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Sharma TL, Lucas S, Barber J, Hoffman JM. Pilot study evaluating treatment with sumatriptan for moderate to severe post-traumatic headache: A phase 2 open-label study. Headache 2024; 64:1135-1142. [PMID: 39136260 DOI: 10.1111/head.14807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVE Our primary outcome was to determine the feasibility of patients with post-traumatic headache (PTH) keeping a daily headache diary and using sumatriptan as directed. Secondary outcomes include determining if sumatriptan is effective in aborting PTH and whether headache resolution is dependent on PTH phenotype. BACKGROUND PTH is prevalent and persistent after traumatic brain injury, yet there have been few studies evaluating the effects of pharmacological treatments in individuals with PTH. METHODS This is a single-arm, prospective, non-randomized phase 2 clinical trial registered at Clinicaltrials.gov (NCT01854385) and conducted from 2013 to 2017. Data analysis was completed in 2022. Of the 299 participants screened, 40 were enrolled in the study. Participants kept a headache diary documenting headache characteristics and severity. Headache characteristics were used to determine PTH phenotypes of migraine-like, probable migraine-like, or non-migraine-like. Participants reported whether sumatriptan was used for their headache, their response to the medication, if a second dose was taken, and their response to the second dose. RESULTS A total of 15 participants out of the 40 enrolled (mean [SD] age, 41.9 [14.2] years, and 53% [21/40] male), met the criteria for the use of sumatriptan, and completed all assessments. Average headache diary compliance rate for the final month of the study was 80% (372/465). While sumatriptan was used for only 19% (122/654) of all reported headaches, 72% (88/122) of those headaches resolved within 2 h of taking the medication. Resolution of headaches with sumatriptan was not significantly different among headache phenotypes (migraine-like: 22/38 [58%], probable migraine-like: 24/29 [83%], non-migraine-like: 6/15 [40%]; p = 0.154). CONCLUSIONS A daily headache diary is feasible for tracking headache symptoms. Preliminary results also suggest that sumatriptan, a migraine-specific medication, may be beneficial for the treatment of PTH of different clinical phenotypes. Future studies, such as a phase 3 clinical trial with a larger sample size, are needed to better understand the efficacy of sumatriptan in the treatment of PTH.
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Affiliation(s)
- Tara L Sharma
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Sylvia Lucas
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jason Barber
- Department of Neurosurgery Seattle, University of Washington, Seattle, Washington, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Mata-Bermudez A, Trejo-Chávez R, Martínez-Vargas M, Pérez-Arredondo A, Martínez-Cardenas MDLÁ, Diaz-Ruiz A, Rios C, Navarro L. Dysregulation of the dopaminergic system secondary to traumatic brain injury: implications for mood and anxiety disorders. Front Neurosci 2024; 18:1447688. [PMID: 39176379 PMCID: PMC11338874 DOI: 10.3389/fnins.2024.1447688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024] Open
Abstract
Traumatic brain injury (TBI) represents a public health issue with a high mortality rate and severe neurological and psychiatric consequences. Mood and anxiety disorders are some of the most frequently reported. Primary and secondary damage can cause a loss of neurons and glial cells, leading to dysfunction of neuronal circuits, which can induce imbalances in many neurotransmitter systems. Monoaminergic systems, especially the dopaminergic system, are some of the most involved in the pathogenesis of neuropsychiatric and cognitive symptoms after TBI. In this work, we summarize the studies carried out in patients who have suffered TBI and describe alterations in the dopaminergic system, highlighting (1) dysfunction of the dopaminergic neuronal circuits caused by TBI, where modifications are shown in the dopamine transporter (DAT) and alterations in the expression of dopamine receptor 2 (D2R) in brain areas with dopaminergic innervation, thus establishing a hypodopaminergic state and (2) variations in the concentration of dopamine and its metabolites in biological fluids of post-TBI patients, such as elevated dopamine (DA) and alterations in homovanillic acid (HVA). On the other hand, we show a large number of reports of alterations in the dopaminergic system after a TBI in animal models, in which modifications in the levels of DA, DAT, and HVA have been reported, as well as alterations in the expression of tyrosine hydroxylase (TH). We also describe the biological pathways, neuronal circuits, and molecular mechanisms potentially involved in mood and anxiety disorders that occur after TBI and are associated with alterations of the dopaminergic system in clinical studies and animal models. We describe the changes that occur in the clinical picture of post-TBI patients, such as alterations in mood and anxiety associated with DAT activity in the striatum, the relationship between post-TBI major depressive disorders (MDD) with lower availability of the DA receptors D2R and D3R in the caudate and thalamus, as well as a decrease in the volume of the substantia nigra (SN) associated with anxiety symptoms. With these findings, we discuss the possible relationship between the disorders caused by alterations in the dopaminergic system in patients with TBI.
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Affiliation(s)
- Alfonso Mata-Bermudez
- Departamento de Fisiología Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Ricardo Trejo-Chávez
- Departamento de Fisiología Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Doctorado en Ciencias Biomedicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Marina Martínez-Vargas
- Departamento de Fisiología Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Adán Pérez-Arredondo
- Departamento de Fisiología Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | | | - Araceli Diaz-Ruiz
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Ciudad de México, Mexico
| | - Camilo Rios
- Laboratorio de Neurofarmacología Molecular, Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana Unidad Xochimilco, Ciudad de México, Mexico
- Dirección de Investigación, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra, Ciudad de México, Mexico
| | - Luz Navarro
- Departamento de Fisiología Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
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Hammond FM, Zafonte RD, Sherer M, Bell KR, Bogner J, Malec JF, Tang Q, Jang JH. Assessing the benefits and risks of amantadine for irritability and aggression after traumatic brain injury. PM R 2024; 16:661-668. [PMID: 38145314 DOI: 10.1002/pmrj.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE To quantify the benefits versus harms of amantadine in the treatment of irritability and aggression following traumatic brain injury. METHODS Secondary outcome data from a randomized controlled multisite trial of amantadine 100 mg twice daily were used to calculate number-needed-to-treat (NNT). Given prior findings of positive clinician-perceived effects and low incidence of adverse events, we hypothesized low number-needed-to-treat for benefit (NNTB; high benefit) and high number-needed-to-treat for harm (NNTH; low risk) based on the clinician ratings, supporting the use of amantadine in clinical practice. Specifically, NNTB values were calculated using number of individuals with improvement on the Clinician Global Impressions-Global Improvement scale (GI). NNTH values were computed using number of individuals with worsening on the GI and experiencing serious and any adverse events. RESULTS Based on clinician ratings, on average for every six patients treated with amantadine rather than placebo, one extra patient would be expected to improve (NNTB = 6.4; 95% confidence interval [CI]: [3.3-76.8]). More participants in the placebo group worsened than in the amantadine group, but the result was not statistically significant (NNTH = -92.4; 95% CI: [NNTB -32.9 to infinity to NNTH -19.2]). The amantadine and placebo groups did not differ on the numbers of adverse events experienced during the trial. CONCLUSION Clinician ratings suggest modest benefit of amantadine 100 mg twice daily with low risk to appropriately selected patients with adequate renal clearance. Thus, amantadine should be considered a treatment option for the experienced brain injury clinician. These data may support treatment decisions when a pharmaceutical agent is being considered to control irritability/aggression.
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Affiliation(s)
- Flora M Hammond
- Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Physical Medicine & Rehabilitation, Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Atrium Health, Charlotte, North Carolina, USA
| | - Ross D Zafonte
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark Sherer
- Research Department, TIRR Memorial Hermann, Houston, Texas, USA
| | - Kathleen R Bell
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jennifer Bogner
- Department of Physical Medicine & Rehabilitation, Ohio State University, Columbus, Ohio, USA
| | - James F Malec
- Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Qing Tang
- Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeong Hoon Jang
- Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Quantitative Risk Management, Yonsei University, Incheon, South Korea
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Sherer M, Juengst S, Sander AM, Leon-Novelo L, Liu X, Bogaards J, Chua W, Tran K. Mood Tracker: A Randomized Controlled Trial of a Self-Monitoring Intervention for Emotional Distress After Traumatic Brain Injury. J Head Trauma Rehabil 2024:00001199-990000000-00161. [PMID: 38833719 DOI: 10.1097/htr.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Persons with traumatic brain injury (TBI) frequently experience emotional distress (ED) manifested in anxiety and depression. However, they may not access mental health services due to external (eg, access, transportation, and cost) or internal (eg, stigma and discomfort with traditional counseling) barriers. Based on substantial literature indicating that self-monitoring can ameliorate several health conditions, we conducted a randomized, parallel group, wait-list control (WLC) trial of a self-monitoring intervention to decrease ED after TBI. SETTING Community in the southwestern United States. PARTICIPANTS Persons with medically documented complicated mild, moderate, and severe TBI. DESIGN About 127 participants were randomized in blocks of 6 to an active treatment (AT) group, wherein they completed multiple assessments of ED each week over a 6-week period via a smartphone app, or a WLC group in a parallel group, controlled trial. Participants received weekly support calls to promote self-monitoring of ED using ecological momentary assessment. MAIN MEASURES ED (Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7), Satisfaction with Life Scale, and Participation Assessment with Recombined Tools-Objective. RESULTS Analysis of the primary study outcome at 6 weeks after initiation of treatment for the AT group did not demonstrate that self-monitoring was effective in decreasing ED as compared to the WLC group. Brief support calls made weekly to promote compliance with self-monitoring were effective in achieving the target number of self-assessments. About 80% of support calls lasted less than 5 minutes. Greater ED was associated with lower life satisfaction and lower participation indicating the importance of addressing ED in persons with TBI. CONCLUSION Additional work is needed to develop nontraditional interventions to circumvent barriers that prevent persons with TBI from accessing care for ED. Brief support calls may be an effective, low-cost intervention to improve compliance with self-monitoring or self-management interventions.
