Patient Characterization Protocols for Psychophysiological Studies of Traumatic Brain Injury and Post-TBI Psychiatric Disorders

Abstract

Psychophysiological investigations of traumatic brain injury (TBI) are being conducted for several reasons, including the objective of learning more about the underlying physiological mechanisms of the pathological processes that can be initiated by a head injury. Additional goals include the development of objective physiologically based measures that can be used to monitor the response to treatment and to identify minimally symptomatic individuals who are at risk of delayed-onset neuropsychiatric disorders following injury. Research programs studying TBI search for relationships between psychophysiological measures, particularly ERP (event-related potential) component properties (e.g., timing, amplitude, scalp distribution), and a participant’s clinical condition. Moreover, the complex relationships between brain injury and psychiatric disorders are receiving increased research attention, and ERP technologies are making contributions to this effort. This review has two objectives supporting such research efforts. The first is to review evidence indicating that TBI is a significant risk factor for post-injury neuropsychiatric disorders. The second objective is to introduce ERP researchers who are not familiar with neuropsychiatric assessment to the instruments that are available for characterizing TBI, post-concussion syndrome, and psychiatric disorders. Specific recommendations within this very large literature are made. We have proceeded on the assumption that, as is typically the case in an ERP laboratory, the investigators are not clinically qualified and that they will not have access to participant medical records.

Onabotulinum ToxinAfor the Treatment of Headache in Service Members With a History of Mild Traumatic Brain Injury: A Cohort Study

“…1,55,56 Our finding may be a result of: (1) a type-I error stemming from small sample size or oversampling of patients who are more likely to respond to placebo effects as a result of time to treatment; (2) primary type headaches, eg, CM, take time to express a change in the neuronal matrix as in later onset post traumatic epilepsy; [57][58][59][60][61] or (3) the resilience of those who wait longer to access treatment, eg, the "healthy warrior effect" 62,63 wherein small improvements may be reported as "much better." [64][65][66][67] We also found that the presence of a continuous headache reduces the likelihood of a good result. The treating diagnosis for OBA was not necessarily continuous headache, as in a patient with CM type who also has a background continuous tension-type headache.…”

“…While studies in non‐traumatic CM have raised the concern that efficacy may be influenced by duration of disease, there is a growing suspicion that certain types of persistent headaches after mTBI may develop later than 7 days after injury . Our finding may be a result of: (1) a type‐I error stemming from small sample size or oversampling of patients who are more likely to respond to placebo effects as a result of time to treatment; (2) primary type headaches, eg, CM, take time to express a change in the neuronal matrix as in later onset post traumatic epilepsy; or (3) the resilience of those who wait longer to access treatment, eg, the “healthy warrior effect” wherein small improvements may be reported as “much better.”…”

Brain Injury Lesion Imaging Using Preconditioned Quantitative Susceptibility Mapping without Skull Stripping

“…Subject age, gender, and TBI demographic information is summarized in Table 1. There was no significant difference between non-TBI subjects and TBI subgroups (mild, moderate or severe - as defined from Ohio TBI score 24 ) for age (one-way ANOVA (F(3,52)=0.74, p =0.53)) or gender ( X 2 = 0.17, p = 0.98, Table 1). …”

“…All subjects were evaluated for history of prior TBI using the Ohio State University TBI-ID score, which was then used to classify subjects as no, mild, moderate or severe TBI 24 . Subjects also underwent neuroimaging.…”

Traumatic Brain Injury Detection Using Electrophysiological Methods

“…They found that TBI is associated with substantially elevated risks of premature mortality, particularly from suicide, injuries, and assaults. Similarly, TBI is a significant risk factor for neuropsychiatric disorders (Rapp et al, 2013a ). These results argue against the view that TBI, even mTBI, typically resolves without lasting consequences.…”