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11 October 2015

Neurologist talks school rugby after son's concussion

This article was first published in October 2015

Professor Matthias Koepp is a neurologist at Epilepsy Society. He is also father to two teenage boys, Noah, 16, (left, below) and Joshua, 13. Both of them are keen rugby players. Here he talks about the dilemma of being both a dad and a neurologist on the touchline and about his anxiety following Noah's recent concussion during a game.

'Watching my two boys play rugby in their school teams has always concerned me as a neurologist. Of course you are on the touchline cheering them on, wanting them to win, but particularly by the age of 16 these boys are huge. They are heavy, they are fit, but their frontal lobes are not fully developed so they have no fear. They do not fully understand the consequences of their actions. They think they are invincible and the adrenaline is pumping.

'In my experience I think the game within the school environment is made as safe as it can be. The boys are taught the rules of the game, they are given very clear safety guidelines and training covers all the appropriate  techniques and dangers. And an ambulance is just a call away.

'But are the boys really aware of how precious their brains are? I don't think so. There is huge camaraderie both on and off the pitch which I applaud. They are out to win, they are out for glory. They are told to tackle low but it doesn't always happen and there is a certain kudos and heroism in an injury. The last thing the boys are focusing on is their health.

Epilepsy risk from TBI

'The long-term risk of epilepsy from a non-penetrative traumatic brain  injury is relatively low, between 1-2 per cent. The real long-term risk from concussion is cognitive decline and dementia.

'There are two peak periods of development for the brain when it is rapidly re-organising  and fine tuning itself. The first is from birth to the age of two and this is when we see the terrible twos.

'The second is during adolescence from 12 to 16 years old - those turbulent teenage years. Again this is a period of fine-tuning for the brain. Cells are dying and neurons streamlining themselves to become more efficient. During both these peak periods the brain is very vulnerable and a bang to the head can be far more injurious than at any other time.

'In school rugby, 24 per cent of injuries are head injuries sustained during a tackle. In adult amateur rugby 72 per cent of all concussions are sustained during a tackle. Research is showing that rugby players who sustain more than four concussions perform worse in tests measuring mental and physical co-ordination, motor speed and multi-tasks.

School rugby concussion

'My eldest son Noah was brought home in an ambulance recently after suffering concussion during a school rugby match. Neither my wife nor I were at the game so we didn't see what happened and no-one is certain about whether Noah was knocked unconscious.

'However he was suffering from sickness and confusion and could not see properly. The only reason that the school did not did send him straight to hospital was because both my wife and I are neurologists.

'The weekend was very worrying with Noah being drowsy and suffering from numbness on his cheek and upper lip. He had blurred vision and developed an orbital hematoma which must have been pressing on his trigeminal nerve. We were having to wake him every 15 minutes and check on him throughout the night. We took him to A&E the next day, but an x-ray showed there was no fracture. Two weeks later he is still left with numbness and pins and needles which suggest nerve damage.

There are two peak periods of development for the brain when it is rapidly re-organising  and fine tuning itself. The first is from birth to the age of two... the second is during adolescence from 12 to 16 years old.

'Following this incident I am adamant I do not want Noah playing rugby again. The school protocol means he cannot play for another six weeks and I hope that will almost take him through to the end of the season.

'Noah has always loved playing rugby and he loves watching the game, but I think he is reluctantly starting to realise that he does not have the right physique for the game, that maybe he needs to look at other sports.

'Then there is Joshua. At 13 he is already taller and heavier than his brother and a prop in the school team. I tell him he should wear a scrum cap but he says the other boys don't and peer pressure is a very powerful thing.

Advice about rugby and epilepsy

'So where does that leave me as a neurologist advising parents or players about the risks and dangers on the field, particularly for people with epilepsy? I would say that for anyone with epilepsy, the risks of head injury and subsequent neurodegenerative disease are the same as for anyone else. Having epilepsy should not be a barrier to playing the game but it should be a conversation with a neurologist. Rugby, and even football, are physical games that come with risks.

'A new film, Concussion, is coming out at Christmas starring Will Smith as the Pittsburgh pathologist (right) who first discovered chronic traumatic encephalopathy in the brains of American football players. This sport is much faster than rugby and the acceleration/deceleration traumas caused are a known trigger for dementia.

'While a recent study looking at the brains of people with epilepsy did not show that there were any more cases of Alzheimer's  disease pathology than anticipated, there was a correlation between the number of incidents of traumatic brain injury and Alzheimer pathology in this study. This would suggest there could possibly be a link between concussion, epilepsy and dementia.

'Will my boys listen? I don't think so, but maybe a trip to the cinema over Christmas....

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