A Systematic Review of Treatments of Post-Concussion Symptoms

Abstract

Approximately 10–20% of patients who have sustained a mild Traumatic Brain Injury (mTBI) show persistent post-concussion symptoms (PCS). This review aims to summarize the level of evidence concerning interventions for PCS. Following the PRISMA guidelines, we conducted a systematic review regarding interventions for PCS post-mTBI until August 2021 using the Medline, Cochrane, and Embase databases. Inclusion criteria were the following: (1) intervention focusing on PCS after mTBI, (2) presence of a control group, and (3) adult patients (≥18 y.o). Quality assessment was determined using the Incog recommendation level, and the risk of bias was assessed using the revised Cochrane risk-of-bias tool. We first selected 104 full-text articles. Finally, 55 studies were retained, including 35 that obtained the highest level of evidence. The risk of bias was high in 22 out of 55 studies. Cognitive training, psycho-education, cognitive behavioral therapy, and graded return to physical activity demonstrated some effectiveness on persistent PCS. However, there is limited evidence of the beneficial effect of Methylphenidate. Oculomotor rehabilitation, light therapy, and headache management using repetitive transcranial magnetic stimulation seem effective regarding somatic complaints and sleep disorders. The preventive effect of early (<3 months) interventions remains up for debate. Despite its limitations, the results of the present review should encourage clinicians to propose a tailored treatment to patients according to the type and severity of PCS and could encourage further research with larger groups.

Risk of Migraine after Traumatic Brain Injury and Effects of Injury Management Levels and Treatment Modalities: A Nationwide Population-Based Cohort Study in Taiwan

“…Managing anxiety may reduce ongoing symptoms [ 58 ]. Moreover, managing socioeconomic and family-related stressors plays a crucial role in managing the effects of persistent PCS [ 49 , 59 ]. Furthermore, pharmacological treatment [ 60 ], such as acute or preventive medications for primary headache disorders, is useful [ 19 , 25 , 61 ].…”

A remote health intervention to reduce impairing post-concussional mild-to-moderate symptoms in adults (GAIN Lite): Study protocol for a parallel group randomised trial

“…Evidence-based recommendations for effective non-pharmacological treatment for people with PPCS are sparse (16). However, early written or oral information, reassurance, and advice are recommended (16,32). Hence, providing EUC as standard treatment to all participants is considered most ethically sound for current participants, although potentially limiting the possibility to demonstrate a potential treatment effect of GAIN Lite for future people with mild to moderate PPCS.…”

Consensus statement: An evidence‐based review of exercise, rehabilitation, rest, and return to activity protocols for the treatment of concussion and mild traumatic brain injury

“…Results from studies evaluating the various treatment modalities are mixed, which limits the conclusions that can be drawn. In general, graded physical activity, psychoeducation, and cognitive training had potential as effective therapies for concussion by some reviewers, 25,26 whereas others concluded that rest is underused and more evidence is needed to determine the effectiveness of graded return to physical activity 27 . Strict rest and intense physical activity were found to be either ineffective or detrimental with respect to symptomatic improvement or neurocognitive assessment in children in randomized controlled trials (RCTs) despite demonstrating a beneficial effect in small retrospective studies 26–28 .…”