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Cancelliere C, Verville L, Stubbs JL, Yu H, Hincapié CA, Cassidy JD, Wong JJ, Shearer HM, Connell G, Southerst D, Howitt S, Guist B, Silverberg ND. Post-Concussion Symptoms and Disability in Adults with Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J Neurotrauma 2023. [PMID: 36472218 DOI: 10.1089/neu.2022.0185] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Studies investigating long-term symptoms and disability after mild traumatic brain injury (mTBI) have yielded mixed results. This systematic review and meta-analysis aimed to determine the prevalence of self-reported post-concussion symptoms (PCS) and disability following mTBI. We systematically searched MEDLINE, Embase, CINAHL, CENTRAL, and PsycInfo to identify inception cohort studies of adults with mTBI. Paired reviewers independently extracted data and assessed risk of bias with the Scottish Intercollegiate Guidelines Network criteria. We identified 43 eligible studies for the systematic review; 41 were rated as high risk of bias, primarily due to high attrition (> 20%). Twenty-one studies (49%) were included in the meta-analyses (five studies were narratively synthesized; 17 studies were duplicate reports). At 3-6 months post-injury, the estimated prevalence of PCS from random-effects meta-analyses was 31.3% (95% confidence interval [CI] = 25.4-38.4) using a lenient definition of PCS (2-4 mild severity PCS) and 18.3% (95% CI = 13.6-24.0) using a more stringent definition. The estimated prevalence of disability was 54.0% (95% CI = 49.4-58.6) and 29.6% (95% CI = 27.8-31.5) when defined as Glasgow Outcome Scale-Extended <8 and <7, respectively. The prevalence of symptoms similar to PCS was higher in adults with mTBI versus orthopedic injury (prevalence ratio = 1.57, 95% CI = 1.22-2.02). In a meta-regression, attrition rate was the only study-related factor significantly associated with higher estimated prevalence of PCS. Setting attrition to 0%, the estimated prevalence of PCS (lenient definition) was 16.1%. We conclude that nearly one in three adults who present to an emergency department or trauma center with mTBI report at least mild severity PCS 3-6 months later, but controlling for attrition bias, the true prevalence may be one in six. Studies with representative samples and high retention rates are needed.
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Affiliation(s)
- Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Ontario, Canada
| | - Leslie Verville
- Faculty of Health Sciences, Ontario Tech University, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Ontario, Canada
| | - Jacob L Stubbs
- Department of Medicine, University of British Columbia, British Columbia, Canada
| | - Hainan Yu
- Faculty of Health Sciences, Ontario Tech University, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Ontario, Canada
| | - Cesar A Hincapié
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.,University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Jessica J Wong
- Faculty of Health Sciences, Ontario Tech University, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Ontario, Canada
| | - Heather M Shearer
- Faculty of Health Sciences, Ontario Tech University, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Ontario, Canada
| | - Gaelan Connell
- Faculty of Health Sciences, Ontario Tech University, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Ontario, Canada
| | - Danielle Southerst
- Faculty of Health Sciences, Ontario Tech University, Ontario, Canada.,Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Ontario, Canada
| | - Scott Howitt
- Department of Clinical Education and Patient Care, Canadian Memorial Chiropractic College, Ontario, Canada
| | - Brett Guist
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Ontario, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, British Columbia, Canada
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Abstract
Traumatic brain injury (TBI) is the cause for long-term disability in more than 3 million patients in the US alone, with chronic pain being the most frequently reported complain. To date, predisposing mechanisms for chronic pain in TBI patients are largely unknown. Psychological disorders, including post-traumatic stress disorder, depression and anxiety following TBI are commonly reported comorbidities to post-traumatic pain. Long term consequences can be debilitating and affect quality of life even when the injury is mild. In this review, we present the most commonly reported chronic pain conditions across the spectrum of severity of TBI, mainly focusing on mild TBI. We discuss chronic post- traumatic headaches, widespread pain as well as post-traumatic central pain. We discuss pain in the context of injury severity and military versus civilian populations. We are only starting to understand the biological mechanisms behind post-traumatic pain and associated psychological distress following TBI, with genetic, biochemical and imaging studies pointing to the dopaminergic, neurotrophic factors and the role of Apolipoprotein. Physiological and neurological mechanisms are proposed to partially explain this interaction between post-traumatic pain and psychological distress. Nevertheless, the evidence for the role of structural brain damage remains incomplete and to a large extent debatable, as it is still difficult to establish clear causality between brain trauma and chronic pain. Finally, general aspects of management of chronic pain post-TBI are addressed.
