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February 16, 2000

Brain Injury in Amateur Soccer Players—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(7):882-883. doi:10.1001/jama.283.7.882

In Reply: We agree with Dr Babbs that both heading injuries and repeated concussions may cause subtle brain injury in soccer players. Babbs suggests that the role of heading injuries is more prominent than we indicate, considering the degree of impairment and the small number of concussions. However, we used a more severe definition of concussion (that of the Dutch Association of Neurology)1 than Babbs. The confusion about the different grading systems of concussion was recently discussed at a sports-related concussion and nervous system injuries symposium in Orlando, Fla. The group concluded that there should be one classification system for concussion. Furthermore, Babbs' suggestion that a grade I concussion, characterized by confusion without amnesia, cannot have a long-lasting effect is questionable. Recent studies2 showed that neurobehavioral impairment (from mild to severe) due to head trauma can have neurochemical substrate changes indicative of brain tissue damage. Nevertheless, we agree that heading injuries have an impact on cognitive functioning.

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