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Affiliation(s)
- Mark Sherer
- Author Affiliations: Brain Injury Research Center TIRR Memorial Hermann, Houston, Texas (Drs Sherer, Juengst, and Sander and Mss Bogaards, Chua, and Tran); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (Drs Sherer and Sander); Department of Physical Medicine and Rehabilitation, McGovern Medical School, UT Health, Houston, Texas (Dr Juengst); and Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas (Dr Leon-Novelo and Ms Liu)
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5
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Karr JE, Iverson GL, Boudreau N, Zafonte R. Treatment of chronic symptoms following mild traumatic brain injury with transcranial LED: a sham run-in pilot study of photobiomodulation therapy. Brain Inj 2024; 38:425-435. [PMID: 38329020 DOI: 10.1080/02699052.2024.2309258] [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: 04/25/2022] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
PRIMARY OBJECTIVE We evaluated whether photobiomodulation with red/near infrared light applied transcranially via light emitting diodes (LED) was associated with reduced symptoms and improved cognitive functioning in patients with chronic symptoms following mild traumatic brain injury. RESEARCH DESIGN Participants (3 men, 6 women; 22-61 years-old) underwent a 6-week intervention involving 18 40-minute transcranial LED treatment sessions. METHODS AND PROCEDURES Reliable change indices were calculated for 10 neuropsychological test scores and 3 self-report questionnaires of subjective cognition, post-concussion symptoms, and depression at baseline and following treatment. Questionnaires were also administered after 2-week sham and at 1-month and 2-month follow-ups. MAIN OUTCOME AND RESULTS Only 2 participants improved on neuropsychological testing. On questionnaires, 4 reported improved cognition, 5 reported improved post-concussion symptoms, and 3 reported improved depression. Significant improvement in 2 or more domains was reported by 4 participants and mostly maintained at both follow-ups. CONCLUSIONS Most participants did not improve on neuropsychological testing. A minority self-reported improvement in symptoms, potentially explained by the intervention, psychiatric medication changes, placebo effects, or other factors. Selecting participants with different clinical characteristics, and dosing and delivery system changes, may produce different results. A study design accounting for placebo effects appears warranted in future trials.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Nancy Boudreau
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Schoen Adams Research Institute at Spaulding Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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van der Veen R, Königs M, Bakker S, van Iperen A, Peerdeman S, Bet PM, Oosterlaan J. Pharmacotherapy to Improve Cognitive Functioning After Acquired Brain Injury: A Meta-Analysis and Meta-Regression. Clin Pharmacol Ther 2024; 115:971-987. [PMID: 38294196 DOI: 10.1002/cpt.3186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
Cognitive impairments, common sequelae of acquired brain injury (ABI), significantly affect rehabilitation and quality of life. Currently, there is no solid evidence-base for pharmacotherapy to improve cognitive functioning after ABI, nevertheless off-label use is widely applied in clinical practice. This meta-analysis and meta-regression aims to quantitatively aggregate the available evidence for the effects of pharmacological agents used in the treatment of cognitive impairments following ABI. We conducted a comprehensive search of Embase, Medline Ovid, and Cochrane Controlled Trials Register databases for randomized controlled and crossover trials. Meta-analytic effects were calculated for each pharmaceutical agent and targeted neuromodulator system. Cognitive outcome measures were aggregated across cognitive domains. Of 8,216 articles, 41 studies (4,434 patients) were included. The noradrenergic agent methylphenidate showed a small, significant positive effect on cognitive functioning in patients with traumatic brain injury (TBI; k = 14, d = 0.34, 95% confidence interval: 0.12-0.56, P = 0.003). Specifically, methylphenidate was found to improve cognitive functions related to executive memory, baseline speed, inhibitory control, and variability in responding. The cholinergic drug donepezil demonstrated a large effect size, albeit based on a limited number of studies (k = 3, d = 1.68, P = 0.03). No significant effects were observed for other agents. Additionally, meta-regression analysis did not identify significant sources of heterogeneity in treatment response. Our meta-analysis supports the use of methylphenidate for enhancing cognitive functioning in patients with TBI. Although donepezil shows potential, it warrants further research. These results could guide clinical decision making, inform practice guidelines, and direct future pharmacotherapeutic research in ABI.
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Affiliation(s)
- Ruud van der Veen
- Follow Me Program & Emma Neuroscience Group, Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Marsh Königs
- Follow Me Program & Emma Neuroscience Group, Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Simon Bakker
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, The Netherlands
| | - Andries van Iperen
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Saskia Peerdeman
- Department of Neurosurgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Follow Me Program & Emma Neuroscience Group, Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Syzdykbayev M, Kazymov M, Aubakirov M, Kurmangazina A, Kairkhanov E, Kazangapov R, Bryzhakhina Z, Imangazinova S, Sheinin A. A Modern Approach to the Treatment of Traumatic Brain Injury. MEDICINES (BASEL, SWITZERLAND) 2024; 11:10. [PMID: 38786549 PMCID: PMC11123131 DOI: 10.3390/medicines11050010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/18/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
Background: Traumatic brain injury manifests itself in various forms, ranging from mild impairment of consciousness to severe coma and death. Traumatic brain injury remains one of the leading causes of morbidity and mortality. Currently, there is no therapy to reverse the effects associated with traumatic brain injury. New neuroprotective treatments for severe traumatic brain injury have not achieved significant clinical success. Methods: A literature review was performed to summarize the recent interdisciplinary findings on management of traumatic brain injury from both clinical and experimental perspective. Results: In the present review, we discuss the concepts of traditional and new approaches to treatment of traumatic brain injury. The recent development of different drug delivery approaches to the central nervous system is also discussed. Conclusions: The management of traumatic brain injury could be aimed either at the pathological mechanisms initiating the secondary brain injury or alleviating the symptoms accompanying the injury. In many cases, however, the treatment should be complex and include a variety of medical interventions and combination therapy.
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Affiliation(s)
- Marat Syzdykbayev
- Department of Hospital Surgery, Anesthesiology and Reanimatology, Semey Medical University, Semey 071400, Kazakhstan
| | - Maksut Kazymov
- Department of General Practitioners, Semey Medical University, Semey 071400, Kazakhstan
| | - Marat Aubakirov
- Department of Pediatric Surgery, Semey Medical University, Semey 071400, Kazakhstan
| | - Aigul Kurmangazina
- Committee for Medical and Pharmaceutical Control of the Ministry of Health of the Republic of Kazakhstan for East Kazakhstan Region, Ust-Kamenogorsk 070004, Kazakhstan
| | - Ernar Kairkhanov
- Pavlodar Branch of Semey Medical University, Pavlodar S03Y3M1, Kazakhstan
| | - Rustem Kazangapov
- Pavlodar Branch of Semey Medical University, Pavlodar S03Y3M1, Kazakhstan
| | - Zhanna Bryzhakhina
- Department Psychiatry and Narcology, Semey Medical University, Semey 071400, Kazakhstan
| | - Saule Imangazinova
- Department of Therapy, Astana Medical University, Astana 010000, Kazakhstan
| | - Anton Sheinin
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv 69978, Israel
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Galimberti A, Tik M, Pellegrino G, Schuler AL. Effectiveness of rTMS and tDCS treatment for chronic TBI symptoms: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110863. [PMID: 37709126 DOI: 10.1016/j.pnpbp.2023.110863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/18/2023] [Accepted: 09/09/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major cause of long-term disability with conventional treatments frequently falling short to restore a good quality-of-life. Non-invasive brain stimulation (NIBS) techniques have shown potential as therapeutic options for neuropsychiatric conditions, including TBI sequelae. This study aims at providing a systematic review and meta-analysis on the effectiveness of repetitive transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) on post-TBI symptoms. METHODS Fifteen randomized controlled trials (RCTs) on adult TBI patients that examined the effects of multiple treatment sessions of NIBS techniques were selected from five databases. Symptoms were clustered into four categories: depression, anxiety, headache and cognitive dysfunctions. Meta-analysis was performed using correlated and hierarchical effects models. RESULTS There were only few and heterogeneous studies with generally small sample sizes. Most studies targeted the dorsolateral prefrontal cortex (dlPFC). Overall, the effects of NIBS were small. However, there was a significant effect for overall symptoms (0.404, p = 0.031). Moreover, subgroup analyses revealed significant overall effects for anxiety (0.195, p = 0.020) and headache (0.354, p = 0.040). CONCLUSIONS To date, there is limited evidence supporting the effectiveness of NIBS concerning treatment for TBI sequelae. The observed effect sizes were modest, suggesting subtle improvements rather than drastic changes. While NIBS techniques remain promising for treating neuropsychiatric conditions, larger RCT studies with longer follow-ups, optimized stimulation parameters and standardized methodology are required to establish their efficacy in addressing TBI sequelae.
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Affiliation(s)
| | - Martin Tik
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Giovanni Pellegrino
- Epilepsy Program, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anna-Lisa Schuler
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; IRCCS San Camillo Hospital, Venice, Italy.
