People who experience a concussion during adolescence are at
significantly elevated risk for multiple sclerosis (MS) later in life,
especially 15 years or more following their head trauma, a large retrospective
study suggests.
This risk for developing MS over time nearly doubled in this
population compared with people without a history of concussion.
"We also found a significantly increased risk among
males and not females" starting at about 8 years post-concussion in a
secondary analysis, lead study author Christopher Povolo, BSc, of the
Department of Clinical Neurological Sciences, Schulich School of Medicine &
Dentistry at Western University in London, Ontario, Canada, told Medscape
Medical News.
The findings were presented during a poster session here at
the 35th Congress of the European Committee for Treatment and Research in
Multiple Sclerosis (ECTRIMS) 2019.
Previously, other investigators linked head trauma,
including concussion, with MS.
For example, a Swedish case control study presented at
ECTRIMS in 2017 showed adolescents with one concussion diagnosis were at
elevated risk to develop MS (odds ratio [OR], 1.22; 95% confidence interval
[CI], 1.05 - 1.42; P = .008).
The study, published the same year in Annals of Neurology, revealed
the risk was even greater among those with two or more concussion diagnoses
(OR, 2.33; 95% CI, 1.35 - 4.04; P = .002).
In the current research, Povolo and colleagues studied the
correlation between concussions in adolescents age 11 to 18 years and future MS
using information from several linked Canadian databases. They assessed 391,860
people, including 97,965 diagnosed with a concussion as adolescents.sed risk of MS
within 15 years of follow-up among those with a history of adolescent
concussion.
In contrast, the same group had a significantly elevated
risk of developing MS at 15 years or longer (hazard ratio [HR], 1.85; P =
.005), according to a stratified Cox regression analysis.
A secondary analysis showed a difference by sex. Males
exposed to concussion as teenagers had an increased risk for MS earlier, at 8
or more years of follow-up (HR, 1.58; P = .02). Females showed no such
significantly increased risk.
Povolo and colleagues also tried a more sensitive definition
for developing MS: three or more hospital or physician claims using all
available years of data. In this case, all participants regardless of sex had
an increased risk of MS (HR, 1.37; P = .008) if they had at least 8 years of
follow-up since their concussion.
The investigators would like to expand their research in
this area. "In the future, we could make it longer, or use a countrywide
database," Povolo said.
"All Is Fine With Their Data"
A main message of the research is "prevention and the
risk during adolescence," Tomas Olsson, MD, PhD, a professor of neurology
affiliated with the Department of Clinical Neuroscience, Center for Molecular
Medicine, Karolinska Hospital in Stockholm, told Medscape Medical News when
asked to comment.
"So tough sports like boxing, ice hockey, American
football may not be good in relation to MS, probably mainly for those having
parents with MS," he added.
Olsson was coauthor of the 2017 study in Sweden that
reported similar associations between adolescent concussion and risk of future
MS. "Basically their findings replicate our own, which were published a
couple of years ago. So I think all is fine with their data."
Support for the study was provided by a Roche Canada
unrestricted, investigator-initiated trial grant and research funding from the
Swedish Research Council, Knut and Alice Wallenberg foundation, and the Swedish
Brain Foundation. Povolo has disclosed no relevant financial relationships.
Olsson reported unrestricted MS research grants and compensation for advisory
boards and/or lectures from Biogen, Genzyme, Novartis, AstraZeneca, and
Allmiral.
35th Congress of the European Committee for Treatment and
Research in Multiple Sclerosis (ECTRIMS) 2019: Abstract P396. Presented
September 11, 2019.
https://www.medscape.com/viewarticle/918794?
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