Sridhar Alla

Self-report scales/checklists for the measurement of concussion symptoms: a systematic review

Objective: To identify self-reported sport concussion symptom scales and to describe the psychometric properties of these identified scales. Design: Systematic review. Intervention: PubMed, Medline, CINAHL, Scopus, Web of Science, Sport Discus, PsycINFO and AMED were searched from their establishment until December 2008. The medical subject heading terms “brain concussion”, “signs or symptoms” and “athletic injuries”. The search was limited to articles published in English. An additional search of the reference lists of the retrieved articles was conducted. Only full-text articles were considered for this study and these were retrieved to determine whether they met the inclusion criteria. Results: The initial search resulted in 421 articles, which were reduced to 290 articles after removing duplicates. The hand search resulted in 17 articles, thus giving a total of 307 articles. Full text was available for 295 articles of which 60 met the criteria for inclusion. The excluded 235 articles were case reports, reviews and guidelines on concussion management or studies that had not used a symptom scale or checklist. Conclusions: Six core scales were identified with a broad range of symptom items but with limited information on their psychometric properties. There were numerous derivative scales reported, most of which have not been methodically developed or subjected to scientific scrutiny. Despite this, they do make a contribution to the detection, assessment and return to play decisions but there is a need for the clinical user to be aware that many of these scales have “evolved” rather than being scientifically developed.

Does exercise evoke neurological symptoms in healthy subjects

Concussion is a common injury in collision sports and is evidenced by a variety of signs and symptoms. The recording of neurological symptoms is an important component of screening for a concussion and in return-to-play decisions. However similar symptoms are prevalent in the general population and are reported to be associated with participation in physical activities. The purpose of this study was to document the neurological symptoms reported by healthy individuals following controlled bouts of exercise. A crossover randomised design with 2 levels of exercise intensity, moderate intensity and high intensity, each of 15min duration was used. Participants completed a standardised postconcussion symptom checklist prior to exercise (pre), immediately following exercise (post-1) and again after 15 min of rest (post-2). 60 participants were recruited into the study. A summed symptom score was calculated and analysed with a 2-way repeated measures ANOVA procedure. The intensityxtime interaction (F(2,118)=23.94, p<0.001) demonstrated a significant increase in symptom scores for the high intensity condition immediately following exercise (p<0.001). Although the moderate intensity showed a similar trend this was not significant. These findings suggest that sports medicine professionals need to be aware of the effect of exercise on symptom reporting when assessing and in making return-to-play decisions.

Deep grey matter MRI abnormalities and cognitive function in relapsing-remitting multiple sclerosis.

Although deep grey matter (GM) involvement in multiple sclerosis (MS) is well documented, in-vivo multi-parameter magnetic resonance imaging (MRI) studies and association with detailed cognitive measures are limited. We investigated volumetric, diffusion and perfusion metrics in thalamus, hippocampus, putamen, caudate nucleus and globus pallidum, and neuropsychological measures, spanning 4 cognitive domains, in 60 relapsing-remitting MS patients (RRMS) (mean disease duration of 5.1 years, median EDSS of 1.5) and 30 healthy controls. There was significantly reduced volume of thalamus, hippocampus and putamen in the RRMS patients, but no diffusion or perfusion changes in these structures. Decreased volume in these deep GM volumes in RRMS patients was associated with a modest reduction in cognitive performance, particularly information processing speed, consistent with a subtle disruption of distributed networks, that subserve cognition, in these patients. Future longitudinal studies are needed to elucidate the influence of deep GM changes on the evolution of cognitive deficits in MS.

Multiple sclerosis in New Zealand.

New Zealand (NZ) is a high risk country for multiple sclerosis (MS) with an overall age and sex standardised prevalence of 73.1 per 100,000 population. The age and sex standardised prevalence within the Māori population is substantially lower at 24.2 per 100,000 population. A latitudinal gradient exists with MS prevalence increasing threefold from the North (37°S) to the South (48°S) of NZ. Over 1600 (56.8%) persons with MS experience moderate to severe disability. Despite the high prevalence of MS and the significant degree of disability experienced by people with MS, the availability and prescribing guidelines for MS disease modifying treatments are more restrictive in NZ than in other developed nations.

