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Concussion in adolescence and the risk of multiple sclerosis: a retrospective cohort study

Povolo CA, Reid JN, Shariff SZ, Welk B, Morrow SA. Mult Scler. 2021; 27(2):180-7. Epub 2020 Feb 24. DOI:

Background — Physical trauma, specifically concussions sustained during adolescence, has been hypothesized to be a risk factor for multiple sclerosis (MS).

Objective — To examine the association between adolescent concussions and future MS diagnosis.

Methods — This retrospective study using linked administrative databases from Ontario, Canada, identified 97,965 adolescents (age 11–18 years) who sustained ⩾1 concussion and presented to an emergency department between 1992 and 2011. Cases were matched 1:3 with individuals who had not sustained a concussion based on age, sex, address, and index date. The primary outcome was MS diagnosis, using a validated MS diagnosis definition: ⩾1 hospitalization or ⩾5 physician billings within 2 years.

Results — A concussion during adolescence was associated with a significantly increased risk of MS (hazard ratio (HR) = 1.29, p = 0.03). Sex-specific analysis revealed that only males who sustained a concussion in adolescence had a raised risk of MS (HR = 1.41, p = 0.04).

Conclusion — This study supports an association between concussions in adolescence and future MS diagnoses, highlighting the potentially serious long-term effects of concussions.