mild traumatic brain injury research

This highlights that the field of neuromodulation is still emerging, and standardized protocols are not yet available. The most recent consensus statement for sports-related concussion states that concussion is a subset of less severe mTBI, where altered brain function results from a traumatic injury (Harmon et al., 2019). Prefrontal tDCS and sertraline in obsessive compulsive disorder: a case report and review of the literature. 28, 755–772. It is recommended that future research combines both symptom-based outcome measures and neurophysiological measures to enable a better understanding of the neurophysiological effects of neuromodulation in the mTBI population, as well as the correlation between those neurophysiological effects and the presenting symptoms. Its use in the mTBI population is of interest, as research has found rTMS to be beneficial for other brain based disorders such as various types of chronic pain (Leung et al., 2009; de Andrade et al., 2011; Lee et al., 2012; Misra et al., 2013) and post-stroke aphasia (Allen et al., 2012). The included studies ranged in level of evidence from level 2 (n = 6) to level 4 (n = 1) and 5 (n = 7), as summarized in Supplementary Tables 2, 3. How long is too long? BMJ 368:l6890. doi: 10.1111/ner.12615, Leung, A., Shukla, S., Fallah, A., Song, D., Lin, L., Golshan, S., et al. (2019). The team of doctors at the Brain Injury Research Institute is working to investigate the relation between mild traumatic brain injury and chronic traumatic encephalopathy, and we welcome donations and fundraising contributions from the public. doi: 10.1016/j.apmr.2019.10.179, Sterne, J. Although the pre-registered study protocol included ascertaining whether neuromodulation reduced delayed recovery from mTBI, no information was found relating to this question in the included studies, so it was not addressed in this review. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., et al. Repetitive transcranial magnetic stimulation in managing mild traumatic brain injury-related headaches. Sports Med. Med. There is a lack of consensus about the expected duration of symptoms following mTBI, with expert physicians giving timelines ranging from 2 weeks to 3 months; whereas patients can report much longer symptom durations (Sharp and Jenkins, 2015). In conclusion, the heterogeneity in both the clinical features of mTBI populations and in the techniques that are termed “neuromodulation” preclude making any systematic conclusions. Syst. NeuroImage 35, 1113–1124. doi: 10.1300/J184v06n02_05, Wilke, S., List, J., Mekle, R., Lindenberg, R., Bukowski, M., Ott, S., et al. People with a mild TBI should:Make an appointment for a follow-up visit with their healthcare provider to confirm the progress of their recovery. Neurol. (2009). Whilst cognitive function is often regained swiftly following mTBI, a recent review reported that out of 45 studies, ~50% of adults with mTBI had persistent cognitive dysfunction 3 months after injury (McInnes et al., 2017). The types of neuromodulation we intended to review included repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), transcutaneous vagus nerve stimulation (tVNS), neurofeedback (NF) and Photobiomodulation (PBM), including low level laser therapy (LLLT). doi: 10.1111/ner.12364, Linden, D. E. J., Habes, I., Johnston, S. J., Linden, S., Tatineni, R., Subramanian, L., et al. Treatment of persistent post-concussion syndrome due to mild traumatic brain injury: current status and future directions. Treat. Pre-existing conditions amongst the participants included depression (n = 9 participants), drug addiction (n = 1 participant), migraine (n = 1 participant), and other medical conditions (n = 4 participants). The 14 studies selected for this review included case reports (n = 4), pilot experimental studies (n = 3), uncontrolled open trials (n = 1) and randomized controlled trials (n = 6). doi: 10.1097/YCT.0b013e3181eb30c6, Gardner, R. C., and Yaffe, K. (2015). doi: 10.1136/bjsports-2017-097729, Jagnoor, J., and Cameron, I. Phys. In football, brain injuries account for 65% to 95% of all fatalities. Improved rates of return to work were also seen with both rTMS and neurofeedback (Walker et al., 2002; Stilling et al., 2019b). Practice 2, 170–185. When you experience another concussion in that same window there is a delay