Brain injury最新文献

Objectives: Previous studies investigated pharmacological options for reducing excessive daytime sleepiness (EDS) after traumatic brain injury (TBI), with mixed results. This meta-analysis aimed to assess the efficacy and safety of modafinil or armodafinil in post-TBI persons experiencing EDS.

Methods: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov and identified studies comparing modafinil/armodafinil versus placebo for treating EDS after TBI. We computed pooled risk ratios (RR) or mean differences (MD) for binary and continuous outcomes, respectively. EDS was assessed using the Epworth Sleepiness Scale (ESS).

Results: We included data from 158 individuals (mean age 34.28 years; 62.64% male) from three randomized controlled trials. In those treated with modafinil (dose range: 100-400 mg) or armodafinil (dose range: 150-250 mg), the mean ESS score was decreased in comparison with placebo (MD -1.65; 95% CI -3.26 to -0.04; p = 0.04). The risk of insomnia was higher in the modafinil/armodafinil group compared with the placebo group (RR 3.73; 95% CI 1.11 to 12.54; p = 0.03). There was no significant difference between groups in the risk of other adverse events (e.g., nausea, headache, dizziness, and nasopharyngitis).

Conclusion: Modafinil/armodafinil effectively improved EDS after TBI, as compared with placebo, albeit with an increased risk of insomnia.

Introduction: Coagulopathy in the setting of traumatic brain injury (TBI) increases the risk of poor outcomes. Thromboelastography with platelet mapping (TEG-PM) provides a dynamic assessment of clotting parameters including adenosine diphosphate (ADP) inhibition and can guide antiplatelet reversal.

Methods: A cross-sectional study of a single Level I Trauma Center traumatic brain injury database from February 2015 to March 2024 was conducted to develop a prediction model of ADP inhibition. Included patients had evidence of traumatic intracranial hemorrhage on CT at the time of presentation and underwent TEG-PM testing. Patients with a history of antiplatelet or anticoagulant use were excluded. Significant ADP inhibition was defined as ≥ 60%.

Results: 485 patients were included. Patients with significant ADP inhibition were younger and more likely to have a severe head injury (Glasgow Coma Scale 3-8). In a multivariate logistic regression model including age and head injury severity as independent variables, severe head injury significantly increased the likelihood of ADP inhibition (odds ratio 2.14, 95% confidence interval 1.28-3.58).

Conclusion: The observation that severe head injury was significantly associated with ADP inhibition could help identify patients at risk for platelet dysfunction in settings without TEG-PM.

Objective: Hypertensive encephalopathy may complicate the course of pediatric nephrotic syndrome, and the resulting brain injury is not always reversible. Subclinical electroencephalographic activities may play a role in this context, as demonstrated by the case vignette.

Method: We report on a girl with IgA nephropathy and secondary hypertension, leading to posterior reversible encephalopathy syndrome (PRES). The correlated neuroimaging and electroencephalographic findings are examined, and their clinical implications are discussed.

Results: PRES could be associated with lateralized periodic discharges on electroencephalogram, which was topographically concordant with neuroimaging findings in this patient. Despite being clinically silent, the lateralized periodic discharges may potentially increase cerebral metabolic demand and adversely impact the neurological outcomes.

Conclusion: Electroencephalographic monitoring should be considered in the context of PRES, as it may help detect subclinical electrical activities in the brain, which is of potential therapeutic relevance.

Objective: This manuscript aims to describe how to use the Integrative Cognitive Rehabilitation Psychotherapy (ICRP) model to formulate neuropsychological recommendations following brain injury that are comprehensive, individually tailored, empirically based, and culturally appropriate.

Background: The ICRP model utilizes a developmental metacognitive approach to increase self awareness after brain injury by first addressing basic cognitive abilities before focusing on higher-level cognitive domains. Detailed within this model are assessments of stages of recovery (e.g. surviving, healing, thriving, and maintaining) and readiness to change (e.g. precontemplation, contemplation, preparation, action, and maintenance) to help determine appropriate recommendations and interventions for management of brain injury sequelae and concomitant issues.

Conclusion: This unique approach to creating recommendations and treatment plans for brain injury recovery may be more time intensive than a traditional outpatient neuropsychological evaluation, but includes the added benefit of collaborating with the patient, family/caregivers, and treatment team to maximize rehabilitation success and improve quality of life.

Objective: Evaluate the clinical utility of the Strength 2 Strength (S2S) program to compare the effectiveness of a 1-day intensive intervention to the 5-week intervention, with regard to improving resilience and social support in families and friends of persons with TBI.

Methods: Thirty-three participants received the 1-day, 5-h intervention, and 32 participants received the 5-week, 2-h intervention. Eighteen participants were waitlist controls. Outcome measures included the Connor-Davidson Resilience Scale, Family Resilience Scale, Social Provision Scale, and a 6-item questionnaire to assess satisfaction with the intervention and self-care.

Results: Feasibility and efficacy of the S2S intervention was demonstrated. It did not increase resilience, but it kept social support stable during the COVID-19 pandemic. The control group showed decreases in social support.

Conclusions: Clinical utility of the program in friends and families of those with TBI was evident and prevented deterioration in social support. Participant satisfaction was supported by the small attrition rate. Similar effects were associated with the brief and longer versions of the intervention, indicating that this type of intervention was carried out in an efficient manner for those who are already struggling to juggle the many needs of being a care partner.

