Treatment of Persistent Post-Concussion Syndrome with Repetitive Transcranial Magnetic Stimulation Using Functional Near-Infrared Spectroscopy as a Biomarker of Response: A Randomized Sham-Controlled Clinical Trial Protocol (Preprint)

Physiological outcomes of physical activity interventions in persistent postconcussive symptoms: a scoping review protocol

There are limited therapeutic options for patients with persistent postconcussive symptoms (PPCSs). Most PPCS assessments focus on subjective measures of progression and symptom monitoring. While early exercise interventions for rehabilitation are now considered best practice for acute concussion, no comprehensive review exists on how physical activity objectively and physiologically affects outcomes in PPCS. This scoping review protocol outlines the methods to identify the efficacy of therapeutic exercise interventions for PPCS, emphasising their impact on physiological parameters, including cardiovascular autonomic responses and cerebral autoregulation. Using the Patient, Intervention, Comparison and Outcome (PICO) framework, we will include all studies presenting original data. Narrative summaries will provide clinicians. An initial search in Medline/EMBASE/PubMed, Cochrane Library, PsycINFO, Web of Science and Scopus will be completed. Key parameters from each study will be extracted, tabulated and discussed in a narrative inquiry. The study references will be reviewed for additional studies meeting the inclusion criteria. Future research applications from the findings will be emphasised. After completion of the review, the results will be stratified by type of physical activity as the intervention, emphasising the physiological outcomes. Mapping these findings will allow us to identify the key research priorities for future studies. Findings will be shared with PPCS practitioners and local/national committees and submitted for conferences and publications.

A Scoping Review on the Use of Non-Invasive Brain Stimulation Techniques for Persistent Post-Concussive Symptoms

BACKGROUND

In the context of managing persistent post-concussive symptoms (PPCS), existing treatments like pharmacotherapy, cognitive behavioral therapy, and physical rehabilitation show only moderate effectiveness. The emergence of neuromodulation techniques in PPCS management has led to debates regarding optimal stimulation parameters and their overall efficacy.

METHODS

this scoping review involved a comprehensive search of PubMed and ScienceDirect databases, focusing on controlled studies examining the therapeutic potential of non-invasive brain stimulation (NIBS) techniques in adults with PPCS.

RESULTS

Among the 940 abstracts screened, only five studies, encompassing 103 patients (12 to 29 per study), met the inclusion criteria. These studies assessed the efficacy of transcranial direct current stimulation (tDCS), or repetitive transcranial magnetic stimulation (rTMS), applied to specific brain regions (i.e., the left dorsolateral pre-frontal cortex (DLPFC) or left motor cortex (M1)) for addressing cognitive and psychological symptoms, headaches, and general PPCSs. The results indicated improvements in cognitive functions with tDCS. In contrast, reductions in headache intensity and depression scores were observed with rTMS, while no significant findings were noted for general symptoms with rTMS.

CONCLUSION

although these pilot studies suggest promise for rTMS and tDCS in PPCS management, further research with larger-scale investigations and standardized protocols is imperative to enhance treatment outcomes for PPCS patients.

Shedding light on functional near-infrared spectroscopy and open science practices

Open science practices work to increase methodological rigor, transparency, and replicability of published findings. We aim to reflect on what the functional near-infrared spectroscopy (fNIRS) community has done to promote open science practices in fNIRS research and set goals to accomplish over the next 10 years.

The importance of screening for functional neurological disorders in patients with persistent post-concussion symptoms

BACKGROUND

Functional neurological disorder (FND) may commonly co-occur with persistent symptoms following a psychological trauma or physical injury such as concussion.

OBJECTIVE

To explore the occurrence of FND in a population with persistent post-concussion symptoms (PPCS) and the associations between FND and depression as well as anxiety in participants with PPCS.

METHODS

Sixty-three individuals with PPCS presenting to a specialized brain injury clinic completed the following questionnaires: screening for somatoform disorder conversion disorder subscale (SOM-CD), Rivermead post-concussion symptom questionnaire (RPQ), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder questionnaire- 7 (GAD-7). Both multiple linear regression and logistic regression were conducted to evaluate the relationship between questionnaires and adjust for covariates.

RESULTS

We found that total RPQ score (βˆ= 0.27; 95% CI = [0.16, 0.38]), GAD-7 score (βˆ= 0.71; 95% CI = [0.50, 0.92]) and PHQ-9 score (βˆ= 0.54; 95% CI = [0.32, 0.76]) were positively associated with SOM-CD score individually, after consideration of other covariates. Participants meeting the criteria for severe FND symptoms were 4.87 times more likely to have high PPCS symptom burden (95% CI = [1.57, 22.84]), 8.95 times more likely to have severe anxiety (95% CI = [3.31, 35.03]) and 4.11 times more likely to have severe depression symptom burden (95% CI = [1.77, 11.53]).

CONCLUSION

The findings of this study indicate an association between FND and post-concussion symptoms as well as an association between FND and symptoms of depression and anxiety in patients with PPCS. Patients with PPCS should be screened for FND to provide a more targeted treatment approach that includes somatic-focused interventions.