The Increasing Prevalence of Multiple Sclerosis in New Zealand

Background: New Zealand (NZ) has a high prevalence of multiple sclerosis (MS). Worldwide, the prevalence of MS appears to be increasing. Objectives: To review all published prevalence studies undertaken in NZ to determine whether the prevalence of MS in NZ is increasing. Methods: PubMed, Medline, Scopus, Web of Knowledge, EMBASE, AMED and CINAHL were searched to identify studies reporting the prevalence of MS in NZ. Prevalence rates from the National MS Prevalence study in 2006 were compared with earlier prevalence rates for the same regions using Poisson regression. Results: Prevalence rates reported in the earlier regional studies ranged from 23.6 to 68.5/100,000 population; in the same regions in 2006, the range was 47.6-134.2/100,000 population. Prevalence rates were significantly increased in all regions studied except for the Bay of Plenty. The increase in prevalence was seen in both sexes. The sex ratio remained constant over time. Conclusions: In studies spanning almost 40 years (1968-2006), the prevalence of MS within the same regions of NZ has significantly increased whereas the sex ratio and latitudinal gradient have remained stable.

Multiple sclerosis in New Zealand Māori

The prevalence of MS in New Zealand in 2006 was 73.2 (age standardized per 100,000) while for those with indigenous Māori ancestry it was 3.6 times lower at 20.6. Earlier regional surveys (1968–2001) all reported much lower, or zero, prevalence for Māori than European. There was no evidence for differences in MS between those with and without Māori ancestry in either clinical features or latitude, confirming that Māori ancestry does not produce the reported increase in prevalence with latitude. It is likely that prevalence is increasing in low risk Māori; however, MS prognosis is independent of Māori ancestry.

Multiple Sclerosis impact on employment and income in New Zealand

We investigated the demographic, social and clinical characteristics associated with employment status and income for people with multiple sclerosis (MS) in New Zealand (NZ).

An investigation of the relationship between latitude and multiple sclerosis severity in New Zealand

Associations between latitude and the prevalence of multiple sclerosis are well recognized,1–3 although the association is not seen in some geographical regions.4 The 2006 New Zealand National Multiple Sclerosis Prevalence Study (NZMSPS)5 reported a three-fold increase in multiple sclerosis prevalence with increasing latitude from northern (37.9°S) to southern (45.8°S) regions of New Zealand. In addition, the study found that of the 2422 subjects assessed, 60% had moderate to severe disability (Expanded Disability Status Score (EDSS)6 score 3.5 to 9.5). There has been little previous investigation of whether disease severity is related to latitude. We therefore investigated, using data acquired in the NZMSPS, whether latitude is associated with disease severity in New Zealand.

Disability profile of multiple sclerosis in New Zealand.

New Zealand is a high risk region for multiple sclerosis (MS). The aim of this study was to investigate demographic, clinical and temporal factors associated with disability status in the New Zealand National Multiple Sclerosis Prevalence Study (NZNMSPS) cohort. Data were obtained from the 2006 NZNMSPS with MS diagnosis based on the 2005 McDonald criteria. Disability was assessed using the Expanded Disability Status Scale (EDSS). Disability profiles were generated using multiple linear regression analysis. A total of 2917 persons with MS was identified, of whom disability data were available for 2422 (75% females). The overall disability was EDSS 4.4±standard deviation 2.6. Higher disability was associated with older age, longer disease duration, older and younger ages of onset, spinal cord syndromes with motor involvement at onset, and a progressive onset type. Lower disability was associated with sensory symptoms at onset and a relapsing onset type. Overall, the factors studied explained about one-third of the variation in disability, and of this, about two-thirds was accounted for by age, age of onset and disease duration and one-third by the nature of first symptoms and type of disease onset (progressive or relapsing). Current age, age at onset and disease duration all had independent associations with disability and their effects also interacted in contributing to higher disability levels over the course of the disease.