Objective: To describe the relationship between sleep-symptom severity and number of days to return to play following concussion in student-athletes.

Design: Case series.

Setting: A D1 NCAA university athletic department (institutional care).

Participants: The study enrolled 84 varsity athletes who suffered a sport-related concussion at the university from 2015 to 2021.

Independent variables: Prior concussion(s), total symptom burden, and sleep symptomatology (sleeping more, sleeping less, trouble falling asleep, drowsiness, and fatigue) scores as reported using Post-Concussion Symptom Scale from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT).

Main outcome measure: The number of days an athlete took to return to play following concussion.

Results: Individuals who reported trouble falling asleep, sleeping less, fatigue, and drowsiness took significantly longer to return to play following concussion than individuals who did not report such symptoms (F_1,102 = 34.12, p < 0.0001).

Conclusions: Sleep symptomatology present after concussion is predictive of days until return to sport. This study demonstrates the importance of sleep symptomatology post-concussion for athletes.

Introduction: Early out-of-bed mobilization is recommended for individuals with severe acquired brain injury and impaired consciousness to promote recovery. Robot-assisted gait training (RAGT) utilizes robotic assistance to facilitate neuroplastic changes through repetitive training and feedback. We aimed to map the evidence of RAGT in non-ambulatory individuals with impaired consciousness or cognitive functioning, focusing on the rationales underpinning its use and the assessment methods employed.

Method: Following the Joanna Briggs Institute and PRISMA scoping review guidelines, we systematically searched for studies involving adults with severe acquired brain injury. Source selection, data extraction, and charting were performed in duplicate.

Results: Out of 10 444 records screened, seven were included, involving 162 participants. The studies included one randomized and two non-randomized clinical trials, two retrospective studies, and two case reports. RAGT aimed to improve physical recovery (n = 6), arousal stimulation (n = 4), and safety (n = 4). Twenty-six outcome measures were reported.

Conclusion: Our review highlights a research gap in RAGT for individuals with severe brain injury and cognitive impairments. Specifically, the underlying rationales need investigation, and standardized outcome measures must be established. RAGT shows potential in improving functional recovery and consciousness, but future studies must address safety, and feasibility while navigating ethical challenges.

Objective: To examine the association between injury-related parental-stress during the acute phase following early-childhood concussion on post-concussion-symptoms (PCS) severity and recovery.

Methods: Thirty-eight children aged 0.1-5.7 years (median 1.3) following concussion, within 72-h post-injury, were included. Injury-related parental-stress was screened using three questions from the Revised-Illness-Perception questionnaire, regarding the child's 1) well-being, 2) injury-outcomes, and 3) recovery. PCS were assessed using the Post-Concussion-Symptoms-Inventory-Parent form (PCSI-P). Since not all symptoms were suitable for all ages, individualized percentage scores for both the PCSI-P number-of-symptoms (number-PCSI-P) and PCSI-P symptom-severity (severity-PCSI-P) were calculated. Parents completed the stress questionnaire and PCSI-P in the emergency-department (T0), and two-weeks post-injury (T1). The PCSI-P was also completed 1-month post-injury (T2).

Results: Parental-stress did not change significantly between T0 and T1. However, the number and severity of PCSI-P significantly decreased over this period (p < 0.001). A significant moderate positive correlation was found between T0 and T1 parental-stress and T0 number-PCSI-P (r_s = 0.39;p = 0.015 and r_s = 0.49;p = 0.002, respectively) and severity-PCSI-P (r_s = 0.42;p = 0.008 and r_s = 0.58;p < 0.001, respectively). At T2, 26 children were fully recovered; they presented lower T0 PCSI-P scores (p < 0.049), but showed no difference in parental-stress scores.

Conclusion: Higher injury-related parental-stress following early childhood concussion is associated with PCS in the first 72-h post-injury, but not with symptom recovery.

Objective: TBI's intricate pathophysiology, which includes oxidative stress, neuroinflammation, apoptosis, and mechanical injury, makes it a serious public health concern. Although stabilization and secondary damage management are the main goals of current treatments, their efficacy is still restricted. The potential for improving patient outcomes by combining phytochemicals with traditional medicines is examined in this review.

Methods: The study examined the neuroprotective qualities of ginsenosides, ginkgolides, resveratrol, and curcumin as well as their antioxidant and anti-inflammatory activities. Analysis was done on molecular pathways and medication delivery techniques to improve translational outcomes and drug availability for clinical practice.

Results: Phytochemical substances directly influence TBI-related neurogenic pathways and functional restoration while also affecting subsequent neural damage processes. Particle-based medicine delivery platforms enhance therapeutic drug efficacy, emerging as innovative solutions for targeted drug delivery. When traditional medical therapies integrate with phytochemicals, it becomes possible to achieve better patient results through enhanced synergy.

Conclusion: This review uniquely integrates phytochemicals with standard TBI treatments, emphasizing advanced drug delivery strategies and their translational potential to enhance neuroprotection and clinical outcomes. Unlike previous studies, it explores novel drug delivery platforms, such as nanoparticle-based systems, and highlights the synergy between phytochemicals and conventional therapies to improve patient recovery.