Concussion

A trial for practical treatments in children

One in five children will experience a concussion before the age of 10 but the jury’s still out on how best to treat them. For around a quarter of these kids, post-concussive symptoms (PPCS) will last several weeks or months after the injury, making it a difficult time for families juggling school and extra-curricular activities.

While there are some published guidelines, clinicians have limited evidence about which PPCS treatments are best and when they should be used. As a paediatric neurologist specialising in traumatic brain injury, I’m keen to find more evidence-based practical treatments to help children recover and help their families get back on track as quickly as possible.

A team of scientists in Australia and Canada, including myself, are now studying whether melatonin can speed up the recovery process. Melatonin is commonly used to help children sleep, and is often prescribed to those with persistent PPCS. There's a substantial amount of evidence from animal-testing suggesting it helps protect the brain after an injury and speeds up recovery.

A patient in the trial.

A patient in the trial.

Using Play Game Trial data from children who experienced PPCS for more than four weeks, we conducted a randomised placebo-controlled trial of sublingual melatonin in 99 children aged between 8 and 18 years old. The children, who were recruited from Alberta Children’s Hospital’s Complex Concussion program in Canada, were randomised to one of three groups: placebo, 3mg of melatonin, or 10mg or melatonin.

After the 28 day trial, we compared the post-concussion symptoms in the three groups and investigated the effects of the melatonin on their quality of life, sleep, cognition and behaviour.

We didn’t end up finding what we were looking for, but we did find a promising path forward. The trial was negative because it didn’t demonstrate any effect of melatonin on PPCS when compared to the placebo. Perhaps we need to use melatonin earlier or for a longer period of time.

We did, however, find evidence to suggest that melatonin may improve hyperactivity and externalising problems. Further, 78 per cent of the children experienced a significant improvement in their symptoms – much greater than expected – and reflects the benefits of the comprehensive care from specialists.

With concussions accounting for 90 per cent of all traumatic brain injuries, it’s a vital step for researchers designing new PPCS treatment trials.

Dr Karen Barlow with a patient during the trial.

Dr Karen Barlow with a patient during the trial.

Dr Karen Barlow currently leads the Acquired Brain Injury in Children Research group at UQCHRC and runs the Complex Concussion program at the Queensland Children’s Hospital and Health Service. Research projects that Dr Barlow is currently involved in can be found at https://child-health-research.centre.uq.edu.au/acquired-brain-injury-children-abic.