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Eide LS, Rike PO, Reme SE, Snekkevik H, Rossner S, Rosen G, Lindeløv JK, Løvstad M. Using hypnotic suggestion in the rehabilitation of working memory capacity after acquired brain injury: study protocol for a randomized controlled trial. Trials 2024; 25:11. [PMID: 38167204 PMCID: PMC10759527 DOI: 10.1186/s13063-023-07867-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES Establishment of effective evidence-based interventions in rehabilitation of working memory (WM) deficits after acquired brain injury (ABI) is sorely needed. Despite robust evidence for the efficiency of clinical hypnosis in a wide range of clinical conditions, and improved understanding of mechanisms underlying its effects, the potential of clinical hypnosis in cognitive rehabilitation is underexplored. A recent study has shown large effects of hypnotic suggestion on WM capacity following ABI. This randomized controlled trial aims to evaluate and explore the replicability of these findings and examine the generalization of treatment effects. The study will also explore possible mechanisms of change. METHODS Ninety patients will be recruited from the Sunnaas Rehabilitation Hospital. Inclusion criteria are nonprogressive ABI, minimum 12-month post-injury, ongoing WM deficits, and age between 18 and 67 years. Patients will be randomized to either (a) an intervention group receiving four weekly 1-h sessions with induction and hypnosis, (b) an active control group receiving four weekly 1-h sessions of induction and mindfulness, or (c) a passive control group without intervention. The targeted procedure consists of suggestions about enhancing WM functions, for example through the instantiation of preinjury WM capacity in the present using age regression or through visualizations of brain plasticity. The non-targeted suggestions contain no explicit mention of ABI- or WM-related abilities. Each participant will be assessed at baseline, immediately after intervention, and 6 months after baseline. The primary outcome is the WM index from WAIS-IV and self- and informant-reported WM subscale from BRIEF-A, a questionnaire exploring executive functioning in everyday life. Secondary outcomes include a cognitive composite score derived from tests measuring processing speed, executive functions, learning capacity and memory, and self-reported measures of emotional distress, quality of life, and community integration. Exploratory measures include self-rated ABI and WM-related self-efficacy. DISCUSSION Rehabilitation of impaired WM after ABI has hitherto yielded limited transfer effects beyond the training material, i.e., improvement effects on everyday WM capacity, and clinical trials of new interventions are thus warranted. Long-standing empirical evidence demonstrates that hypnosis is an effective therapeutic technique in a wide range of conditions, and recent exploratory research has suggested a high efficacy of hypnosis in improving WM capacity in patients with ABI. However, these extraordinary findings need replication in studies applying scientifically rigorous designs. If successful, our ambition is to provide recommendations and materials to implement hypnotic suggestion as an adjunct treatment following ABI. Study findings may inform future studies exploring the use of clinical hypnosis in other areas of rehabilitation, such as mild TBI, and in other neurological conditions where WM deficit is prominent. TRIAL REGISTRATION ClinicalTrials.gov NCT05287542. Registered on March 2022 PROTOCOL VERSION: Protocol version 2.0, December 2023.
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Affiliation(s)
- Line Sophie Eide
- Sunnaas Rehabilitation Hospital, Nesodden, Norway.
- Norwegian Society of Clinical Evidence-Based Hypnosis (NEKEH), Oslo, Norway.
| | - Per-Ola Rike
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | | | | | - Stephan Rossner
- Norwegian Society of Clinical Evidence-Based Hypnosis (NEKEH), Oslo, Norway
- Molde Hospital, Molde, Norway
| | - Gunnar Rosen
- Norwegian Society of Clinical Evidence-Based Hypnosis (NEKEH), Oslo, Norway
| | | | - Marianne Løvstad
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
- University of Oslo (UiO), Oslo, Norway
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10
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Li LM, Carson A, Dams-O'Connor K. Psychiatric sequelae of traumatic brain injury - future directions in research. Nat Rev Neurol 2023; 19:556-571. [PMID: 37591931 DOI: 10.1038/s41582-023-00853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
Despite growing appreciation that traumatic brain injury (TBI) is an important public health burden, our understanding of the psychiatric and behavioural consequences of TBI remains limited. These changes are particularly detrimental to a person's sense of self, their relationships and their participation in the wider community, and they continue to have devastating individual and cumulative effects long after TBI. This Review relates specifically to TBIs that confer objective clinical or biomarker evidence of structural brain injury; symptomatic head injuries without such evidence are outside the scope of this article. Common psychiatric, affective and behavioural sequelae of TBI and their proposed underlying mechanisms are outlined, along with a brief overview of current treatments. Suggestions for how scientists and clinicians can work together in the future to address the chasms in clinical care and knowledge are discussed in depth.
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Affiliation(s)
- Lucia M Li
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Thomas DG, Erpenbach H, Hickey RW, Waltzman D, Haarbauer-Krupa J, Nelson LD, Patterson CG, McCrea MA, Collins MW, Kontos AP. Implementation of active injury management (AIM) in youth with acute concussion: A randomized controlled trial. Contemp Clin Trials 2022; 123:106965. [PMID: 36252936 PMCID: PMC10924688 DOI: 10.1016/j.cct.2022.106965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/10/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Nearly 2 million youth seek acute medical care following concussion in the U.S. each year. Current standard of care recommends rest for the first 48 h after a concussion. However, research suggests that prolonged rest may lengthen recovery time especially for patients with certain risk profiles. Research indicates that physical activity and behavioral management interventions (sleep, stress management) may enhance recovery. To date, there is limited empirical evidence to inform acute (<72 h) concussion recommendations for physical activity and behavioral management in adolescents. OBJECTIVE To determine the effectiveness of physical activity and behavioral management for acute concussion in adolescents and young adults, and to evaluate the role of patient characteristics on treatment response. METHODS This multicenter prospective randomized controlled trial will determine which combination of physical activity and behavioral management is most effective for patients 11-24 years old who present to the emergency department or concussion clinic within 72 h of injury. Participants are randomized into: 1) rest, 2) physical activity, 3) mobile health application (mHealth) behavioral management, or 4) physical activity and mHealth app conditions. Assessments at enrollment, 3-5 days, 14 days, 1 month, and 2 months include: concussion symptoms, balance, vestibular-ocular and cognitive assessments, quality of life, and recovery time. Somatic symptoms and other risk factors are evaluated at enrollment. Compliance with treatment and symptoms are assessed daily using actigraph and daily self-report. The primary study outcome is symptoms at 14 days. CONCLUSION Prescribed physical activity and behavioral management may improve outcomes in youth following acute concussion.
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Affiliation(s)
- D G Thomas
- Medical College of Wisconsin, Department of Pediatrics, United States of America.
| | - H Erpenbach
- Medical College of Wisconsin, Department of Pediatrics, United States of America
| | - R W Hickey
- University of Pittsburgh, Department of Pediatrics, United States of America
| | - D Waltzman
- Centers for Disease Control and Prevention, United States of America
| | - J Haarbauer-Krupa
- Centers for Disease Control and Prevention, United States of America
| | - L D Nelson
- Medical College of Wisconsin, Department of Neurosurgery, United States of America
| | - C G Patterson
- University of Pittsburgh, Department of Physical Therapy, United States of America
| | - M A McCrea
- Medical College of Wisconsin, Department of Neurosurgery, United States of America
| | - M W Collins
- University of Pittsburgh, Department of Orthopedic Surgery, United States of America
| | - A P Kontos
- University of Pittsburgh, Department of Orthopedic Surgery, United States of America
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12
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Pardo-Cabello AJ, Manzano-Gamero V, Puche-Cañas E. Placebo: a brief updated review. Naunyn Schmiedebergs Arch Pharmacol 2022; 395:1343-1356. [PMID: 35943515 PMCID: PMC9361274 DOI: 10.1007/s00210-022-02280-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/03/2022] [Indexed: 11/04/2022]
Abstract
Our aims were to provide updated information on placebo/nocebo effect and the potential use of placebo in clinical practice. This article can only provide a rough overview on the placebo and nocebo effect and is intended to serve as a starting point for the reader to go deeper into the corresponding literature. The placebo effect has been observed in multiple medical conditions, after oral administration, with manual therapies as well as with surgery and invasive procedures. The use of placebo in clinical trials is fundamental, although the ethics of its use is under discussion. The placebo may behave like a drug from the pharmacokinetic and pharmacodynamic point of view and can also be associated with adverse events (nocebo effect). Placebo can modify treatment by increasing or decreasing the effects of drugs. The factors associated with the occurrence of placebo effect are multiple, but in addition to those that depend on the placebo itself, the doctor-patient relationship would be the most important. As a result of findings that were published in the last two decades, the psycho-neurobiological basis of placebo is becoming better understood, although further studies are needed. In conclusion, the placebo effect in the clinic exhibits weak to moderate intensity. Placebo, in addition to its use in the clinical trial, should be considered another therapeutic remedy either as stand alone or in association with treatment, and could be useful in certain circumstances. The use of placebo should be regulated by the European health authorities through a guide in clinical practice that will improve patient care.
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Affiliation(s)
- Alfredo Jose Pardo-Cabello
- Department of Internal Medicine, Hospital Universitario San Cecilio, Avda. de La Innovación, s/n, 18016, Granada, Spain.
| | - Victoria Manzano-Gamero
- Department of Internal Medicine, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Emilio Puche-Cañas
- Department of Pharmacology, School of Medicine, University of Granada, Granada, Spain
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13
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Hicks AJ, Clay FJ, James AC, Hopwood M, Ponsford JL. Effectiveness of Pharmacotherapy for Depression after Adult Traumatic Brain Injury: an Umbrella Review. Neuropsychol Rev 2022; 33:393-431. [PMID: 35699850 PMCID: PMC10148771 DOI: 10.1007/s11065-022-09543-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Symptoms of depression are common following traumatic brain injury (TBI), impacting survivors' ability to return to work, participate in leisure activities, and placing strain on relationships. Depression symptoms post TBI are often managed with pharmacotherapy, however, there is little research evidence to guide clinical practice. There have been a number of recent systematic reviews examining pharmacotherapy for post TBI depression. The aim of this umbrella review was to synthesize systematic reviews and meta-analyses of the effectiveness of pharmacotherapy for the management of post TBI depression in adults. Eligible reviews examined any pharmacotherapy against any comparators, for the treatment of depression in adults who had sustained TBI. Seven databases were searched, with additional searching of online journals, Research Gate, Google Scholar and the TRIP Medical Database to identify published and unpublished systematic reviews and meta-analyses in English up to May 2020. A systematic review of primary studies available between March 2018 and May 2020 was also conducted. Evidence quality was assessed using Joanna Briggs Institute Critical Appraisal Instruments. The results are presented as a narrative synthesis. Twenty-two systematic reviews were identified, of which ten reviews contained a meta-analysis. No new primary studies were identified in the systematic review. There was insufficient high quality and methodologically rigorous evidence to recommend prescribing any specific drug or drug class for post TBI depression. The findings do show, however, that depression post TBI is responsive to pharmacotherapy in at least some individuals. Recommendations for primary studies, systematic reviews and advice for prescribers is provided. Review Registration PROSPERO (CRD42020184915).
