Legarda Stella B, Lahti Caroline E, McDermott Dana, Michas-Martin Andreas
Neurology, Montage Health, Montage Medical Group, Monterey, CA, United States.
Front Hum Neurosci. 2022 May 24;16:894758. doi: 10.3389/fnhum.2022.894758. eCollection 2022.
Concussion is a growing public health concern. No uniformly established therapy exists; neurofeedback studies report treatment value. We use infralow frequency neuromodulation (ILF) to remediate disabling neurological symptoms caused by traumatic brain injury (TBI) and noted improved outcomes with a novel concussion protocol. Postconcussion symptoms (PCS) and persistent postconcussion symptoms (PPCS; >3 months post head injury) are designated timelines for protracted neurological complaints following TBI. We performed a retrospective study to explore effectiveness of ILF in PCS/PPCS and investigated the value of using this concussion protocol.
Patients with PCS/PPCS seen for their first neurology office visit or received their first neurofeedback session between 1 August 2018 and 31 January 2021 were entered. Outcomes were compared following treatment as usual (TAU) vs. TAU with ILF neurotherapy (TAU+ILF). The study cohort was limited to PPCS patients; the TAU+ILF group was restricted further to PPCS patients receiving at least 10 neurotherapy sessions. Within the TAU+ILF group, comparisons were made between those who trained at least 10 sessions using concussion protocol (TAU+ILF+CP) and those who trained for at least 10 sessions of ILF regardless of protocol (TAU+ILF-CP).
Among our resultant PPCS cohort ( = 59) leading persistent neurological complaints were headache (67.8%), memory impairment (57.6%), and brain fog (50.8%). PPCS patients in TAU+ILF+CP ( = 25) demonstrated greater net ( = 0.004) and percent ( = 0.026) improvement of symptoms compared to PPCS subjects in TAU ( = 26). PPCS patients in TAU+ILF-CP ( = 8) trended toward significant symptom improvements compared to TAU, and TAU+ILF+CP trended toward greater efficacy than TAU+ILF-CP.
PPCS patients who received TAU+ILF+CP demonstrated significantly greater improvement as a group when compared to TAU. When used as an integrative modality to treatment as usual in managing patients with PPCS, ILF neuromodulation with use of concussion protocol provided significant symptom improvements.
脑震荡是一个日益引起公众健康关注的问题。目前尚无统一确立的治疗方法；神经反馈研究报告了其治疗价值。我们使用超低频神经调节（ILF）来改善创伤性脑损伤（TBI）引起的致残性神经症状，并通过一种新的脑震荡方案取得了更好的治疗效果。脑震荡后症状（PCS）和持续性脑震荡后症状（PPCS；头部受伤后超过3个月）是TBI后长期神经症状的指定时间线。我们进行了一项回顾性研究，以探讨ILF在PCS/PPCS中的有效性，并研究使用这种脑震荡方案的价值。
纳入2018年8月1日至2021年1月31日期间首次到神经科门诊就诊或接受首次神经反馈治疗的PCS/PPCS患者。将常规治疗（TAU）与TAU联合ILF神经治疗（TAU+ILF）后的结果进行比较。研究队列仅限于PPCS患者；TAU+ILF组进一步限制为接受至少10次神经治疗的PPCS患者。在TAU+ILF组中，比较了使用脑震荡方案训练至少10次的患者（TAU+ILF+CP）和无论方案如何训练至少10次ILF的患者（TAU+ILF-CP）。
在我们最终的PPCS队列（n = 59）中，主要的持续性神经症状是头痛（67.8%）、记忆障碍（57.6%）和脑雾（50.8%）。与TAU组（n = 26）的PPCS患者相比，TAU+ILF+CP组（n = 25）的PPCS患者症状的净改善（P = 0.004）和百分比改善（P = 0.026）更大。与TAU组相比，TAU+ILF-CP组（n = 8）的PPCS患者症状有显著改善的趋势，并且TAU+ILF+CP组的疗效有高于TAU+ILF-CP组的趋势。
与TAU组相比，接受TAU+ILF+CP治疗的PPCS患者作为一个整体有显著更大的改善。当作为一种综合方式与常规治疗一起用于管理PPCS患者时，使用脑震荡方案的ILF神经调节可显著改善症状。
