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Sports-related concussion: ongoing debate
  1. Semyon Slobounov1,
  2. Jeff Bazarian2,
  3. Erin Bigler3,
  4. Robert Cantu4,
  5. Mark Hallett5,
  6. Robert Harbaugh6,
  7. David Hovda7,
  8. Andrew R Mayer8,
  9. Marc R Nuwer9,10,
  10. Zhifeng Kou11,
  11. Giuseppe Lazzarino12,
  12. Linda Papa13,
  13. Roberto Vagnozzi14
  1. 1Department of Kinesiology and Neurosurgery, Penn State Center for Sports Concussion, The Pennsylvania State University, Penn State Hershey Medical Center, University Park, Pennsylvania, USA
  2. 2Department of Emergency Medicine, Neurology, Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
  3. 3Department of Psychology and Neuroscience, Brigham Young University, Provo, Utah, USA
  4. 4Department of Neurosurgery, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
  6. 6Department of Neurosurgery, Engineering and Mechanics, Penn State Institute of the Neurosciences, Engineering and Mechanics, Penn State University Hershey Medical Center, Hershey, Pennsylvania, USA
  7. 7Department of Neurosurgery, Molecular and Medical Pharmacology, UCLA Brain Injury Research Center, David Geffen School of Medicine, Los Angeles, California, USA
  8. 8The Mind Research Network, Albuquergue, New Mexico, USA
  9. 9Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  10. 10Department of Clinical Neurophysiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
  11. 11Department of Biomedical Engineering and Radiology, Wayne State University School of Medicine, Detroit, Michigan, USA
  12. 12Department of Biology, Geology and Environmental Sciences, Division of Biochemistry and Molecular Biology, University of Catania, Italy
  13. 13Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
  14. 14Department of Biomedicine and Prevention, Section of Neurosurgery, University of Rome ‘Tor Vergata’, Rome, Italy
  1. Correspondence to Dr Semyon Slobounov, Department of Kinesiology and Neurosurgery, Penn State Center for Sports Concussion, The Pennsylvania State University, Penn State Hershey Medical Center, 19 Recreation Hall, University Park, PA 16802, USA; sms18{at}

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Research in mild traumatic brain injury (mTBI), also known as concussion, has increased significantly within the past decade parallel to the increased attention being given from injured athletes on high school, collegiate and professional sports teams. These patients have focused the research community's efforts into further understanding the pathophysiological underpinnings of the injury as well as its both short-term and long-term effects.1 Widespread media coverage and several high-profile cases have raised the issue of possible severe and devastating long-term consequences of repetitive sports-related brain trauma that may involve the acquisition of a proteinopathy2 as well as an increased risk for developing neurodegenerative diseases associated with repetitive concussive and subconcussive blows.3

Following a concussive episode there is a destructive pathophysiological and biochemical response that initiates a chain of neurometabolic and neurochemical reactions that include activation of inflammatory response, imbalances of ion concentrations, increase in the presence of excitatory amino acids, dysregulation of neurotransmitter synthesis and release, imbalance in mitochondrial functions and energy metabolism, and production of free radicals.4 Most of these molecular changes resolve spontaneously but, since cells are highly vulnerable, a second concussive event during this period of altered cell functions may have catastrophic …

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  • Correction notice This paper has been corrected since it was published Online First. The fifth reference has been added.

  • Competing interests None.

  • Contributors All authors contributed equally.

  • Provenance and peer review Not commissioned; externally peer reviewed.