Post-concussion Syndrome Symptoms Research Articles

Investigation of long-term symptoms and influencing factors in patients with mild traumatic brain injury: A cross-sectional study

BackgroundTraumatic brain injury is the leading cause of death and disability in individuals under the age of 45, which places a heavy disease burden on patients and society. However, the prevalence of long-term symptoms in individuals who suffered from mild traumatic brain injury and how psychosocial factors affect their long-term symptoms remain unclear. ObjectiveTo determine howpsychosocial factors influence long-term symptomsin individuals who suffered from mild traumatic brain injury as well as the prevalence of long-term symptoms. MethodsA demographic characteristics questionnaire, adapted self-report questionnaire of family relationship quality, revised Chinese version of the disease perception questionnaire, Rivermead postconcussion syndrome symptom questionnaire, Glasgow Outcome Scale-Extended, and Brief Symptoms Inventory 18 were used to collect data anonymously. Psychosocial factors associated with long-term symptoms in individuals who suffered from mild traumatic brain injury weremeasuredusingmultiple linear regression. ResultsMore than half of individuals who suffered from mild traumatic brain injury showed at least 1 long-term symptom after injury. Our results indicated that family relationship quality, disease perception, and demographic characteristics were related to the long-term symptoms of individuals who suffered from mild traumatic brain injury. ConclusionsOur study shows that theprevalence of long-term symptomsfollowingmild traumatic brain injuryishigh. Psychosocial factors are related to patients' long-term symptoms.The findings indicate that healthcare administrators ought to adopt a robust health promotion strategy that prioritizes familial support and health education of diseases to ameliorate long-term symptoms in individuals who suffered from mild traumatic brain injury.

Neuro-psychiatric symptoms in directly and indirectly blast exposed civilian survivors of urban missile attacks

BackgroundBlast-explosion may cause traumatic brain injury (TBI), leading to post-concussion syndrome (PCS). In studies on military personnel, PCS symptoms are highly similar to those occurring in post-traumatic stress disorder (PTSD), questioning the overlap between these syndromes. In the current study we assessed PCS and PTSD in civilians following exposure to rocket attacks. We hypothesized that PCS symptomatology and brain connectivity will be associated with the objective physical exposure, while PTSD symptomatology will be associated with the subjective mental experience.MethodsTwo hundred eighty nine residents of explosion sites have participated in the current study. Participants completed self-report of PCS and PTSD. The association between objective and subjective factors of blast and clinical outcomes was assessed using multivariate analysis. White-matter (WM) alterations and cognitive abilities were assessed in a sub-group of participants (n = 46) and non-exposed controls (n = 16). Non-parametric analysis was used to compare connectivity and cognition between the groups.ResultsBlast-exposed individuals reported higher PTSD and PCS symptomatology. Among exposed individuals, those who were directly exposed to blast, reported higher levels of subjective feeling of danger and presented WM hypoconnectivity. Cognitive abilities did not differ between groups. Several risk factors for the development of PCS and PTSD were identified.ConclusionsCivilians exposed to blast present higher PCS/PTSD symptomatology as well as WM hypoconnectivity. Although symptoms are sub-clinical, they might lead to the future development of a full-blown syndrome and should be considered carefully. The similarities between PCS and PTSD suggest that despite the different etiology, namely, the physical trauma in PCS and the emotional trauma in PTSD, these are not distinct syndromes, but rather represent a combined biopsychological disorder with a wide spectrum of behavioral, emotional, cognitive and neurological symptoms.

Post-Traumatic Craniocervical Disorders From a Postural Control Perspective: A Narrative Review.