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Affiliation(s)
- Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Ground Floor, 185-187 Hoddle St, Richmond, Melbourne, VIC, 3121, Australia.
| | - Fiona J Clay
- Department of Forensic Medicine, Monash University, Southbank, Australia
| | - Amelia C James
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Ground Floor, 185-187 Hoddle St, Richmond, Melbourne, VIC, 3121, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, Department of Psychiatry, University of Melbourne, 31 Albert Road, Melbourne, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Ground Floor, 185-187 Hoddle St, Richmond, Melbourne, VIC, 3121, Australia
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14
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Sharma TL. Returning to Work After Mild Traumatic Brain Injury-Considering the Impact of Employer Support. JAMA Netw Open 2022; 5:e2219454. [PMID: 35767264 DOI: 10.1001/jamanetworkopen.2022.19454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tara L Sharma
- Department of Neurology, University of Washington, Seattle
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15
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Mollica A, Greben R, Oriuwa C, Siddiqi SH, Burke MJ. Neuromodulation Treatments for Mild Traumatic Brain Injury and Post-concussive Symptoms. Curr Neurol Neurosci Rep 2022; 22:171-181. [PMID: 35175543 DOI: 10.1007/s11910-022-01183-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Mild traumatic brain injury (mTBI) can result in prolonged post-concussive symptoms (e.g., depression, headaches, cognitive impairment) that are debilitating and difficult to treat. This article reviews recent research on neuromodulation for mTBI. RECENT FINDINGS Transcranial magnetic stimulation (TMS) is the most studied neuromodulation approach for mTBI (four studies for depression, four for headache, one for cognitive impairment, and two for global post-concussive symptoms) with promising results for post-concussive depression and headache. Transcranial direct current stimulation (tDCS) has also been evaluated (one study for post-traumatic headache, and three for cognitive impairment), with more mixed results overall. TMS appears to be a potentially promising neuromodulation treatment strategy for post-concussive symptoms; however, integration into clinical practice will require larger sham-controlled randomized trials with longer and more consistent follow-up periods. Future studies should also explore new stimulation protocols, personalized approaches, and the role of placebo effects.
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Affiliation(s)
- Adriano Mollica
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, FG26, Toronto, ON, M4N 3M5, Canada
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Rachel Greben
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, FG26, Toronto, ON, M4N 3M5, Canada
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Chika Oriuwa
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, FG26, Toronto, ON, M4N 3M5, Canada
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, FG26, Toronto, ON, M4N 3M5, Canada.
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
- Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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16
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Hawley L, Morey C, Sevigny M, Ketchum J, Simpson G, Harrison-Felix C, Tefertiller C. Enhancing Self-Advocacy After Traumatic Brain Injury: A Randomized Controlled Trial. J Head Trauma Rehabil 2022; 37:114-124. [PMID: 33935227 PMCID: PMC8628308 DOI: 10.1097/htr.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy of a novel intervention aimed at enhancing self-advocacy in individuals living with traumatic brain injury (TBI). SETTING Community. PARTICIPANTS Sixty-seven (35 allocated to treatment, 32 to control) community-dwelling adults 9 months or more post-TBI (mean of 8.9 years postinjury); previously discharged from inpatient or outpatient TBI rehabilitation; able to travel independently in the community, indicating a level of independence needed to engage in self-advocacy. DESIGN Longitudinal randomized 2-arm controlled trial (NCT no. 03385824). Computer-generated block randomization allocated participants to treatment/intervention or control/no-intervention. All outcome assessments completed by blinded study staff. INTERVENTION A manualized group intervention, Self-Advocacy for Independent Life (SAIL), addressing the self-efficacy beliefs, knowledge, and skills for self-advocacy following TBI. MAIN OUTCOME MEASURES The Self-Advocacy Scale (SAS) (primary); General Self-Efficacy Scale (GSE); Personal Advocacy Activity Scale (PAAS); Satisfaction With Life Scale (SWLS). RESULTS The treatment group showed significantly greater improvement than controls from baseline to posttreatment on the primary measure (SAS) of self-efficacy specific to self-advocacy after TBI (effect size = 0.22). Similar improvements were found on secondary measures of general self-efficacy and satisfaction with life from baseline to posttreatment. However, significant between-groups gains for primary and secondary measures were not maintained over 6- and 12-week follow-up. CONCLUSIONS Individuals living with chronic TBI sequelae can increase self-efficacy specific to self-advocacy, general self-efficacy, and satisfaction with life, through a TBI-specific intervention aimed at empowering individuals to advocate for their own needs and wishes. Sustaining gains over time may require ongoing community collaboration and support. This could involve community-based systems of self-advocacy education, resources, and peer support.
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Affiliation(s)
- Lenore Hawley
- Research Department, Craig Hospital, Englewood, Colorado (Mss Hawley and Morey, Mr Sevigny, and Drs Ketchum, Harrison-Felix, and Tefertiller); and John Walsh Centre for Rehabilitation Research, Sydney School of Medicine, The University of Sydney, Sydney, New South Wales, Australia (Dr Simpson)
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17
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Mollica A, Dey A, Cairncross M, Silverberg N, Burke MJ. Neuropsychiatric Treatment for Mild Traumatic Brain Injury: Nonpharmacological Approaches. Semin Neurol 2022; 42:168-181. [PMID: 35114694 DOI: 10.1055/s-0041-1742143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Postconcussive symptoms following mild traumatic brain injury (mTBI)/concussion are common, disabling, and challenging to manage. Patients can experience a range of symptoms (e.g., mood disturbance, headaches, insomnia, vestibular symptoms, and cognitive dysfunction), and neuropsychiatric management relies heavily on nonpharmacological and multidisciplinary approaches. This article presents an overview of current nonpharmacological strategies for postconcussive symptoms including psychoeducation; psychotherapy; vestibular, visual, and physical therapies; cognitive rehabilitation; as well as more novel approaches, such as neuromodulation. Ultimately, treatment and management of mTBI should begin early with appropriate psychoeducation/counseling, and be tailored based on core symptoms and individual goals.
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Affiliation(s)
- Adriano Mollica
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Ayan Dey
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Molly Cairncross
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Noah Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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18
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Ptito A, Papa L, Gregory K, Folmer RL, Walker WC, Prabhakaran V, Wardini R, Skinner K, Yochelson M. A Prospective, Multicenter Study to Assess the Safety and Efficacy of Translingual Neurostimulation Plus Physical Therapy for the Treatment of a Chronic Balance Deficit Due to Mild-to-Moderate Traumatic Brain Injury. Neuromodulation 2021; 24:1412-1421. [PMID: 32347591 PMCID: PMC9291157 DOI: 10.1111/ner.13159] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/28/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Translingual neurostimulation (TLNS) studies indicate improved outcomes in neurodegenerative disease or spinal cord injury patients. This study was designed to assess the safety and efficacy of TLNS plus targeted physical therapy (PT) in people with a chronic balance deficit after mild-to-moderate traumatic brain injury (mmTBI). MATERIALS AND METHODS This international, multicenter, randomized study enrolled 122 participants with a chronic balance deficit who had undergone PT following an mmTBI and had plateaued in recovery. Randomized participants received PT plus either high-frequency pulse (HFP; n = 59) or low-frequency pulse (LFP; n = 63) TLNS. The primary efficacy and safety endpoints were the proportion of sensory organization test (SOT) responders (SOT composite score improvement of ≥15 points) and fall frequency after five weeks of treatment, respectively. RESULTS The proportion of SOT responders was significant in the HFP + PT (71.2%) and LFP + PT (63.5%) groups compared with baseline (p < 0.0005). For the pooled population, the SOT responder rate was 67.2% (p < 0.00005), and there were clinically and statistically significant improvements in SOT composite scores after two and five weeks (p < 0.0005). Both groups had reductions in falls and headache disability index scores. Mean dynamic gait index scores in both groups also significantly increased from baseline at weeks 2 and 5. CONCLUSIONS Significant improvements in balance and gait, in addition to headaches, sleep quality, and fall frequency, were observed with TLNS plus targeted PT; in participants who had a chronic balance deficit following an mmTBI and had plateaued on prior conventional physiotherapy.