in that recovery and that is where the risk of more severe complications really starts to increase.” Study selection and data extraction was conducted by the first author (FB) and independently reviewed by another author (FA), concordance was 100%. Assessment of methodological quality was conducted using the Cochrane handbook of Systematic Reviews of Interventions (Higgins et al., 2019), a risk of bias tool (Sterne et al., 2019) and a published guide for assessing risk of bias (RoB) in observational studies (Viswanathan et al., 2013). J. Site Map | Articles, Centro Neurolesi Bonino Pulejo (IRCCS), Italy, Inria Nancy - Grand-Est research centre, France. doi: 10.1017/S1355617709991287, Bergersen, K., Halvorsen, J. O., Tryti, E. A., Taylor, S. I., and Olsen, A. Int. Risk factors for the development of PPCS have been identified in two categories, those that occur before injury and those that occur after. Given the above statistics on symptom recovery following mTBI, for the purposes of this review one could consider two broad timepoints for treatment one is from the time of the event up to 2 weeks post injury (early intervention), and the other is after 2 weeks (post-acute intervention). doi: 10.1037/spy0000107, Belanger, H. G., Spiegel, E., and Vanderploeg, R. D. (2010). Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 (updated July 2019). The level of evidence and RoB analysis was conducted by two authors (FB and CP) and any discrepancies were resolved by discussion. A sham stimulation-controlled trial of rTMS of the unaffected hemisphere in stroke patients. J. Phys. doi: 10.1007/s11940-006-0031-9. J. Neurother. Clin. While the above recommendations may improve research methodology, the field of neuromodulation in the mTBI population highlights the challenges of individualized intervention, which may not be amenable to the standardized protocol approach used in current health care practices. Arch. Rep. 9:5498. doi: 10.1038/s41598-019-41923-6, Munivenkatappa, A., Rajeswaran, J., Indira Devi, B., Bennet, N., and Upadhyay, N. (2014). Almost half of the injuries involve a child’s head, face, mouth or eyes. (2016a). Whilst there is a wide variation of symptom patterns following mTBI (Faul et al., 2010), multiple mTBIs are more likely to lead to worse outcomes compared to a single mTBI (Belanger et al., 2010; Mez et al., 2017). The following section will provide background information about the neuromodulation techniques covered in the review, the use of these modalities in mTBI will be covered in the body of the systematic review. (1997). Whilst treating a well-defined disorder may be straightforward, functional disorders require a much more complex approach to treatment. Once the individual is medically stable, education is provided about the nature of mTBI, the expectation of a short recovery process and how to manage any symptoms that may arise (Government of South Australia, 2009; Prince and Bruhns, 2017). Additionally, efficacy may be impacted by the type of neuromodulation used, in that the mechanism of action for one type of neuromodulation may be more beneficial at certain stages of the recovery period. Brain injury interdisciplinary special interest group, mild traumatic brain injury task force. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. Am. Not all the included studies listed the diagnostic criteria used and some of those listed included more than one diagnostic criteria. Pain 10, 1205–1216. Completion rates were high throughout most of the studies, with an average of 84%. doi: 10.1016/j.pmrj.2015.10.017, Lee, S. J., Kim, D. Y., Chun, M. H., and Kim, Y. G. (2012). Clin. Consequently, research has focussed on further understanding the pathophysiological sequalae of mTBI as well as novel interventions to modulate this process, in order to reduce the functional impact associated with persistent symptoms following mTBI (Girgis et al., 2016; Hadanny and Efrati, 2016; Leung et al., 2016a; Stilling et al., 2019b). Left dorsolateral prefrontal cortex rTMS in alleviating mTBI related headaches and depressive symptoms. The classification of mild TBI also includes concussion, … Finally, a mild traumatic brain injury is likely to result in cognitive difficulties including trouble with concentrating or thinking clearly and short-term memory loss. 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