Mild traumatic brain injury (mTBI) and whiplash injury (WI) may lead to long-term disabling consequences known as post-concussive syndrome (PCS) and whiplash-associated disorders (WADs). PCS and WAD patients commonly complain of conditions encompassing dizziness, vertigo, headache, neck pain, visual complaints, anxiety, and neurocognitive dysfunctions. A proper medical work-up is a priority in order to rule out any acute treatable consequences. However investigations may remain poorly conclusive. Gathered in the head and neck structures, the ocular sensorimotor, the vestibular, and the cervical proprioceptive systems, all involved in postural control, may be damaged by mTBI or WI. Their dysfunctions are associated with a wide range of functional disorders including symptoms reported by PCS and WAD patients. In addition, the stomatognathic system needs to be specifically assessed particularly when associated to WI. Evidence for considering the post-traumatic impairment of these systems in PCS and WAD-related symptoms is still lacking but seems promising. Furthermore, few studies have considered the assessment and/or treatment of these widely interconnected systems from a comprehensive perspective. We argue that further research focusing on consequences of mTBI and WI on the systems involved in the postural control are necessary in order to bring new perspective of treatment.

Falling Out of Time, Relationships, and Mood: A Case Study of Post-Concussion Syndrome

Abstract In this article, the authors examine post-concussion syndrome (PCS) from an existential-phenomenological perspective, specifically as a Heideggerian analysis of Dasein (or Daseinsanalysis; Condrau, 1988). As a medical syndrome, PCS was once defined in terms of its pathophysiology. However, in the absence of reliable evidence of pathophysiology, PCS has been removed from the DSM-5. We have suspended the natural attitude, in this case the biomedical model, and have taken seriously the symptoms of PCS as indications that meaningful changes have occurred within the structure of the patient’s existence. Following the medical theories of Goldstein (1995) and Gadamer (1996), the authors describe the significance of PCS as it is lived by Tyrese, an NCAA Division II football player whose series of concussions left him permanently sidelined. Careful consideration is paid to the existential dimensions of the syndrome, specifically the backgrounds of temporality, sociality, and attunement. In conclusion, a new approach to rehabilitation is explored.

Prevalence of post-concussion syndrome and associated factors among patients with traumatic brain injury at Debre Tabor Comprehensive Hospital, North Central Ethiopia.

The occurrence of three or more of the following signs and symptoms, such as headache, dizziness, exhaustion, irritability, sleeplessness, difficulties in concentrating, or memory problems, following a head injury is referred to as post-concussion syndrome (PCS). Even though post-concussion syndrome has not been studied in Ethiopia, the productive age group is frequently affected by health issues related to head trauma, which either directly or indirectly affect the growth of the nation. To assess the prevalence and associated factors of post-concussion syndrome among patients with traumatic brain injury at Debre Tabor Comprehensive Hospital, Debre Tabor, North Central Ethiopia. A successive sampling technique was used to conduct a hospital-based cross-sectional study on 405 traumatic brain injury patients at Debre Tabor Comprehensive Hospital from January 1, 2022, to May 30, 2022. SPSS version 25 was used to analyze the data. The factors connected to post-concussion syndrome were found using bivariate and multivariable logistic regression analysis. Statistical significance was determined by a P-value of ≤ 0.05. During the data collection period, 405 cases in total were interviewed, with a 98% response rate. More than half (60.7%) of patients were married, with the majority of patients (39.8%) falling between the ages of 18 and 29. At least three post-concussion syndrome symptoms were present in 42.8% of subjects. A history of comorbidities, GCS levels of 8 or below, 9 to 12 at the time of presentation, brain neuroimaging findings, and having fair or poor social support were found to be substantially linked with PCS in multivariate logistic regression. About 41.5% of study participants had at least three symptoms of PCS. The Glasgow coma scale level at the time of presentation, the reason for the injury, social support, and the site of the injury were all significantly associated with the occurrence of PCS.

The Relation of Subjective and Objective Assessment of Sleep quality with Post Concussive Symptoms in Veterans