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Affiliation(s)
- Alain Ptito
- Psychology DepartmentMcGill University Health Centre; Montreal Neurological Institute and HospitalMontrealQCCanada
| | - Linda Papa
- Department of Emergency MedicineOrlando HealthOrlandoFLUSA
| | - Kenton Gregory
- Center for Regenerative MedicineOregon Health and Science UniversityPortlandORUSA
| | - Robert L. Folmer
- Department of OtolaryngologyOregon Health and Science UniversityPortlandORUSA
- National Center for Rehabilitative Auditory ResearchVA Portland Health Care SystemPortlandORUSA
| | - William C. Walker
- Department of Physical Medicine and RehabilitationVirginia Commonwealth UniversityRichmondVAUSA
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin Hospitals and ClinicsUniversity of WisconsinMadisonWIUSA
| | | | | | - Michael Yochelson
- Shepherd CenterAtlantaGAUSA
- MedStar National Rehabilitation NetworkWashingtonDCUSA
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19
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Hammond FM, Zafonte RD, Tang Q, Jang JH. Carbamazepine for Irritability and Aggression after Traumatic Brain Injury: A Randomized, Placebo-Controlled Study. J Neurotrauma 2021; 38:2238-2246. [PMID: 33563104 DOI: 10.1089/neu.2020.7530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This study tested the hypothesis that carbamazepine (CBZ) reduces irritability/aggression among individuals >6 months post-traumatic brain injury (TBI). Seventy individuals were enrolled in a parallel-group, randomized, double-blind, placebo-controlled, forced-titration trial of CBZ (n = 35) versus placebo (n = 35). Participants were randomly assigned to receive CBZ or placebo 42 days with outcome assessed at baseline and Day 42. Dose was titrated up to 400 mg CBZ or placebo equivalent two times daily. Symptoms of irritability and aggression were measured using the Neuropsychiatric Inventory Irritability (NPI-I) and Aggression (NPI-A) domains as a composite measure (NPI-I/A). Global impression of change was recorded from participant, observer, and study clinician. The CBZ group did not differ significantly from the placebo group (p = 0.60 and 0.59 for NPI-I/A observer and participant ratings, respectively). High placebo effects were observed with minimal clinically important difference in observer NPI-I/A 57% in CBZ group and 77% in placebo group (p = 0.09). Findings were similar for participant ratings. Eighteen of 35 had therapeutic CBZ level ≥4. Therapeutic sample analysis revealed similar high placebo response and non-significant differences except clinician ratings favoring CBZ. Non-serious adverse events occurred more frequently in the CBZ group with greater nervous system effects. CBZ up to 400 mg two times daily was not superior to placebo at reducing irritability/aggression according observers and participants. Large placebo effects may have masked the detection of differences. Clinician rating metrics suggest benefit, and thus, CBZ should remain a treatment option for the experienced brain injury clinician. Data are provided that may aid treatment decisions.
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Affiliation(s)
- Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Atrium Health, Charlotte, North Carolina, USA
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Ross D Zafonte
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Qing Tang
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeong Hoon Jang
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
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20
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The Nocebo Effect and Pediatric Concussion. J Sport Rehabil 2021; 30:837-843. [PMID: 34050035 DOI: 10.1123/jsr.2020-0519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
While placebo effects are well recognized within clinical medicine, "nocebo effects" have received much less attention. Nocebo effects are problems caused by negative expectations derived from information or treatment provided during a clinical interaction. In this review, we examine how nocebo effects may arise following pediatric concussion and how they may worsen symptoms or prolong recovery. We offer several suggestions to prevent, lessen, or eliminate such effects. We provide recommendations for clinicians in the following areas: terminology selection, explicit and implicit messaging to patients, evidence-based recommendations, and awareness of potential biases during clinical interactions. Clinicians should consider the empirically grounded suggestions when approaching the care of pediatric patients with concussion.
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21
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Yang WC, Chen YF, Yang CC, Wu PF, Chan HM, Chen JLY, Chen GY, Cheng JCH, Kuo SH, Hsu FM. Hippocampal avoidance whole-brain radiotherapy without memantine in preserving neurocognitive function for brain metastases: a phase II blinded randomized trial. Neuro Oncol 2021; 23:478-486. [PMID: 32789503 DOI: 10.1093/neuonc/noaa193] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hippocampal avoidance whole-brain radiotherapy (HA-WBRT) shows potential for neurocognitive preservation. This study aimed to evaluate whether HA-WBRT or conformal WBRT (C-WBRT) is better for preserving neurocognitive function. METHODS This single-blinded randomized phase II trial enrolled patients with brain metastases and randomly assigned them to receive HA-WBRT or C-WBRT. Primary endpoint is decline of the Hopkins Verbal Learning Test-Revised (HVLT-R) delayed recall at 4 months after treatment. Neurocognitive function tests were analyzed with a mixed effect model. Brain progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS From March 2015 to December 2018, seventy patients were randomized to yield a total cohort of 65 evaluable patients (33 in the HA-WBRT arm and 32 in the C-WBRT arm) with a median follow-up of 12.4 months. No differences in baseline neurocognitive function existed between the 2 arms. The mean change of HVLT-R delayed recall at 4 months was -8.8% in the HA-WBRT arm and +3.8% in the C-WBRT arm (P = 0.31). At 6 months, patients receiving HA-WBRT showed favorable perpetuation of HVLT-R total recall (mean difference = 2.60, P = 0.079) and significantly better preservation of the HVLT-R recognition-discrimination index (mean difference = 1.78, P = 0.019) and memory score (mean difference = 4.38, P = 0.020) compared with patients undergoing C-WBRT. There were no differences in Trail Making Test Part A or Part B or the Controlled Oral Word Association test between the 2 arms at any time point. There were no differences in brain PFS or OS between arms as well. CONCLUSION Patients receiving HA-WBRT without memantine showed better preservation in memory at 6-month follow-up, but not in verbal fluency or executive function.
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Affiliation(s)
- Wen-Chi Yang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Chengchi University, Taipei, Taiwan.,Cancer Research Center, National Chengchi University, Taipei, Taiwan
| | - Ya-Fang Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Chi-Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan.,Holistic Mental Health Center, Taipei City Hospital, Taipei, Taiwan
| | - Pei-Fang Wu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsing-Min Chan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenny Ling-Yu Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Guann-Yiing Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Jason Chia-Hsien Cheng
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Chengchi University, Taipei, Taiwan.,Cancer Research Center, National Chengchi University, Taipei, Taiwan
| | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Chengchi University, Taipei, Taiwan.,Cancer Research Center, National Chengchi University, Taipei, Taiwan
| | - Feng-Ming Hsu
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Chengchi University, Taipei, Taiwan.,Cancer Research Center, National Chengchi University, Taipei, Taiwan
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22
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Rodrigues PA, Zaninotto AL, Ventresca HM, Neville IS, Hayashi CY, Brunoni AR, de Paula Guirado VM, Teixeira MJ, Paiva WS. The Effects of Repetitive Transcranial Magnetic Stimulation on Anxiety in Patients With Moderate to Severe Traumatic Brain Injury: A Post-hoc Analysis of a Randomized Clinical Trial. Front Neurol 2020; 11:564940. [PMID: 33343483 PMCID: PMC7746857 DOI: 10.3389/fneur.2020.564940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Traumatic brain injury (TBI) is one of the leading causes of neuropsychiatric disorders in young adults. Repetitive Transcranial Magnetic Stimulation (rTMS) has been shown to improve psychiatric symptoms in other neurologic disorders, such as focal epilepsy, Parkinson's disease, and fibromyalgia. However, the efficacy of rTMS as a treatment for anxiety in persons with TBI has never been investigated. This exploratory post-hoc analyzes the effects of rTMS on anxiety, depression and executive function in participants with moderate to severe chronic TBI. Methods: Thirty-six participants with moderate to severe TBI and anxiety symptoms were randomly assigned to an active or sham rTMS condition in a 1:1 ratio. A 10-session protocol was used with 10-Hz rTMS stimulation over the left dorsolateral prefrontal cortex (DLPFC) for 20 min each session, a total of 2,000 pulses were applied at each daily session (40 stimuli/train, 50 trains). Anxiety symptoms; depression and executive function were analyzed at baseline, after the last rTMS session, and 90 days post intervention. Results: Twenty-seven participants completed the entire protocol and were included in the post-hoc analysis. Statistical analysis showed no interaction of group and time (p > 0.05) on anxiety scores. Both groups improved depressive and executive functions over time, without time and group interaction (p s < 0.05). No adverse effects were reported in either intervention group. Conclusion: rTMS did not improve anxiety symptoms following high frequency rTMS in persons with moderate to severe TBI. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02167971.
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Affiliation(s)
| | - Ana Luiza Zaninotto
- Department of Neurology, University of São Paulo, São Paulo, Brazil.,Speech and Feeding Disorders Lab, Massachusetts General Hospital Institute of Health Professions (MGHIHP), Boston, MA, United States
| | - Hayden M Ventresca
- Speech and Feeding Disorders Lab, Massachusetts General Hospital Institute of Health Professions (MGHIHP), Boston, MA, United States
| | | | | | - Andre R Brunoni
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Univerdade de São Paulo, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), São Paulo, Brazil.,Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
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23
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Hicks AJ, Clay FJ, Hopwood M, James AC, Perry LA, Jayaram M, Batty R, Ponsford JL. Efficacy and Harms of Pharmacological Interventions for Anxiety after Traumatic Brain Injury: Systematic Review. J Neurotrauma 2020; 38:519-528. [PMID: 33045912 DOI: 10.1089/neu.2020.7277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
After a traumatic brain injury (TBI), many persons experience significant and debilitating problems with anxiety. The aim of this systematic review was to critically evaluate the evidence regarding efficacy of pharmacological interventions for anxiety after TBI. We reviewed studies published in English before July 2020 and included original research on pharmacological interventions for anxiety after TBI in adults ≥16 years of age. MEDLINE, PubMed, CINAHL, EMBASE, PsycINFO, and CENTRAL databases were searched, with additional searching of key journals, clinical trials registries, and international drug regulators. The primary outcomes of interest were reduction in symptoms of anxiety and occurrence of harms. The secondary outcomes of interest were changes in depression, cognition, quality of life, and participation. Data were summarized in a narrative synthesis, and evidence quality was assessed using the Cochrane Risk of Bias tool. Only a single non-peer-reviewed, randomized controlled trial of 19 male military service members with mild TBI met inclusion criteria. This study found no significant effect of citalopram on anxiety symptoms over a 12-week intervention. The trial was stopped early because of poor recruitment, and much of the study detail was not included in the report. The methodological quality of the study was difficult to assess because of the lack of detail. No recommendations could be drawn from this review. There is a critical need for adequately powered and controlled studies of pharmacological interventions for anxiety after TBI across all severities that examine side-effect profiles and consider issues of comorbidity and effects of long-term pharmacotherapy.
