Clinics in neurology and neurosurgery of sport: traumatic cerebral contusion

Depression and sports-related concussion: A systematic review

CONTEXT

Head injuries are risk factors for chronic depressive disorders, but this association remains poorly explored with regards to concussion.

OBJECTIVES

The objective of this review was to evaluate the incidence of depressive symptoms and depression after sports-related concussion. We also endeavored to identify the response elements regarding the pathophysiology of these symptoms.

METHODS

A systematic search of PubMed and Embase was conducted focusing on papers published until 1st December, 2016, according to PRISMA criteria The following MESH terms were used: (concussion or traumatic brain injury) and sport and (depression or depressive disorder).

RESULTS

A depressive disorder can appear immediately after a concussion: depressive symptoms seem to be associated with the symptoms of the concussion itself. A depressive disorder can also appear later, and is often linked to the frequency and number of concussions. Furthermore, the existence of a mood disorder prior to a concussion can contribute to the onset of a depressive disorder after a concussion.

LIMITS

There is an overall limit concerning the definition of a depressive disorder. In addition, when these studies had controls, they were often compared to high-level athletes; yet, practicing sport regularly is a protective factor against mood pathologies.

CONCLUSIONS

Depressive symptoms after a concussion seem to be associated with postconcussion symptoms. Repeat concussions can contribute to later-onset major depressive disorders. However, playing sports can protect against major depressive disorders: thus, it is essential to evaluate concussions as accurately as possible.

The increase of serum Bcl-2 concentration in moderate head injury outcome: The role of ACTH4-10Pro(8)-Gly(9)-Pro(10.)

BACKGROUND

Traumatic brain injury (TBI) is one of the major causes of death and disability. Apoptosis after TBI contributes significantly to the final extent of tissue damage. The Bcl-2 family proteins are important apoptosis modulators which increased in injured neurons. Bcl-2 has shown an antiapoptotic effect in rats and mice. ACTH4-10Pro(8)-Gly(9)-Pro(10) is a synthetic short fragment of ACTH devoid of hormonal effects and has neuromodulatory properties. ACTH4-10Pro8-Gly9-Pro10 has been shown to increase levels of Bcl-2 and BDNF in vitro as well as in vivo. It has been postulated that ACTH4-10Pro(8)-Gly(9)-Pro(10) will result in improved clinical outcome and reduce hospital length of stay. The goal of this study is to compare the effect of standard therapy only with standard therapy and ACTH4-10Pro(8)-Gly(9)-Pro(10), the increase of Bcl-2, and clinical outcome with reduction of hospital stay.

MATERIALS AND METHODS

Subjects of moderate head injury (MHI) with no indication of surgery were taken consecutively (n = 40) and separated into two groups: standard treatment only and standard treatment combined with ACTH4-10Pro(8)-Gly(9)-Pro(10). Blood samples were taken on day 1 and day 5 from each subject for measurements of Bcl-2 concentration. Barthel Index and MMSE were measured, at discharge and hospital length of stay was noted.

RESULTS

Forty subjects have been involved in this study, three subjects died in the standard therapy group, and one subject in ACTH4-10Pro(8)-Gly(9)-Pro(10) group. Bcl-2 serum level in standard therapy was 1.39 ± 0.75 ng/mL on day 1 and 1.48 ± 0.77 ng/mL on day 5. After treatment with ACTH4-10Pro(8)-Gly(9)-Pro(10), Bcl-2 level was 1.39 ± 0.70 ng/mL on day 1 and 3.70 ± 1.02 ng/mL on day 5. The serum Bcl-2 concentration was significantly increased with ACTH4-10Pro(8)-Gly(9)-Pro(10) therapy with shorter hospital length of stay (P < 0.05).

CONCLUSION

ACTH4-10Pro(8)-Gly(9)-Pro(10) increased serum Bcl-2 levels and reduced hospital length of stay significantly compared with standard therapy alone.