Sleep complaints are a significant and persistent health problem reported by military Veterans. Veterans with traumatic brain injury (TBI) experience a higher incidence of sleep disturbances, with mild TBI (mTBI) resulting in chronic sleep disruption post injury. However, the relation between sleep and mTBI history is still poorly understood.PurposeThe purpose of this study is to assess sleep using subjective (Pittsburgh Quality Sleep index; PSQI) and objective (actigraphy) measurements in Veterans with a history of mTBI using remote assessments.MethodsSeven Veterans (7 Males; age: 54±7yrs, body mass index (BMI): 31±7 kg/m2 mean±SD) completed a telemedicine VA clinical evaluation and enrolled in the study. Participants completed web‐based versions of the PSQI to assess subjective sleep quality (range 0‐21) and the Neurobehavioral Symptom Inventory (NSI) to assess post concussive syndrome (PCS) symptoms (range 0‐88). Participants wore a wrist‐worn actigraph (wGT3X‐BT) over a 7‐day baseline period to measure total sleep time and sleep variability (standard deviation) from home. Data were analyzed using Pearson’s correlations.ResultsNSI scores are significantly correlated with global PSQI (R2=0.81, P=0.02) where higher NSI scores are associated with a greater PSQI total score. There is no relation between NSI score and sleep time (R2=0.22, P=0.34). There are trending relations between sleep time variability (R2=0.50, P=0.07) and sleep disturbances (R2=0.5, P=0.10; ex. Feeling too hot or too cold, having bad dreams) and NSI, such that those with higher NSI scores have greater sleep variability and sleep disturbances.ConclusionHome‐based assessments offer a promising means of monitoring sleep in Veterans. Our preliminary data suggests that subjective measurement of sleep relate to PCS symptoms, however trending results suggest that specific features of sleep quality may be affected by mTBI history. Remote evaluations are critical to understand sleep quality of Veterans to aid improvements in PCS symptoms following mTBI.

Post-Concussion Syndrome Latent Onset Related to Intracranial Lesion on Head Injury Patient in Dr. M. Djamil General Hospital Padang

Background. Post-concussion syndrome is associated with damaged axons in patients with a mild head injury but little is known about their consequences for brain tissue. This study aims to examine the relationship between latent onset post-concussion and intracranial lesions in head injury patients at Dr. M. Djamil General Hospital Padang.
 Methods. The research design is an analytical observational study with a cross-sectional approach. A total of 25 patients with head injuries participated in this study with inclusion criteria being hospitalized patients alive without physical and mental disabilities and patients diagnosed with latent onset post-concussion syndrome (PCS) without any additional diagnoses for patients with a history of trauma.
 Results. The average age of the respondents in this study was 34.08 ± 17.45 years and more than half of the respondents were male, namely 18 (72%) respondents. half of respondents with persistent PCS symptoms > 6 months experienced EDH, as many as 5 (55.6%) respondents, ICH 2 (66.7%) respondents, and cerebral contusion 6 (60%) respondents. The results of statistical tests showed that there was no relationship between latent onset PCS and lesion appearance (p>0.05). The results of statistical tests showed that there was no relationship between latent onset PCS and the degree of head injury (p>0.05).
 Conclusion. There is no significant relationship between post-concussion syndrome (PCS) latent onset with a degree of head injury and lesion description in head injury patients at Dr. M. Djamil General Hospital Padang.

Different Methods for Traumatic Brain Injury Diagnosis Influence Presence and Symptoms of Post-Concussive Syndrome in United States Veterans.

Common methods for evaluating history of traumatic brain injury (TBI) include self-report, electronic medical record review (EMR), and structured interviews such as the Head Trauma Events Characteristics (HTEC). Each has strengths and weaknesses, but little is known regarding how TBI diagnostic rates or the associated symptom profile differ among them. This study examined 200 Veterans recruited within the VA Portland Health Care System, each evaluated for TBI using self-report, EMR, and HTEC. Participants also completed validated questionnaires assessing chronic symptom severity in broad health-related domains (pain, sleep, quality of life, post-concussive symptoms). The HTEC was more sensitive (80% of participants in our cohort) than either self-report or EMR alone (40%). As expected from the high sensitivity, participants screening positive for TBI through the HTEC included many people with mild or no post-concussive symptoms. Participants were grouped according to degree of concordance across these diagnostic methods: no TBI, n = 43; or TBI-positive in any one method (TBI-1dx, n = 53), positive in any two (TBI-2dx, n = 45), or positive in all three (TBI-3dx, n = 59). The symptom profile of the TBI-1dx group was indistinguishable from the no TBI group. The TBI-3dx group had the most severe symptom profile. Our results show that understanding the exact methods used to ascertain TBI is essential when interpreting results from other studies, given that results and conclusions may differ dramatically depending on the method. This issue will become even more critical when interpreting data merged from multiple sources within newer, centralized repositories (e.g., Federal Interagency Traumatic Brain Injury Research [FITBIR]).