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Affiliation(s)
- Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Fiona J Clay
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Amelia C James
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Luke A Perry
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Mahesh Jayaram
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Batty
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
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24
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Mollica A, Safavifar F, Fralick M, Giacobbe P, Lipsman N, Burke MJ. Transcranial Magnetic Stimulation for the Treatment of Concussion: A Systematic Review. Neuromodulation 2020; 24:803-812. [PMID: 33184973 DOI: 10.1111/ner.13319] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Post-concussive symptoms (PCSs) are common, disabling, and challenging to manage. Evolving models of concussion pathophysiology suggest evidence of brain network dysfunction that may be amenable to neuromodulation. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential novel treatment option for PCSs. OBJECTIVES To systematically review rTMS trials for the treatment of symptoms following concussion/mild traumatic brain injury (mTBI). MATERIALS AND METHODS We conducted a systematic review of Pubmed/Medline, Embase, and PsychINFO databases were searched up to May 19, 2020. Studies were included if they were prospective rTMS treatment studies of patients with mTBI/concussion. Variables including patient demographics, study design, rTMS protocol parameters, primary outcome measures, and efficacy data were extracted and qualitatively synthesized. rTMS methodology and study quality were also evaluated. RESULTS Of the 342 studies identified, 11 met eligibility criteria and were included for synthesis. Forty-one percent of patients were female and age ranged from 18 to 65 (average age = 38.5 years). Post-concussive depression (seven studies) and headache (four studies) were the most commonly investigated symptoms. The majority of trials were sham-controlled with randomized control trial (RCT) designs, but all were small pilot samples (n < 30). Methodological heterogeneity and a low number of identified trials precluded quantitative meta-analysis. Regarding rTMS for post-concussive depression, positive results were found in two out of four studies with depression as a primary outcome, and all three studies that assessed depression as a secondary outcome. All four rTMS studies for post-concussive headache reported positive results. CONCLUSIONS rTMS for the treatment of concussion/mTBI shows promising preliminary results for post-concussive depression and headache, symptoms that otherwise have limited effective treatment options. More studies with larger sample sizes are needed to further establish potential efficacy.
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Affiliation(s)
- Adriano Mollica
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Farnaz Safavifar
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Michael Fralick
- Department of Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Peter Giacobbe
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nir Lipsman
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Matthew J Burke
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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25
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Bender Pape TL, Livengood SL, Kletzel SL, Blabas B, Guernon A, Bhaumik DK, Bhaumik R, Mallinson T, Weaver JA, Higgins JP, Wang X, Herrold AA, Rosenow JM, Parrish T. Neural Connectivity Changes Facilitated by Familiar Auditory Sensory Training in Disordered Consciousness: A TBI Pilot Study. Front Neurol 2020; 11:1027. [PMID: 33132997 PMCID: PMC7578344 DOI: 10.3389/fneur.2020.01027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 08/06/2020] [Indexed: 12/19/2022] Open
Abstract
For people with disordered consciousness (DoC) after traumatic brain injury (TBI), relationships between treatment-induced changes in neural connectivity and neurobehavioral recovery have not been explored. To begin building a body of evidence regarding the unique contributions of treatments to changes in neural network connectivity relative to neurobehavioral recovery, we conducted a pilot study to identify relationships meriting additional examination in future research. To address this objective, we examined previously unpublished neural connectivity data derived from a randomized clinical trial (RCT). We leveraged these data because treatment efficacy, in the RCT, was based on a comparison of a placebo control with a specific intervention, the familiar auditory sensory training (FAST) intervention, consisting of autobiographical auditory-linguistic stimuli. We selected a subgroup of RCT participants with high-quality imaging data (FAST n = 4 and placebo n = 4) to examine treatment-related changes in brain network connectivity and how and if these changes relate to neurobehavioral recovery. To discover promising relationships among the FAST intervention, changes in neural connectivity, and neurobehavioral recovery, we examined 26 brain regions and 19 white matter tracts associated with default mode, salience, attention, and language networks, as well as three neurobehavioral measures. Of the relationships discovered, the systematic filtering process yielded evidence supporting further investigation of the relationship among the FAST intervention, connectivity of the left inferior longitudinal fasciculus, and auditory-language skills. Evidence also suggests that future mechanistic research should focus on examining the possibility that the FAST supports connectivity changes by facilitating redistribution of brain resources. For a patient population with limited treatment options, the reported findings suggest that a simple, yet targeted, passive sensory stimulation treatment may have altered functional and structural connectivity. If replicated in future research, then these findings provide the foundation for characterizing the unique contributions of the FAST intervention and could inform development of new treatment strategies. For persons with severely damaged brain networks, this report represents a first step toward advancing understanding of the unique contributions of treatments to changing brain network connectivity and how these changes relate to neurobehavioral recovery for persons with DoC after TBI. Clinical Trial Registry: NCT00557076, The Efficacy of Familiar Voice Stimulation During Coma Recovery (http://www.clinicaltrials.gov).
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Affiliation(s)
- Theresa L Bender Pape
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sherri L Livengood
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sandra L Kletzel
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States
| | - Brett Blabas
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States
| | - Ann Guernon
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States.,Marianjoy Rehabilitation Hospital Part of Northwestern Medicine, Wheaton, IL, United States
| | - Dulal K Bhaumik
- Division of Epidemiology and Biostatistics, Department of Psychiatry, Biostatistical Research Center, University of Illinois at Chicago, Chicago, IL, United States.,Research Service, Cooperative Studies Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, United States
| | - Runa Bhaumik
- Division of Epidemiology and Biostatistics, Department of Psychiatry, Biostatistical Research Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Trudy Mallinson
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
| | - Jennifer A Weaver
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
| | - James P Higgins
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Xue Wang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Amy A Herrold
- The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States.,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Northwestern Memorial Hospital, Chicago, IL, United States
| | - Todd Parrish
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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26
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Lee B, Leem J, Kim H, Jo HG, Kwon CY. Herbal Medicine for Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Limitations. Front Neurol 2020; 11:772. [PMID: 33071922 PMCID: PMC7530840 DOI: 10.3389/fneur.2020.00772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022] Open
Abstract
Background: This systematic review aimed to evaluate the effectiveness (functional outcomes and clinical symptoms) and safety (incidence of adverse events) of herbal medicine (HM) as monotherapy or adjunctive therapy to conventional treatment (CT) for traumatic brain injury (TBI). Methods: We comprehensively searched 14 databases from their inception until July 2019. Randomized controlled trials (RCTs) using HM as monotherapy or adjunctive therapy to treat TBI patients were included. The primary outcome was functional outcomes, consciousness state, morbidity, and mortality. Meta-analysis was performed to calculate a risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs), when appropriate data were available. Methodological quality of RCTs and the strength of evidence were also assessed. Results: Thirty-seven RCTs with 3,374 participants were included. According to meta-analysis, HM as a monotherapy (RR 1.29, 95% CI: 1.21–1.37) or an adjunctive therapy to CT (RR 1.21, 95% CI: 1.16–1.27) showed significantly better total effective rate based on clinical symptoms, compared to CT alone. Subgroup analysis showed that HM had significantly improved post-concussion syndrome, dizziness, headache, epilepsy, and mild TBI, but not traumatic brain edema, compared to CT. Moreover, HM combined with CT had significantly improved post-concussion syndrome, mental disorder, headache, epilepsy, and mild TBI-like symptoms, but not cognitive dysfunction and posttraumatic hydrocephalus, compared to CT alone. When HM was combined with CT, functional outcomes such as activities of daily living and neurological function were significantly better than in patients treated using CT alone. In terms of the incidence of adverse events, HM did not differ from either CT (RR 0.88, 95% CI: 0.33–2.30) or placebo (RR 2.29, 95% CI: 0.83–6.32). However, HM combined with CT showed better safety profile than CT alone (RR 0.64, 95% CI: 0.44–0.93). Most studies had a high risk of performance bias, and the quality of evidence was mostly rated “very low” to “moderate,” mostly because the included studies had a high risk of bias and imprecise quantitative synthesis results. Conclusion: The current evidence suggests that there is insufficient evidence for recommending HM for TBI in clinical practice. Therefore, further larger, high-quality, rigorous RCTs should be conducted.
