Particularities of Electrophysiological and Psychoneurological Assessment of Mild Traumatic Brain Injury

Neuropsychological functioning after mTBI is individualized and dynamic, with no currently known predictors and usually having a trajectory of gradual improvement. It is still a challenge to identify specific cognitive profiles associated with mTBI. One of the causes is the transient character of TBI symptoms as they are not appearing immediately after the injury. Another explanation resides in the individual and group variability of cognitive impairements following mTBI, which also affects the standardisation of the neuropsychological tests to use in mTBI assessment batteries (Iverson et al., 2013; Prince & Bruhns, 2017; Tulsky et al., 2017). Presently concussion has no accepted definition or diagnostic criteria. Also, there is no standard (or gold standard) for screening or properly identifying and diagnosing all population with concussion. (Borg et al., 2004). Patients with mTBI could evolve in a bunch of physical, cognitive, and emotional symptoms (Permenter et al., 2021) that are usually known as post-concussion syndrome (PCS). In terms of symptoms, we target neuropsychological evaluation of four key domains (“higher-order attention”, “executive function”, “episodic memory”, and “speed of information processing”) implicated in chronic impairment after mTBI. Alternatively, studies on the EEG frequency domain shed new light on the possibility to have a diagnostic marker based on QEEG patterns identified in the mTBI population and some prognostic factors for the PCS syndrome.(Rapp et al., 2015; Thornton & Carmody, 2009). Given the particularities of neuropsychological functioning after mTBI we emphasize the need of a mixed methodology, using both electrophysiological and psychoneurological tools, to provide the best sensitivity and specificity in assessing cognitive and functional deficits and in predicting further PCS.

Cognitive evoked potentials in the diagnosis of post-concussion syndrome due to blast mild traumatic brain injury

Hostilities in the East of Ukraine are characterized by the use of new weapons, including rocket artillery, rocket-propelled grenades and landmines. This has led to an increase in the number of victims with blast mild traumatic brain injury (BMTBI) and the need to provide them with effective assistance and rehabilitation. An important task is to improve the BMTBI diagnosis by specifying the objective criteria for structural and functional disorders of the central nervous system. This will improve the prognosis of the course of BMTBI in the injured and the treatment program, including personalized, to prevent the development of persistent neurological deficit. Objective: to investigate the possibilities of the cognitive evoked potentials (CEP) method for the objective diagnosis of cognitive disorders in post-concussion syndrome (PCS) BMTBI. Materials and methods. The study involved 115 men with PCS (main group) and 30 healthy individuals (control group). The cognitive functions of the study participants were studied using the questionnaire "Cicerone". The neurophysiological method for assessing the functional state of the brain involved the registration of CEP, event-related (P300 CEP). Results. The selection of a subgroup of patients with PCS, characterized by a predominance of cognitive impairments, allowed us to trace the relationship between the results of neurophysiological studies with the cognitive indicators of patients with BMTBI. P300 latency indices are inversely proportional to cognitive assessment the questionnaire "Cicerone" and statistically significantly depend on the severity of cognitive impairment. Conclusions. The CEP P300 method can be an effective means of objectifying the degree of cognitive impairment in patients with PCS due to BMTBI.

Acute Concussion vs Post-Concussion Syndrome (PCS): How Can We Prevent Progression?

ObjectiveTo contrast the presentation and recovery of acute concussion and post-concussion syndrome (PCS) in order to identify factors for PCS prevention.BackgroundConcussions are classified as acute (<90 days to resolution) or post-concussion syndrome (PCS, = 90 days to resolution). PCS poses a great burden to the individual and to public health. Further investigation is warranted for understanding the progression of acute concussion to PCS and potential mitigating strategies.Design/MethodsRetrospective chart review of concussion patients seen by Sports Medicine and Exercise Physicians over a five-year period. Outcome measures included demographics, wait-times, injury mechanisms, Sport Concussion Assessment Tool (SCAT) scores, management plans, and recovery timelines.ResultsFour hundred ninety-six patients (289 male/207 female, 19.7 ± 9.4 years) presented with 561 concussions in 1,471 visits. Acute concussions accounted for 88% of injuries and 12% were PCS. Females (RR = 1.4) and adults = 25 years (RR = 3.6) were more likely to be diagnosed with PCS. In both, injuries occurred most commonly in hockey, football, and soccer. Family physicians were the most frequent referral provider (58% acute, 76% PCS). Median injury-appointment time was 11.0 days (acute) compared to 182.0 days (PCS). Initial total SCAT symptom score was significantly greater (p < 0.001) in PCS (56.0 ± 33.0) compared to acute concussion (39.8 ± 31.9). Therapies (i.e., referral, medication, intervention) were prescribed in 44% of acute injury visits compared to 73% of PCS visits. Recovery timelines for return to work, school, and sport were significantly longer in PCS patients than in those with acute concussions (p < 0.05).ConclusionsOur findings of the incidence/presentation of PCS agree with previous literature. Athletes who are female and/or = 25 years may be at greater risk for PCS progression, requiring close monitoring and further injury prevention efforts. Considering the number of referrals from family physicians, further concussion education may better optimize initial management and shorten delays in seeking necessary sports medicine consultation.