Hyperbaric oxygen therapy ameliorates the symptoms of post-concussion syndrome by inhibiting MMP-9 activity: a randomized controlled trial in Indonesia

Introduction: Post-concussion syndrome is common in young adults and can greatly interfere with the quality of daily life. It has a wide range of symptoms that require prompt and well-targeted treatment to avoid further brain impairment. Hyperbaric oxygen therapy (HBOT) is a promising regenerative treatment option for these patients to help prevent the progression of post-concussion syndrome. This study aims to determine whether HBOT accelerates the healing process and reduces symptoms in patients with post-concussion syndrome. Methods: 20 patients with post-concussion syndrome participated in this randomized controlled trial study. After receiving standard mild traumatic brain injury treatment in accordance with the Advanced Trauma Life Support guidelines, the patients were divided into HBOT and control groups. Matrix metallopeptidase 9 (MMP-9) levels and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) scores were used to compare the two groups (before HBOT & after 1st, 3rd, and 5th week). Results: The study sample was predominantly male (65%) with an average age of 60 years old. HBOT reduced serum MMP-9 levels by nearly 20 ng/mL (p < 0.001) compared with the control treatment. The efficacy of HBOT was also reflected in the RPQ scores, which were significantly lower in the HBOT group than the control group (before HBOT & after 1st, 3rd, 5th week) (-3.80 on RPQ-3, p = p<0.001; -16.20 on RPQ-13, p = p<0.001). Conclusion: HBOT ameliorated the symptoms associated with post-concussion syndrome through a mechanism that involves MMP-9 activity. The accelerated recovery observed in the present study supports the use of HBOT to treat post-concussion syndrome and potentially other forms of traumatic brain injury.

Анализ симптоматики и функционального исхода легкой черепно-мозговой травмы

The consequences of TBI are most often grouped into the so-called Post-concussion Syndrome (PCS). At present, there is no clear understanding of the evolution, duration, or resolution of the symptoms of PCS after mild traumatic brain injury (mTBI). Aim of the study. A prospective characterization of the frequency and evolution of PCS symptoms and outcomes of patients after mTBI for 3, 6, and 12 months in a large prospective cohort of patients in the emergency department. Material and methods. A total of 375 patients met the inclusion criteria. Patients were evaluated using the PCS checklist, as well as the Extended Glasgow Outcome Scale (EGOS), the Short List of Symptoms-18 (SLS-18), the Rivermead Post-Concussion Questionnaire (RPCQ), and the Life Satisfaction Scale (LSS). Results. The population was 70.1% male, with a median age of 44 years. Approximately 44% of the population were considered to have complicated mTBI, having positive results of computed tomography (CT). The average injury severity score (ISS), calculated only for patients admitted to the hospital, was 9.37±9.72 (279 in total). ISS was significantly higher in patients with positive CT (16.5±8.39) compared to patients with negative CT (3.8±6.6). Conclusion. Patients with negative CT scans had significantly increased rates of neurological problems, prior TBI, and alcohol use, which may contribute to increased symptoms and a deterioration in BSI-18 scores. After examining only those patients with a negative history of the disease, there was no significant difference between the groups with positive and negative results for any indicator of outcome.

