FAANNational Director, The Sports Neurology Clinic
Slide2Disclosures National Director, The Sports Neurology Clinic™ Team Neurologist, US Ski & Snowboard Team
Director, NBA Concussion Program
Consultant, NHLPA
Consultant,
NFLPA
Consultant, ElMindA, Ltd.
Slide3Definition: transient state of excessive and/or synchronous neuronal activity, i.e., a positive phenomenon
Partial v. Generalized:
based on how the seizure starts electrically, typically mean very different things
Clinical effects:
tonic and tonic/clonic activity
l
oss of awareness (absence)
What is a seizure?
Slide4Slide5Slide6Seizure or not?Syncope: situational LOC
short post-event confusion
clinical
prodrome
ICD 10 code 780.39:
“unspecified convulsions” or “spells” most commonly called “Psychogenic Nonepileptic Seizure” (PNES) in literature.
Slide7Seizure or not?Sign
Epileptic
PNES
Duration < 2 min > 5 min
Eyes open closed
Motor synchronous variable
Language uncommon more common
Post-Ictal > 30 minutes often short
Incontinence common uncommon
Slide8Provoked or not?Common Provocations:
s
leep deprivation
s
ubstances
i
nfections
m
etabolic disturbancesmechanical trauma
Provoked or not makes a difference in management
Slide9Work up for a single seizure
Slide10What is epilepsy?Epilepsy: A group of individual pathologies that each results in repetitive seizures. Common types of epilepsy include:
genetic syndromes
cortical dysplasias
benign or malignant tumors
o
ther intracranial structural pathology
Common clinical rule:
Diagnose epilepsy after the occurrence of more than one unprovoked seizure.
Slide11Epilepsy risks and sportsEpilepsy risk factors:f
amily history
early significant febrile illness
c
omplicated pregnancy birth
b
rain trauma (more than mTBI)
Concussion IS NOT a risk factor for epilepsy
Slide12When to treat> 1 unprovoked seizure1 unprovoked seizure and compelling abnormality on EEG or MRI, or family history
p
rovoked seizure, with unreasonable expectation of avoiding future provocation
c
ommon medications: leviteracetam, lamotrigine
Slide13RTP after seizureSingle seizure - normal workup: no change in RTP process
Single seizure - significant workup:
whether medicated or not, carefully consider sport exposure
Epilepsy:
consider typical seizure risks (heights, open water, etc.)
If treating with medication:
monitor for medication effects on reaction time, balance, coordination, decision making, etc.
Slide14Thank You!