Li Lucia M, Vichayanrat Ekawat, Del Giovane Martina, Lai Helen Hoi Lun, Iodice Valeria
Division of Brain Sciences, Imperial College, London, UK.
UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, UK.
BMJ Neurol Open. 2022 Apr 24;4(1):e000308. doi: 10.1136/bmjno-2022-000308. eCollection 2022.
Survivors of moderate-to-severe traumatic brain injury (msTBI) frequently experience troublesome unexplained somatic symptoms. Autonomic dysfunction may contribute to these symptoms. However, there is no previous study of clinical subjective and objective autonomic dysfunction in msTBI.
We present results from two groups of patients with msTBI. The first, a case-control comparative study, comprises prospectively recruited msTBI outpatients, in whom we measured burden of autonomic symptoms using the Composite Autonomic Symptom Score (COMPASS31) questionnaire. The second, a descriptive case series, comprises retrospectively identified msTBI outpatients who had formal clinical autonomic function testing at a national referral autonomics unit.
Group 1 comprises 39 patients with msTBI (10F:20M, median age 40 years, range 19-76), median time from injury 19 months (range 6-299) and 44 controls (22F:22M, median age 45, range 25-71). Patients had significantly higher mean weighted total COMPASS-31 score than controls (p<0.001), and higher gastrointestinal, orthostatic and secretomotor subscores (corrected p<0.05). Total COMPASS31 score inversely correlated with subjective rating of general health (p<0.001, r=-0.84). Group 2 comprises 18 patients with msTBI (7F:11M, median age 44 years, range 21-64), median time from injury 57.5 months (range 2-416). Clinical autonomic function testing revealed a broad spectrum of autonomic dysfunction in 13/18 patients.
There is clinically relevant autonomic dysfunction after msTBI, even at the chronic stage. We advocate for routine enquiry about potential autonomic symptoms, and demonstrate the utility of formal autonomic testing in providing diagnoses. Larger prospective studies are warranted, which should explore the causes and clinical correlates of post-TBI autonomic dysfunction.
中重度创伤性脑损伤（msTBI）幸存者经常经历令人困扰的不明躯体症状。自主神经功能障碍可能导致这些症状。然而，之前尚无关于msTBI临床主观和客观自主神经功能障碍的研究。
我们展示了两组msTBI患者的结果。第一组为病例对照比较研究，前瞻性招募了msTBI门诊患者，我们使用复合自主神经症状评分（COMPASS31）问卷测量自主神经症状负担。第二组为描述性病例系列，包括在国家转诊自主神经科进行正式临床自主神经功能测试的回顾性确定的msTBI门诊患者。
第一组包括39例msTBI患者（10名女性：20名男性，中位年龄40岁，范围19 - 76岁），受伤后中位时间19个月（范围6 - 299个月）和44名对照者（22名女性：22名男性，中位年龄45岁，范围25 - 71岁）。患者的COMPASS - 31平均加权总分显著高于对照者（p<0.001），胃肠道、直立性和分泌运动亚评分更高（校正p<0.05）。COMPASS31总分与总体健康主观评分呈负相关（p<0.001，r = -0.84）。第二组包括18例msTBI患者（7名女性：11名男性，中位年龄44岁，范围21 - 64岁），受伤后中位时间57.5个月（范围2 - 416个月）。临床自主神经功能测试显示13/18例患者存在广泛的自主神经功能障碍。
msTBI后即使在慢性期也存在临床相关的自主神经功能障碍。我们主张常规询问潜在的自主神经症状，并证明正式自主神经测试在提供诊断方面的效用。有必要进行更大规模的前瞻性研究，以探索TBI后自主神经功能障碍的原因和临床相关性。