Post-Concussion Syndrome and Factors Associated With Post- Concussion Syndrome Following Mild Traumatic Brain Injury

Background: Traumatic Brain Injury (TBI) is a worldwide public health concern especially in developingcountries. This study was conducted to describe the prevalence, severity symptoms and determine factorsassociated with post-concussion syndrome (PCS) following mild traumatic brain injury (MTBI).Methods: A cross-sectional study was carried out with 218 patients following MTBI after dischargedhospital from one week to one year at Odor Meanchey Provincial Hospital (OMCPH) and Anlong VengReferral Hospital (AVRH). Multiple linear regression was applied to determine factors association.Results: Of the total 218 patients following MTBI, 79.4% had symptoms of PCS, with 5.8% re-hospitalizationdue to PCS. The most frequently occurring symptoms in PCS following MTBI were from headache 71.7%,being irritable 68.8%, forgetfulness 66.5%, fatigue 62.4%, and taking longer to think 57.2%. Marital statusß=-.236, p=.001, loss of consciousness (LoC) at the time of injury ß=-.205, p=.003, length of hospitalizationß=.288, p<0.001, and readmission ß=-.271, p<0.001 were statistically associated with PCS following MTBI.Conclusion: Majority of patients had symptoms of PCS. The most frequent symptoms were headache, beingirritable, and forgetfulness. Socio-demographic and injury characteristics factors play an essential role inPCS following MTBI.

Effects of CranioSacral therapy upon symptoms of post-acute concussion and Post-Concussion Syndrome: A pilot study

ObjectiveThe purpose of this study was to investigate the utilization of CranioSacral Therapy (CST) in patients with Post-Concussion Syndrome (PCS) and capture patient-reported perceptions of clinical outcomes of lived treatment experiences. DesignTwo-part, longitudinal study conducted through a chart review of target group, followed by a Patient-reported Treatment Outcome Survey (PTOS). ParticipantsA convenience sample of 212 patients with a historical incidence of head trauma not requiring hospitalization was obtained through medical records department dating back ten years. Inclusion criteria for further chart review (n = 67) was determined by identifying patients with a confirmed concussion directly correlated with presenting symptoms and for which CST was specifically sought as a treatment option. Demographics and patient-determined treatment duration data were analyzed by comparison groups extensively suggested in existing literature: Recovery time since injury as either Post-acute concussion (<6 months) or Post-Concussion Syndrome (PCS) (≥6 months); Athletes (A) or Non-athletes (NA); and traditional gender. Final PTOS group criteria was determined by eliminating confounding issues reporting (n = 47): (A, n = 24 and NA, n = 23). ResultsQuantitative data was analyzed via Numerical Analysis, and qualitative data was analyzed via Inductive Content Analysis. Symptoms reported in all charts as well as in the PTOS were consistent with identified PCS subtypes. Utilization of CST revealed that most patients determined the treatment effect upon concussion symptoms within 1–3 sessions. Nearly twice as many sessions were attended in the PCS than post-acute groups. Referral sources, studied for a perspective on local concussion after-care discharge planning, ranged from professional to personal recommendation or self-discovery. A majority of patients met goals of reducing post-acute or PCS as reasons cited by self-determined change-in-status or discharge from service. Patients were asked to indicate on the PTOS which pre- and post-treatment symptoms were helped or not helped by this particular intervention. ConclusionsPatient-reported changes of PCS symptoms is critical when evaluating treatment options. CST is an experiential treatment that addresses subjective levels of dysfunction, thus it is the patient deciding the value of an intervention. A sizable portion of patients in all groups reported a positive effect upon their symptoms by CST. Patients indicated personal meaning to CST through their utilization of multiple sessions. A high percentage indicated the likelihood of referring others with PCS for CST. Of the 212 patient charts first studied, the 145 not meeting inclusion criteria suggest some chronic conditions may present as long-term effects of older head injuries. CST is a low-risk, conservative treatment option for PCS sub-types worthy of further clinical study.

Reader Response: Exosomal Neurofilament Light: A Prognostic Biomarker for Remote Symptoms After Mild Traumatic Brain Injury?

Guedes et al.1 measured exosomal and plasma biomarkers in veterans with a history of mild traumatic brain injury (mTBI) and tested their relationships with chronic symptoms. Neurofilament light (NfL) chain, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and vascular endothelial growth factor were measured, and the symptoms of postconcussive syndrome (PCS), posttraumatic stress disorder (PTSD), and depression were evaluated. Repetitive mTBIs are associated with elevated exosomal and plasma levels of NfL chain, with the greatest elevations in those with chronic PCS, PTSD, and depression symptoms. The authors speculated that there is a possible neuroinflammatory and axonal disruptive basis for symptoms that persist years after mTBI, especially in repetitive cases. I have a concern about their study.