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Roberts CM, Spitz G, Mundy M, Ponsford JL. Prospective evaluation of first and last memory reports following moderate to severe traumatic brain injury. J Clin Exp Neuropsychol 2018; 41:109-117. [DOI: 10.1080/13803395.2018.1490392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Caroline M. Roberts
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | - Gershon Spitz
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | - Matthew Mundy
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Jennie L. Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
- Epworth Healthcare, Richmond, VIC, Australia
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Kerr ZY, Zuckerman SL, Wasserman EB, Vander Vegt CB, Yengo-Kahn A, Buckley TA, Solomon GS, Sills AK, Dompier TP. Factors associated with post-concussion syndrome in high school student-athletes. J Sci Med Sport 2018; 21:447-452. [DOI: 10.1016/j.jsams.2017.08.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/28/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
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Telegdy G, Kovács AK, Rákosi K, Zarándi M, Tóth GK. Antiamnesic properties of analogs and mimetics of the tripeptide human urocortin 3. Amino Acids 2016; 48:2261-6. [PMID: 27262310 DOI: 10.1007/s00726-016-2268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/27/2016] [Indexed: 11/29/2022]
Abstract
Amnesia is a deficit in memory caused by brain damage, disease, or trauma. Until now, there are no successful medications on the drug market available to treat amnesia. Short analogs and mimetics of human urocortin 3 (Ucn 3) tripeptide were synthetized and tested for their action against amnesia induced by eletroconvulsion in mice. Among the 16 investigated derivatives of Ucn 3 tripeptide, eight compounds displayed antiamnesic effect. Our results proved that the configuration of chiral center of glutamine does not affect the antiamnesic properties. Alkyl amide or isoleucyl amide at the C-terminus may lead to antiamnesic compounds. As concerned the N-terminus, acetyl, Boc, and alkyl ureido moieties were found among the active analogs, but the free amino function at the N-terminus usually led to an inactive derivatives. These observations may lead to the design and synthesis of small peptidomimetics and amino acid derivatives as antiamnesic drug candidates, although the elucidation of the mechanism of the action requires further investigations.
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Affiliation(s)
- Gyula Telegdy
- Department of Pathophysiology, University of Szeged, Semmelweis u. 1, Szeged, 6725, Hungary
- MTA-SZTE Neuroscience Research Group of the Hungarian Academy of Sciences, University of Szeged, Semmelweis u. 1, Szeged, 6725, Hungary
| | - Anita Kármen Kovács
- Department of Medical Chemistry, University of Szeged, Dóm tér 8, Szeged, 6720, Hungary
| | - Kinga Rákosi
- Department of Medical Chemistry, University of Szeged, Dóm tér 8, Szeged, 6720, Hungary
| | - Márta Zarándi
- Department of Medical Chemistry, University of Szeged, Dóm tér 8, Szeged, 6720, Hungary
| | - Gábor K Tóth
- Department of Medical Chemistry, University of Szeged, Dóm tér 8, Szeged, 6720, Hungary.
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Zuckerman SL, Yengo-Kahn AM, Buckley TA, Solomon GS, Sills AK, Kerr ZY. Predictors of postconcussion syndrome in collegiate student-athletes. Neurosurg Focus 2016; 40:E13. [DOI: 10.3171/2016.1.focus15593] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Sport-related concussion (SRC) has emerged as a public health problem, especially among student-athletes. Whereas most concussions resolve by 2 weeks, a minority of patients experience postconcussion syndrome (PCS), in which symptoms persist for months. The objective of this study was to elucidate factors predictive of PCS among a sample of National Collegiate Athletic Association (NCAA) student-athletes in the academic years 2009–2010 to 2014–2015.
METHODS
The SRC data originated from the NCAA Injury Surveillance Program (ISP) in the 2009–2010 to 2014–2015 academic seasons. The NCAA ISP is a prospective database made up of a convenience sample of schools across all divisions. All SRCs are reported by certified athletic trainers. The PCS group consisted of concussed student-athletes with concussion-related symptoms that lasted ≥ 4 weeks. The non-PCS group consisted of concussed student-athletes with symptom resolution in ≤ 2 weeks. Those with symptoms that resolved in the intermediate area of 2–4 weeks were excluded. Odds ratios (ORs) were estimated using logistic regression.
RESULTS
During the 2009–2010 to 2014–2015 seasons, 1507 NCAA student-athletes sustained an SRC, 112 (7.4%) of whom developed PCS (i.e., concussion-related symptoms that lasted ≥ 4 weeks). Men's ice hockey contributed the largest proportion of concussions to the PCS group (28.6%), whereas men's football contributed the largest proportion of concussions in the non-PCS group (38.6%). In multivariate analysis, recurrent concussion was associated with increased odds of PCS (OR 2.08, 95% CI 1.28–3.36). Concussion symptoms that were also associated with increased odds of PCS included retrograde amnesia (OR 2.75, 95% CI 1.34–5.64), difficulty concentrating (OR 2.35, 95% CI 1.23–4.50), sensitivity to light (OR 1.97, 95% CI 1.09–3.57), and insomnia (OR 2.19, 95% CI 1.30–3.68). Contact level, sex, and loss of consciousness were not associated with PCS.
CONCLUSIONS
Postconcussion syndrome represents one of the most impactful sequelae of SRC. In this study of exclusively collegiate student-athletes, the authors found that recurrent concussions and various concussion-related symptoms were associated with PCS. The identification of initial risk factors for the development of PCS may assist sports medicine clinicians in providing timely interventions and treatments to prevent morbidity and shorten recovery time after SRC.
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Affiliation(s)
- Scott L. Zuckerman
- 1Vanderbilt Sports Concussion Center and
- 2Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Thomas A. Buckley
- 3Department of Kinesiology and Applied Physiology, University of Delaware, Newark; and
| | - Gary S. Solomon
- 1Vanderbilt Sports Concussion Center and
- 2Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Allen K. Sills
- 1Vanderbilt Sports Concussion Center and
- 2Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Zachary Y. Kerr
- 4Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana
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