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Affiliation(s)
- Boram Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jungtae Leem
- Research and Development Institute, CY Pharma Co., Seoul, South Korea.,Chung-Yeon Central Institute, Gwangju, South Korea
| | - Hyunho Kim
- Chung-Yeon Central Institute, Gwangju, South Korea
| | - Hee-Geun Jo
- Chung-Yeon Central Institute, Gwangju, South Korea.,Chung-Yeon Korean Medicine Hospital, Gwangju, South Korea
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, Busan, South Korea
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27
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Polich G, Gray S, Tran D, Morales-Quezada L, Glenn M. Comparing focused attention meditation to meditation with mobile neurofeedback for persistent symptoms after mild-moderate traumatic brain injury: a pilot study. Brain Inj 2020; 34:1408-1415. [DOI: 10.1080/02699052.2020.1802781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ginger Polich
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Sarah Gray
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Duc Tran
- Department of Physical Medicine and Rehabilitation, Loma Linda University, Loma Linda, CA, USA
| | - Leon Morales-Quezada
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA, USA
| | - Mel Glenn
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA, USA
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28
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Haddad R, Lenze EJ, Nicol G, Miller JP, Yingling M, Wetherell JL. Does patient expectancy account for the cognitive and clinical benefits of mindfulness training in older adults? Int J Geriatr Psychiatry 2020; 35:626-632. [PMID: 32017250 DOI: 10.1002/gps.5279] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/20/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Patient expectations of treatment effects could influence neuropsychological and clinical outcomes in clinical trials of behavioral and lifestyle interventions, which could potentially confound the interpretation of findings. Our aim was to examine whether patient expectancy mediated effectiveness of Mindfulness-Based Stress Reduction (MBSR) for improving cognitive function and clinical outcome. METHODS The present study uses data from a single-blind, multi-site, randomized controlled trial comparing MBSR to a health education attention control in older adults with anxiety and/or depressive disorders and subjective cognitive concerns. Using the Credibility and Expectations Questionnaire, we measured expectancy and perceived credibility of the interventions assigned to patients. Using mediational analysis, we examined the influence of expectancy and credibility on two key outcomes: memory performance and clinical global improvement. RESULTS Neither expectancy nor perceived credibility of intervention accounted significantly for MBSR's effectiveness for memory test performance or clinical global improvement. CONCLUSION In this clinical trial, expectancy for improvement did not account for the effectiveness of MBSR on memory performance or clinical outcomes in depressed and anxious older adults. We advise that clinical trials of behavioral and lifestyle interventions for brain health in older adults should measure and test the role of expectancy.
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Affiliation(s)
- Rita Haddad
- Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric J Lenze
- Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St. Louis, MO, USA
| | - Ginger Nicol
- Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St. Louis, MO, USA
| | - J Philip Miller
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Yingling
- Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St. Louis, MO, USA
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29
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Abstract
This comprehensive review discusses clinical studies of patients following brain injuries (traumatic, acquired, or stroke), who have been treated with amantadine or memantine. Both amantadine and memantine are commonly used in the acute rehabilitation setting following brain injuries, despite their lack of FDA-approval for neuro-recovery. Given the broad utilization of such agents, there is a need to review the evidence supporting this common off-label prescribing. The purpose of this review is to describe the mechanisms of action for memantine and amantadine, as well as to complete a comprehensive review of the clinical uses of these agents. We included 119 original, clinical research articles from NCBI Medline, published before 2019. We focused on the domains of neuroplasticity, functional recovery, motor recovery, arousal, fatigue, insomnia, behavior, agitation, and cognition. Most of the existing research supporting the use of amantadine and memantine in recovery from brain injuries was done in very small populations, limiting the significance of conclusions. While most studies are positive; small effect sizes are usually reported, or populations are subject to bias. Furthermore, evidence is so limited that this review includes research regarding both acute and chronic acquired brain injury populations. Fortunately, reported short-term side effects generally are modest, and stop soon after amantadine/memantine is discontinued. However, responses are inconsistent, and the phenotype of responders remains elusive.
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Affiliation(s)
- Heather M Ma
- Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA
| | - Ross D Zafonte
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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30
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Lee B, Kim BK, Kim HJ, Jung IC, Kim AR, Park HJ, Kwon OJ, Lee JH, Kim JH. Efficacy and Safety of Electroacupuncture for Insomnia Disorder: A Multicenter, Randomized, Assessor-Blinded, Controlled Trial. Nat Sci Sleep 2020; 12:1145-1159. [PMID: 33328773 PMCID: PMC7735782 DOI: 10.2147/nss.s281231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/19/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of electroacupuncture in treating insomnia. PATIENTS AND METHODS In a multicenter, randomized, assessor-blinded, controlled trial, 150 patients with DSM-5-diagnosed insomnia with Insomnia Severity Index (ISI) scores ≥ 15 were randomly assigned to three different groups that underwent 10 sessions of electroacupuncture, sham-electroacupuncture, or usual care for 4 weeks from October 2015 to June 2016 at four Korean medicine hospitals, Republic of Korea. The primary outcome included the ISI score at Week 4; the secondary outcomes included evaluations of Pittsburgh Sleep Quality Index (PSQI), sleep diary, Hospital Anxiety and Depression Scale (HADS), EuroQoL five dimension (EQ-5D), Patient Global Impression of Change (PGIC), and salivary melatonin and cortisol levels. Assessments were performed at baseline (Week 0) and at Weeks 2, 4, 8, and 12. RESULTS Compared with the usual care group, electroacupuncture group showed a greater improvement in ISI, PSQI, sleep diary-derived variables and HADS and EQ-5D scores at Week 4. The effects mostly persisted until Week 12. There were no significant differences between electroacupuncture and sham-electroacupuncture groups at Week 4 in all outcome measures, except sleep diary-derived sleep efficiency. However, the ISI score showed a significant difference between these groups at Weeks 8 and 12. Treatment success as per PGIC was significantly and borderline higher for electroacupuncture compared with usual care and sham-electroacupuncture, respectively. No significant changes in salivary melatonin and cortisol levels before and after treatment were observed in all groups. No serious adverse events were reported. Blinding was maintained in the sham-electroacupuncture group. CONCLUSION Ten sessions of electroacupuncture can improve the sleep quality of patients with insomnia without serious adverse effects. Thus, it can be recommended as an effective, safe, and well-tolerated intervention.
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Affiliation(s)
- Boram Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Bo-Kyung Kim
- Department of Neuropsychiatry, School of Korean Medicine, Pusan National University, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Hyeong-Jun Kim
- Department of Oriental Gynecology, Jecheon Oriental Hospital of Semyung University, Jecheon, Republic of Korea
| | - In Chul Jung
- Department of Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Ae-Ran Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Hyo-Ju Park
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - O-Jin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.,Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Joo-Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju-si, Gangwon-do, Republic of Korea.,Research Institute of Korean Medicine, Sangji University, Wonju-si, Gangwon-do 26339, Republic of Korea
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31
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Tyler M, Skinner K, Prabhakaran V, Kaczmarek K, Danilov Y. Translingual Neurostimulation for the Treatment of Chronic Symptoms Due to Mild-to-Moderate Traumatic Brain Injury. Arch Rehabil Res Clin Transl 2019; 1:100026. [PMID: 33543056 PMCID: PMC7853385 DOI: 10.1016/j.arrct.2019.100026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare the efficacy of high- and low-frequency noninvasive translingual neurostimulation (TLNS) plus targeted physical therapy (PT) for treating chronic balance and gait deficits due to mild-to-moderate traumatic brain injury (mmTBI). DESIGN Participants were randomized 1:1 in a 26-week double-blind phase 1/2 study (NCT02158494) with 3 consecutive treatment stages: in-clinic, at-home, and no treatment. Arms were high-frequency pulse (HFP) and low-frequency pulse (LFP) TLNS. SETTING TLNS plus PT training was initiated in-clinic and then continued at home. PARTICIPANTS Participants (N=44; 18-65y) from across the United States were randomized into the HFP and LFP (each plus PT) arms. Forty-three participants (28 women, 15 men) completed at least 1 stage of the study. Enrollment requirements included an mmTBI ≥1 year prior to screening, balance disorder due to mmTBI, a plateau in recovery with current PT, and a Sensory Organization Test (SOT) score ≥16 points below normal. INTERVENTIONS Participants received TLNS (HFP or LFP) plus PT for a total of 14 weeks (2 in-clinic and 12 at home), twice daily, followed by 12 weeks without treatment. MAIN OUTCOME MEASURES The primary endpoint was change in SOT composite score from baseline to week 14. Secondary variables (eg, Dynamic Gait Index [DGI], 6-minute walk test [6MWT]) were also collected. RESULTS Both arms had a significant (P<.0001) improvement in SOT scores from baseline at weeks 2, 5, 14 (primary endpoint), and 26. DGI scores had significant improvement (P<.001-.01) from baseline at the same test points; 6MWT evaluations after 2 weeks were significant. The SOT, DGI, and 6MWT scores did not significantly differ between arms at any test point. There were no treatment-related serious adverse events. CONCLUSIONS Both the HFP+PT and LFP+PT groups had significantly improved balance scores, and outcomes were sustained for 12 weeks after discontinuing TLNS treatment. Results between arms did not significantly differ from each other. Whether the 2 dosages are equally effective or whether improvements are because of provision of PT cannot be conclusively established at this time.
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Key Words
- 6MWT, 6-minute walk test
- AE, adverse event
- ANOVA, analysis of variance
- Balance
- DGI, Dynamic Gait Index
- Facial nerve
- Gait
- HFP, high-frequency pulse
- ITP, in-clinic training program
- LFP, low-frequency pulse
- Neurostimulation
- PSQI, Pittsburgh Sleep Quality Index
- PT, physical therapy
- PoNS, portable neuromodulation stimulator
- Rehabilitation
- SOT, Sensory Organization Test
- TBI, traumatic brain injury
- TLNS, translingual neurostimulation
- Trigeminal nerve
- mmTBI, mild-to-moderate traumatic brain injury
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Affiliation(s)
- Mitchell Tyler
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kim Skinner
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Vivek Prabhakaran
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kurt Kaczmarek
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Yuri Danilov
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
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Zafonte RD, Fregni F, Bergin MJG, Goldstein R, Boudreau N, Monge I, Luz M, Frazier J, Giacino JT. Huperzine A for the treatment of cognitive, mood, and functional deficits after moderate and severe TBI (HUP-TBI): results of a Phase II randomized controlled pilot study: implications for understanding the placebo effect. Brain Inj 2019; 34:34-41. [PMID: 31638455 DOI: 10.1080/02699052.2019.1677941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To investigate the effect of Huperzine A on memory and learning in individuals with moderate-severe traumatic brain injury (TBI).Design: Randomized, double-blind, placebo-controlled Phase II clinical trial.Methods: Subjects were randomly assigned to receive Huperzine A or placebo for 12 weeks and were assessed during in-person visits at screening/baseline, and 6, 12, 24, and 52 weeks post-injury. Changes in memory and learning scores on the California Verbal Learning Test - 2nd Edition (CVLT-II) from baseline to week 12 were assessed using permutation tests and regression analyses.Results: There was no difference between the Huperzine A and placebo groups in memory performance after 12 weeks of treatment. In the placebo group, significant improvements were noted in learning and memory scores. Both groups showed clinically important improvements in depression on the Beck Depression Index.Conclusions: The clinically important improvements in cognitive and emotional outcomes observed in both the placebo and active treatment arms of this clinical trial of Huperzine A are best understood in the context of a placebo effect. Future trials involving patients with moderate-severe TBI in the subacute to chronic phases of recovery should be designed to account for placebo effects as failure to do so may lead to spurious conclusions.