CORTICAL INTEGRATIVE THERAPY EFFECTIVENESS IN THE TREATMENT OF POST-CONCUSSION SYNDROME AND MILD TRAUMATIC BRAIN INJURY

Post-Concussion Syndrome (PCS) is a relatively prevalent condition that emerges after sustaining a head injury. Individuals with PCS experience prolonged impairments and distress associated with the injury which can impact the individuals’ quality of life experiences. In this retrospective chart review of refractory adult patients diagnosed with PCS and mild Traumatic Brain Injury (mTBI), the effectiveness of Cortical Integrative Therapy (PedroCIT®) was investigated by comparing measures of postural stability, brain sequencing and timing, and self-reports of physical and psychosocial symptoms of PCS obtained before and after PedroCIT®. Multivariate and Repeated Measures General Linear Models showed improvements across the measures from before to after treatment in all subjects, highlighting the effectiveness of PedroCIT®. To further underscore the capacity of PedroCIT® to elicit improvements in patients who have been resistant to treatment prior to PedroCIT®, the duration of time that the subjects underwent PedroCIT® was compared to the duration of time since the injury to the subjects’ first PedroCIT® intervention session. The findings of this study showed significant improvements from pre- to post-treatment in postural stability, brain sequencing and timing, and self-reported symptoms for patients affected by PCS and mTBI, and treatment outcomes were largely not contingent upon the severity of the condition at the beginning of treatment. Altogether, this retrospective study suggests that refractory individuals affected by PCS and mTBI can benefit from undergoing PedroCIT® and their treatment outcomes may not be related to the degree of impairment presented at the beginning of treatment.

Head- and neck-related symptoms post-motor vehicle collision (MVC): Separate entities or two-sides of the same coin?

Although post-motor vehicle collision (MVC) pain and symptoms are largely convergent among those with mild traumatic brain injury (mTBI) and whiplash associated disorder (WAD), and patients oftentimes report initial neck and head complaints, the clinical picture of mTBI and WAD has been primarily studied as separate conditions which may result in an incomplete clinical picture. As such, this study was conducted to explore the role of pain and post-traumatic psychological features in explaining both head and neck-related symptom variability in a cohort of post-collision patients. This is with the goal of disentangling if contributory factors are uniquely related to each diagnosis, or are shared between the two. Patients recruited in the very early acute phase (<72h) returned for clinical and psychological assessment at 6 months post-accident. In order to determine which factors were unique and which ones were overlapping the same potential contributors: mean head pain, mean neck pain, female gender, number of post-collision painful body areas, PTSD, and depression were included in the regression models for both neck disability index (NDI) and Rivermead post-concussion symptoms questionnaire (RPQ). Of 223 recruited participants, 70 returned for a follow-up visit (age range 18-64, mean(SD) 37.6 (11.9), 29F). This cohort primarily met the criteria for mTBI, but also fulfilled the criteria for whiplash, reinforcing the duality of injury presentation. Correlations existed between the NDI and RPQ scores (Spearman's ρ=0.66, p<0.001), however overlap was only partial. Regression analysis showed that after the removal of area-of-injury pain neck related disability (r=0.80, p <0.001) was explained solely by number of painful body areas (ß=0.52, p <0.001). In contrast, post-concussion syndrome symptoms (r=0.86, p<0.001) are influenced by clinical pain, painful body areas (ß=0.31, p=0.0026), female gender (ß=0.19, p=0.0053), and psychological factors of depression (ß=0.31, p=0.0028) and PTSD symptoms (ß=0.36, p=0.0013). It seems that while mechanisms of neck- and head-related symptoms in post-collision patients do share a common explanatory feature, of residual body pain, they are not entirely overlapping. In that psychological factors influence post-concussion syndrome symptoms, but not post-whiplash neck disability.

