…each clinical neurologist will encounter patients whose neurologic disorders either are a consequence of or impact upon participation in an athletic activity.
It is certainly self-evident, not to mention a bit cliché, that the practice of sports neurology is a team effort, both figuratively and literally. What may be less obvious is that each of us, as a neurologist, is a sports neurologist. Whether a general neurologist or a designated subspecialist (within any subspecialty field of neurology); whether seeing patients on the field, in the office, or in the hospital; whether caring for acute or chronic neurologic diseases; and whether caring for individuals who participate in organized sports or just occasional exercise, each clinical neurologist will encounter patients whose neurologic disorders either are a consequence of or impact upon participation in an athletic activity. In this issue of CONTINUUN, Guest Editors Drs Jeffrey S. Kutcher and Christopher C. Giza have assembled a group of world-class experts in the growing academic field of sports neurology to provide us with the information we need to diagnose and manage our patients with acute or chronic, and central or peripheral, sports-related neurologic dysfunction, as well as manage sports-related issues that arise in our patients with neurologic disease.
This issue begins with an introductory article by Drs Giza and Kutcher that provides a broad and current overview of the pathophysiologic and epidemiologic concepts of sports concussions, laying a thorough foundation for the subsequent articles that relate to concussion in sports in this issue. Drs Kutcher and Giza next again lend their combined expertise and experience to more specifically guide us in providing comprehensive and the most up-to-date care as we diagnosis and manage our patients with sports-related concussion. Dr Giza then carefully reviews those issues that are most specifically and especially relevant to pediatric-aged patients with sports concussion. Dr Barry D. Jordan next provides a state-of-the-art overview of the evolving concepts of chronic traumatic encephalopathy and other recently recognized and potentially devastating long-term sequelae of sports-related brain injuries that can impact cognitive, behavioral, and motor function.
Moving beyond the brain, Dr Brian W. Hainline provides an encyclopedic and wonderfully illustrated review of diagnosis and management of the variety of peripheral nerve injuries of the upper and lower extremities that can occur in sports. Dr Vernon B. Williams next provides a thorough overview of the planning for, and the management of, the wide variety of both common and less common neurologic emergencies that can occur in sports and can affect the brain, the spinal cord, or the peripheral nervous system. Dr Frank Conidi then details several unusual sports-related neurologic conditions, ranging from mild to severe, that can occur in relation to specific types of athletic endeavors, which will be quite instructive to all neurologists and of which all of us should be aware.
Dr Kevin E. Crutchfield next reviews the multifaceted issues that arise in counseling and managing our patients with common neurologic disorders (particularly migraine, epilepsy, and multiple sclerosis) with regard to participation in sports activities. Continuing on a similar theme, in the final review article of the issue, Dr Tad Seifert reviews the current evidence with regard to the role of exercise in the management of various neurologic diseases to help guide us in providing the most up-to-date recommendations to our patients.
In this issue’s Ethical Perspectives section, Drs Matthew P. Kirschen and Judy Illes carefully explain and analyze the neurologic and subsequent complex ethical implications arising when a Chiari malformation is incidentally discovered in a competitive athlete. In this issue’s Practice section, Dr Raman Malhotra provides a case discussion of a 16-year-old boy requesting clearance for return to play after a football-related concussion to illustrate how providing the most up-to-date, informed, and well-documented return-to-play decisions can mitigate legal risk while providing optimal neurologic care to our patients.
As with every CONTINUUN issue, a number of opportunities exist for CME. If you need to earn credits specifically approved by the American Board of Psychiatry and Neurology (ABPN) for self-assessment, submit your answers to the multiple-choice questions in the Self-Assessment Pretest that were crafted by Drs Adam Kelly and James Owens before you read the issue; review your results to better tailor your learning needs; and then complete the Postreading Test after reading the issue. By doing so you may earn up to 12 AMA PRA Category 1 CME Credits™ toward self-assessment. Alternatively, you may wish to receive credits toward CME only, in which case, reading the issue and submitting the Postreading Test will allow you to earn up to 10 AMA PRA Category 1 CME Credits. The Patient Management Problem, skillfully crafted by Drs Anthony Alessi and Tanzid Shams, involves the management of a 20-year-old college football player who is involved in a head-to-head collision during a game. By following this case, beginning from the sideline and continuing through return-to-learn and return-to-play decisions, and answering multiple-choice questions corresponding to important management points along this patient’s course, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits.
My sincerest thanks to the guest editors and to each of the authors of this issue for providing such an expert, thorough, and up-to-date review of the many issues that intersect neurology and sports, and that each one of us may encounter no matter what our official named position is on the neurology team.
—Steven L. Lewis, MD, FAAN