University Health Network - Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G2A2, Canada.
Department of Medical Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 L8, Canada.
Syst Rev. 2019 Dec 18;8(1):332. doi: 10.1186/s13643-019-1208-0.
Our understanding of recovery after moderate-to-severe traumatic brain injury (TBI) has shifted. Until recently, it was presumed that following a period of acute neurological vulnerability, the brain remained stable in the chronic stages of injury. However, recent research has shown neurodegeneration in the chronic stages of moderate-to-severe TBI, challenging the assumption of neurological stability. While there is extensive evidence that neurodegeneration occurs, debate remains regarding the scale and timing. This systematic review will evaluate the scale and timelines of neurodegeneration in adult patients with moderate-to-severe TBI.
Literature searches will be conducted in six electronic databases (from inception onwards), including MEDLINE, EMBASE, PsycINFO, CINAHL, SportDiscus, and Cochrane Central Register of Controlled Trials. We will include observational studies that examine neurodegenerative changes within a single sample of TBI patients or studies that compare neuroimaging outcomes between TBI patients and healthy controls. Our primary outcome is structural neuroimaging, and our secondary outcome is diffusion tensor imaging for detection of post-injury white matter changes. All screening, data extraction, and study quality appraisal will be performed independently by the same two study members. It is expected that a narrative summary of the literature will be produced. If feasible, we will conduct a random-effects meta-analysis. However, given the expected heterogeneity between studies (with respect to, for example, timing of imaging, regions imaged) we do not expect to perform a meta-analysis; rather, a narrative synthesis of our findings is expected to be performed.
Understanding the scale and timelines of neurodegeneration in moderate-to-severe TBI (as well as which brain areas are most vulnerable to chronic declines) can inform intervention research designed to offset such changes. This may help improve patient outcome following moderate-to-severe TBI and, in turn, reduce the burden of the injury.
PROSPERO CRD42019117548.
我们对中度至重度创伤性脑损伤（TBI）后恢复的理解已经发生了变化。直到最近，人们还认为，在急性神经脆弱期过后，大脑在损伤的慢性期保持稳定。然而，最近的研究表明，在中度至重度 TBI 的慢性期存在神经退行性变，这对神经稳定的假设提出了挑战。虽然有大量证据表明神经退行性变确实存在，但仍存在争议，包括其程度和时间进程。本系统评价将评估中度至重度 TBI 成年患者的神经退行性变程度和时间进程。
将在六个电子数据库（从创建开始）中进行文献检索，包括 MEDLINE、EMBASE、PsycINFO、CINAHL、SportDiscus 和 Cochrane 中央对照试验注册库。我们将纳入研究单一 TBI 患者样本中神经退行性变化的观察性研究，或比较 TBI 患者和健康对照组神经影像学结果的研究。我们的主要结局是结构神经影像学，次要结局是扩散张量成像以检测损伤后白质变化。所有的筛选、数据提取和研究质量评估将由相同的两名研究人员独立进行。预计将对文献进行叙述性总结。如果可行，我们将进行随机效应荟萃分析。然而，由于预计研究之间存在异质性（例如，成像时间、成像区域），我们预计不会进行荟萃分析，而是对我们的研究结果进行叙述性综合。
了解中度至重度 TBI 中的神经退行性变程度和时间进程（以及哪些大脑区域最容易受到慢性衰退的影响）可以为旨在抵消这些变化的干预研究提供信息。这可能有助于改善中度至重度 TBI 后的患者预后，并相应减轻损伤的负担。
PROSPERO CRD42019117548。