Specialty-Specific Diagnoses in Pediatric Patients With Postconcussion Syndrome: Experience From a Multidisciplinary Concussion Clinic.

Objective:To describe the collaborative findings across a broad array of subspecialties in children and adolescents with postconcussion syndrome (PCS) in a pediatric multidisciplinary concussion clinic (MDCC) setting.Design:Retrospective analysis.Setting:Multidisciplinary concussion clinic at a pediatric tertiary-level hospital.Patients:Fifty-seven patients seen in MDCC for evaluation and management of PCS between June 2014 and January 2016.Interventions:Clinical evaluation by neurology, sports medicine, otolaryngology, optometry, ophthalmology, physical therapy, and psychology.Main Outcome Measures:Specialty-specific clinical findings and specific, treatable diagnoses relevant to PCS symptoms.Results:A wide variety of treatable, specialty-specific diagnoses were identified as potential contributing factors to patients' postconcussion symptoms. The most common treatable diagnoses included binocular vision dysfunction (76%), anxiety, (57.7%), depression (44.2%), new or change in refractive error (21.7%), myofascial pain syndrome (19.2%), and benign paroxysmal positional vertigo (17.5%).Conclusions:Patients seen in a MDCC setting receive a high number of treatable diagnoses that are potentially related to patients' PCS symptoms. The MDCC approach may (1) increase access to interventions for PCS-related impairments, such as visual rehabilitation, physical therapy, and psychological counseling; (2) provide patients with coordinated medical care across specialties; and (3) hasten recovery from PCS.

Ability of S100B to predict post-concussion syndrome in paediatric patients who present to the emergency department with mild traumatic brain injury

Introduction Among children who sustain mild traumatic brain injury (mTBI), 10–30% develop a cluster of cognitive, physical, and emotional symptoms commonly referred to as post-concussion syndrome (PCS). Symptoms typically resolve within 7–10 days, but a minority of patients report symptoms that persist for months or even years. The aim of our study was to identify a neurobiochemical marker after mTBI that can predict the presence of post-concussion syndrome three months after head injury in paediatric patients. Materials and methods Children between 7 and 16 years of age who had head trauma and no other complaints were included. Three months after the initial visit, participants or parents/guardians were interviewed in person about the children’s PCS symptoms using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Results The mean value of S100B protein in serum in 38 patients without signs of PCS was 0.266 μg L−1, with a 95% confidence interval (CI) of 0.221 − 0.310 μg L−1. Among the 22 patients with signs of PCS, the mean value of S100B protein in serum was 0.845 μg L−1, with a 95% CI of 0.745–0.945 μg L−1. Patients with signs of PCS had higher S100B protein levels than those without signs of PCS (p < 0.0001). Conclusions Our prospective study showed that S100B protein is a useful neurobiomarker for detecting paediatric patients at risk for post-concussion syndrome. We found that the biomarker S100B correlated with the severity of traumatic brain injury (number of lesions on CT) and the presence of post-concussion syndrome.

Cognitive complaint and objective cognition during the post-acute period after mild traumatic brain injury in pre-morbidly healthy adults

ABSTRACT Primary Objective: The most widely used proxies of cognitive complaint after mTBI are post-concussion syndrome (PCS) symptom checklists, which do not have a clear relationship with cognition. This study investigated whether an mTBI-specific cognitive complaint measure would have clearer associations with objective cognition than a widely used PCS symptom checklist. Research Design: An observational design was used. A sample of 109 participants (52 mTBI and 57 healthy controls) completed a PCS symptom checklist, a cognitive complaint measure, and measures of information processing speed, attention, memory, executive function, depression and anxiety. Main Outcomes and Results: In the healthy control group, cognitive complaint was significantly associated with objective cognitive performance and was not associated with psychological status. In contrast, PCS endorsement was unrelated to objective cognition but was associated with psychological status. For the mTBI group, neither PCS endorsement nor cognitive complaint was associated with cognitive performance, but both measures were associated with psychological status. Conclusions: This study indicates that neither cognitive nor PCS symptom measures are reliable indicators of underlying cognitive function in the post-acute period after mTBI. Further, suffering an mTBI may affect the linear relationship that exists between cognitive symptom endorsement and cognitive function in healthy adults.