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Affiliation(s)
- Ross D Zafonte
- Department of Physical Medicine Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA.,Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Felipe Fregni
- Department of Physical Medicine Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael J G Bergin
- Department of Physical Medicine Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Richard Goldstein
- Department of Physical Medicine Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Boudreau
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Iris Monge
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Matthew Luz
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Judith Frazier
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Joseph T Giacino
- Department of Physical Medicine Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
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34
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Silverberg ND, Panenka WJ. Antidepressants for depression after concussion and traumatic brain injury are still best practice. BMC Psychiatry 2019; 19:100. [PMID: 30917802 PMCID: PMC6438030 DOI: 10.1186/s12888-019-2076-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/12/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Depression is a common complication of traumatic brain injury (TBI). New evidence suggests that antidepressant medication may be no more effective than placebo in this population. MAIN BODY Selective serotonin reuptake inhibitors are recommended as first-line treatment for depression in contemporary expert consensus clinical practice guidelines for management of TBI. This recommendation is based on multiple prior meta-analyses of clinical trials in depression after TBI as well as depression in the general population. The evidence is mixed. A recent clinical trial and new meta-analysis including that trial found no benefit of antidepressants for depression following TBI. We argue that this finding should not change practice, i.e., patients who present with depression after TBI should still be considered for antidepressant treatment, because they may (1) benefit from robust placebo effects, (2) benefit from an alternative or adjunctive medication if the agent prescribed first does not achieve a depression remission, and (3) make improvements that are not captured well by traditional depression outcome measures, which are confounded by TBI sequelae. Patients with mild TBI are especially appropriate for antidepressant therapy because they, on average, more closely resemble patients with no known TBI history enrolled in typical primary Major Depressive Disorder clinical trials than patients enrolled in TBI trials in placebo-controlled trials published to date. CONCLUSION TBI, and especially mild TBI, is not a contraindication for antidepressant therapy. Health providers should routinely screen and initiate treatment for depression after TBI.
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Affiliation(s)
- Noah D. Silverberg
- 0000 0001 2288 9830grid.17091.3eDivision of Physical Medicine and Rehabilitation, University of British Columbia, 4255 Laurel St, Vancouver, BC V5Z 2G9 Canada ,0000 0004 0384 4428grid.417243.7Rehabilitation Research Program, Vancouver Coastal Health Research Institute, GF Strong Rehab Centre, 4255 Laurel St, Vancouver, British Columbia V5Z 2G9 Canada
| | - William J. Panenka
- 0000 0001 2288 9830grid.17091.3eDivision of Physical Medicine and Rehabilitation, University of British Columbia, 4255 Laurel St, Vancouver, BC V5Z 2G9 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, Canada; 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, British Columbia Mental Health and Addictions Research Institute, University of British Columbia, Vancouver, Canada; 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada
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Lee B, Leem J, Kim H, Jo HG, Yoon SH, Shin A, Sul JU, Choi YY, Yun Y, Kwon CY. Herbal medicine for acute management and rehabilitation of traumatic brain injury: A protocol for a systematic review. Medicine (Baltimore) 2019; 98:e14145. [PMID: 30653148 PMCID: PMC6370117 DOI: 10.1097/md.0000000000014145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/26/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of herbal medicine in treating traumatic brain injury. METHODS AND ANALYSIS The following electronic databases will be searched up to December 2018 without language or publication status restrictions: Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature. We will also search Korean, Chinese, and Japanese databases. Any randomized controlled trials related to herbal medicine for traumatic brain injury will be included. The functional outcome, consciousness state, morbidity, and mortality will be assessed as primary outcomes. The quality of life, adverse events, and total effective rate will be evaluated as secondary outcomes. Two researchers will independently perform the study selection, data extraction, assessment of study quality, and evaluation of the quality of evidence for the main findings. Data synthesis and analysis will be performed using RevMan version 5.3. The results will be expressed as a risk ratio for the binary outcome and as the mean difference or standardized mean difference for a continuous outcome. We will synthesize the data by either fixed effects or random effects model according to a heterogeneity test or the number of studies included in the meta-analysis. The methodological quality of the included studies will be evaluated using the Cochrane Collaboration's risk of bias tool. The quality of evidence for each main outcome will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. ETHICS AND DISSEMINATION Ethical approval is not required because individual patient data are not included. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentations. PROSPERO REGISTRATION NUMBER CRD42018116559.
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Affiliation(s)
- Boram Lee
- Department of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul
| | - Jungtae Leem
- Chung-Yeon Medical Institute, Gwangju
- Dongshin Korean Medicine Hospital, Seoul
| | - Hyunho Kim
- Chung-Yeon Medical Institute, Gwangju
- Dongshin Korean Medicine Hospital, Seoul
| | - Hee-Geun Jo
- Chung-Yeon Medical Institute, Gwangju
- Chung-Yeon Korean Medicine Hospital, Gwangju
| | - Sang-Hoon Yoon
- Chung-Yeon Medical Institute, Gwangju
- Chung-Yeon Korean Medicine Hospital, Gwangju
| | | | - Jae-Uk Sul
- Chung-Yeon Medical Institute, Gwangju
- Chung-Yeon Korean Medicine Hospital, Gwangju
| | - Ye-Yong Choi
- Chung-Yeon Medical Institute, Gwangju
- Research and Development Institute, CY Pharma Co
| | - Younghee Yun
- Chung-Yeon Medical Institute, Gwangju
- Research and Development Institute, CY Pharma Co
| | - Chan-Young Kwon
- Chung-Yeon Medical Institute, Gwangju
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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Polich G, Iaccarino MA, Zafonte R. Psychopharmacology of traumatic brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:253-267. [PMID: 31727216 DOI: 10.1016/b978-0-444-64012-3.00015-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The pathophysiology of traumatic brain injury (TBI) can be highly variable, involving functional and/or structural damage to multiple neuroanatomical networks and neurotransmitter systems. This wide-ranging potential for physiologic injury is reflected in the diversity of neurobehavioral and neurocognitive symptoms following TBI. Here, we aim to provide a succinct, clinically relevant, up-to-date review on psychopharmacology for the most common sequelae of TBI in the postacute to chronic period. Specifically, treatment for neurobehavioral symptoms (depression, mania, anxiety, agitation/irritability, psychosis, pseudobulbar affect, and apathy) and neurocognitive symptoms (processing speed, attention, memory, executive dysfunction) will be discussed. Treatment recommendations will reflect general clinical practice patterns and the research literature.
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Affiliation(s)
- Ginger Polich
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States.
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Hammond FM, Sherer M, Malec JF, Zafonte RD, Dikmen S, Bogner J, Bell KR, Barber J, Temkin N. Amantadine Did Not Positively Impact Cognition in Chronic Traumatic Brain Injury: A Multi-Site, Randomized, Controlled Trial. J Neurotrauma 2018; 35:2298-2305. [PMID: 29742960 PMCID: PMC6157374 DOI: 10.1089/neu.2018.5767] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Despite limited evidence to support the use of amantadine to enhance cognitive function after traumatic brain injury (TBI), the clinical use for this purpose is highly prevalent and is often based on inferred belief systems. The aim of this study was to assess effect of amantadine on cognition among individuals with a history of TBI and behavioral disturbance using a parallel-group, randomized, double-blind, placebo-controlled trial of amantadine 100 mg twice-daily versus placebo for 60 days. Included in the study were 119 individuals with two or more neuropsychological measures greater than 1 standard deviation below normative means from a larger study of 168 individuals with chronic TBI (>6 months post-injury) and irritability. Cognitive function was measured at treatment days 0, 28, and 60 with a battery of neuropsychological tests. Composite indices were generated: General Cognitive Index (included all measures), a Learning Memory Index (learning/memory measures), and Attention/Processing Speed Index (attention and executive function measures). Repeated-measures analysis of variance revealed statistically significant between-group differences favoring the placebo group at day 28 for General Cognitive Index (p = 0.002) and Learning Memory Index (p = 0.001), but not Attention/Processing Speed Index (p = 0.25), whereas no statistically significant between-group differences were found at day 60. There were no statistically significant between-group differences on adverse events. Cognitive function in individuals with chronic TBI is not improved by amantadine 100 mg twice-daily. In the first 28 days of use, amantadine may impede cognitive processing. However, the effect size was small and mean scores for both groups were generally within expectations for persons with history of complicated mild-to-severe TBI, suggesting that changes observed across assessments may not have functional significance. The use of amantadine to enhance cognitive function is not supported by these findings.
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Affiliation(s)
- Flora M. Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Carolinas HealthCare System, Charlotte, North Carolina
- Address correspondence to:Flora M. Hammond, MDRehabilitation Hospital of Indiana4141 Shore DriveIndianapolis, IN 46254
| | | | - James F. Malec
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana
| | | | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio
| | - Kathleen R. Bell
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle, Washington
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