The Incidence of Postconcussion Syndrome Remains Stable Following Mild Traumatic Brain Injury in Children

Barlow, Karen M.; Crawford, Susan; Brooks, Brian L.; Turley, Brenda; Mikrogianakis, Angelo

doi:10.1016/j.pediatrneurol.2015.04.011

Cited by 95 publications

(73 citation statements)

References 30 publications

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“…A large proportion of children have persistent postconcussion symptoms (PPCS) following mTBI 2,3 which is defined as the presence of at least two or more post-concussive symptoms that persist for 4 weeks or longer 4 . Around 12% of children sustaining a mTBI have PPCS three months following injury 5 . There are several PPCS phenotypes with the commonest symptoms being headaches, fatigue, sleep disturbances and cognitive difficulties 6 .…”

Section: Introductionmentioning

confidence: 99%

Default mode network anatomy and function is linked to pediatric concussion recovery

Iyer

Zalesky

Barlow

et al. 2019

Preprint

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Objective:To determine whether anatomical and functional brain features relate to key persistent post-concussion symptoms (PPCS) in children recovering from mild traumatic brain injuries (mTBI), and whether such brain indices can predict individual recovery from PPCS.Methods: 110 children with mixed recovery following mTBI were seen at the concussion clinic at Neurology department Alberta Children's Hospital. The primary outcome was the Post-Concussion Symptom Inventory (PCSI, parent proxy). Sleep disturbance scores (PCSI sub-domain) and the Neurocognition Index (CNS Vital Signs) were also measured longitudinally. PPCS was assessed at 4 weeks post-injury and 8-10 weeks post-injury. Grey matter volumes were assessed using magnetic resonance imaging (MRI) and voxel-based morphometry. Functional connectivity was estimated using resting-state MRI. Two complementary machine learning methods were used to assess if the combination of grey matter and functional connectivity indices carried meaningful prognostic information.Results: Higher scores on a composite index of sleep disturbance, including fatigue, were associated with converging decreases in grey matter volume and local functional connectivity in two key nodes of the default mode network: the posterior cingulate cortex and the medial prefrontal cortex. Sleep-related disturbances also significantly correlated with reductions in functional connectivity between these brain regions. The combination of structural and functional brain indices associated to individual variations in the default mode network accurately predicted clinical outcomes at follow-up (area under the curve = 0.86). Interpretation:These results highlight that the function-structure profile of core default mode regions underpins sleep-related problems following mTBI and carries meaningful prognostic information for pediatric concussion recovery.

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Section: Introductionmentioning

confidence: 99%

Default mode network anatomy and function is linked to pediatric concussion recovery

Iyer

Zalesky

Barlow

et al. 2019

Preprint

Self Cite

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“…Concussions are associated with a number of physical and cognitive symptoms, including problems with memory, attention, balance, and most commonly, post‐traumatic headaches. Although these symptoms often disappear over a period of several days to several weeks, in a sizeable proportion of patients these symptoms continue for months to years . The neuropathology underlying persistent symptoms following concussion is still not understood.…”

Section: Introductionmentioning

confidence: 99%

Research Imaging of Brain Structure and Function After Concussion

Chong

Schwedt

2018

Headache

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Even when concussions are associated with prolonged physical and cognitive sequelae, concussions are typically "invisible" on diagnostic brain imaging, indicating that the neuropathology associated with concussion lies under the detection threshold of routine imaging. However, data from brain structural and functional research imaging studies using diffusion tensor imaging, resting-state functional magnetic resonance imaging, and brain perfusion imaging indicate that these imaging sequences have a role in identifying concussion-related neuropathology. These advanced imaging techniques provide insights into concussion neuropathology and might be useful for differentiating concussed patients from healthy controls. In this review article, we provide an overview of research findings from brain structural and functional imaging studies of concussion, and discuss the accuracy of classification models developed via machine-learning algorithms for identifying individual patients with concussion based on imaging data.

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“…The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) has strict criteria for PCS: a. history of TBI b. evidence from neurobehavioral testing of cognitive deficits in memory and/or attention c. three or more of the following symptoms: fatigue, headache, dizziness, sleep disturbance, irritability, apathy, affective disturbance, or personality change; and, symptom onset must relate to the TBI event and last more than 3 months. A large prospective epidemiological study of children with mTBI, followed over a year, 39 showed that posttraumatic headaches are often accompanied by other physical, cognitive, emotional, and/or behavioral symptoms. Prevalence rates as high as 12% at 3 months are reported.…”

Section: Common Data Elements For Outcome Metrics In Pediatric Mild Tmentioning

confidence: 99%

Pediatric Traumatic Brain Injury: Common Data Elements to Inform Diagnosis, Neuroimaging, and Outcome Metrics

Filippi

Sanelli

2016

J Pediatr Neuroradiol

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Currently, it is difficult for clinicians to reach consensus on best practices for the treatment and management of mild traumatic brain injury (mTBI) in children because of the paucity and quality of existing scientific evidence. Most studies of mTBI, or concussion in pediatric patients are limited by small sample sizes, retrospective study design, and lack of standardization with regard to computed tomography (CT) and magnetic resonance imaging (MRI) protocols, clinical assessments, outcome metrics, treatment management, and even definitions of mTBI and clinical severity. Common data elements (CDEs) is an initiative of the National Institute of Health (NIH) to standardize data acquisition, data collection, definitions, and outcome metrics in pediatric mTBI. CDEs might make it easier to compare research studies performed at different institutions in different settings, so that consensus recommendations can be achieved. The purpose of this review is to inform neuroradiologists about the development of CDEs for pediatric mTBI, which can inform longitudinal, prospective studies that will provide the data for much needed evidence-based guidelines in the management of pediatric mTBI.

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The Incidence of Postconcussion Syndrome Remains Stable Following Mild Traumatic Brain Injury in Children

Cited by 95 publications

References 30 publications

Default mode network anatomy and function is linked to pediatric concussion recovery

Default mode network anatomy and function is linked to pediatric concussion recovery

Research Imaging of Brain Structure and Function After Concussion

Pediatric Traumatic Brain Injury: Common Data Elements to Inform Diagnosis, Neuroimaging, and Outcome Metrics

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