Management of unfavorable outcome after mild traumatic brain injury: Review of physical and cognitive rehabilitation and of psychological care in post-concussive syndrome

IntroductionMild Traumatic Brain Injury (mTBI) is a public health issue with approximately 42 million people worldwide affected yearly. Most patients have a favorable short-term recovery but 10-20% are likely to develop post-concussive syndrome (association of physical, cognitive, and psychological difficulties after injury). Post-concussive syndrome can be associated with Post-Traumatic Stress Disorder (PTSD). There is to date no recommendation on the interventions that could be done to reduce post-concussive syndrome. The present review aims at summarizing the effect of therapeutic education, physical and cognitive rehabilitation and of psychological care in mTBI patients with post-concussive syndrome. MethodsIn the current international literature, we investigated the effects of therapeutic education, physical and cognitive rehabilitation and of psychological care in this population using the Medline database and we discussed the results of these studies. ResultsThe application of a therapeutic education intervention within 3 months after mTBI has been found appropriate and effective to prevent post-concussion syndrome in several studies but the timeline of this intervention differs among the existing studies. Concerning physical disabilities, several pharmacological, rehabilitative and non-pharmacological techniques have shown some efficacy in reducing headache and vertigo; rTMS seems also promising in this context. The management of fatigue is also crucial and requires a multidisciplinary approach. We did not find any intervention in mTBI patients with post-concussive syndrome suffering from dysosmia and/or dysgueusia. No pharmacological treatment is currently recommended to reduce the cognitive symptoms of post-concussive syndrome after mTBI. Rehabilitation and brain-stimulation techniques have already proven their efficacy to reduce the cognitive impairment in this population. Even if the use of Virtual Reality software seems well tolerated in this population, its efficacy and additional value needs to be demonstrated in larger studies. Concerning the psychological care after mTBI, Cognitive and Behavioral Therapy interventions are the most frequently reported in this population, followed by psychoeducational interventions. PTSD management seems crucial in overall recovery of patients with post-concussive syndrome. ConclusionMany studies have sought to demonstrate the effectiveness of various rehabilitation techniques, including different cognitive rehabilitation programs, technology-assisted rehabilitation, different types of brain stimulation and some pharmacological treatments. However, most of these studies are of a low level of scientific evidence and it would be necessary to carry out well-conducted prospective randomized trials in order to offer an appropriate and effective multidisciplinary management for patients with post-concussive syndrome after mTBI.

Examining changes in rodent temperament following repetitive mild traumatic brain injury in adolescence.

Mild traumatic brain injuries are known to cause a host of symptoms, including headaches, nausea, and depression, that when persistent, are known as postconcussive syndrome. In addition to these overt symptomologies, individuals may experience changes in day-to-day behavior or temperament, which although not meeting criteria for postconcussive diagnosis, does cause distress to the individual. The aim of this study was to determine whether we could measure temperament in a rat and, if so, determine whether temperament is altered in response to repetitive mild traumatic brain injuries (RmTBI). Forty male and female adolescent Sprague-Dawley rats were same-sex pair housed and subjected to RmTBIs or sham injuries. The rats were recorded at 6 different time points throughout the study for the temperament assessment protocol, a measure of the complex behavioral profile of each rat within its dyadic home cage environment. The temperaments were quantified via a novel behavioral scoring algorithm. The rats were also tested on a battery of tests that were designed to measure symptoms of postconcussion syndrome. We determined that rodent temperament is quantifiable, is sex dependent, changes with age, and is modifiable in response to experiential factors such as RmTBI. Rats that received the RmTBIs were significantly less active and showed decreased levels of social interaction compared with their sham-injury counterparts. Moreover, both task switching and recovery patterns for RmTBI rats were dependent on the injury status of their cage mates. Future studies are now required to determine the mechanisms underlying these important changes in temperament. (PsycInfo Database Record (c) 2020 APA, all rights reserved).