Heslot Camille, Azouvi Philippe, Perdrieau Valérie, Granger Aurélie, Lefèvre-Dognin Clémence, Cogné Mélanie
AP-HP, GH Paris Saclay, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation 104, Boulevard Raymond Poincaré, 92380 Garches, France.
CESP, Inserm, Paris-Saclay University, UVSQ, 94807 Villejuif, France.
J Clin Med. 2022 Oct 21;11(20):6224. doi: 10.3390/jcm11206224.
Approximately 10−20% of patients who have sustained a mild Traumatic Brain Injury (mTBI) show persistent post-concussion symptoms (PCS). This review aims to summarize the level of evidence concerning interventions for PCS. Following the PRISMA guidelines, we conducted a systematic review regarding interventions for PCS post-mTBI until August 2021 using the Medline, Cochrane, and Embase databases. Inclusion criteria were the following: (1) intervention focusing on PCS after mTBI, (2) presence of a control group, and (3) adult patients (≥18 y.o). Quality assessment was determined using the Incog recommendation level, and the risk of bias was assessed using the revised Cochrane risk-of-bias tool. We first selected 104 full-text articles. Finally, 55 studies were retained, including 35 that obtained the highest level of evidence. The risk of bias was high in 22 out of 55 studies. Cognitive training, psycho-education, cognitive behavioral therapy, and graded return to physical activity demonstrated some effectiveness on persistent PCS. However, there is limited evidence of the beneficial effect of Methylphenidate. Oculomotor rehabilitation, light therapy, and headache management using repetitive transcranial magnetic stimulation seem effective regarding somatic complaints and sleep disorders. The preventive effect of early (<3 months) interventions remains up for debate. Despite its limitations, the results of the present review should encourage clinicians to propose a tailored treatment to patients according to the type and severity of PCS and could encourage further research with larger groups.
约10%-20%的轻度创伤性脑损伤（mTBI）患者会出现持续的脑震荡后症状（PCS）。本综述旨在总结关于PCS干预措施的证据水平。遵循PRISMA指南，我们使用Medline、Cochrane和Embase数据库，对截至2021年8月的mTBI后PCS干预措施进行了系统综述。纳入标准如下：（1）针对mTBI后PCS的干预措施；（2）存在对照组；（3）成年患者（≥18岁）。使用Incog推荐水平进行质量评估，并使用修订后的Cochrane偏倚风险工具评估偏倚风险。我们首先筛选出104篇全文文章。最终保留了55项研究，其中35项获得了最高证据水平。55项研究中有22项偏倚风险较高。认知训练、心理教育、认知行为疗法和逐步恢复体育活动对持续性PCS显示出一定效果。然而，关于哌甲酯有益效果的证据有限。眼动康复、光疗以及使用重复经颅磁刺激进行头痛管理，对于躯体不适和睡眠障碍似乎有效。早期（<三个月）干预的预防效果仍存在争议。尽管存在局限性，但本综述的结果应鼓励临床医生根据PCS的类型和严重程度为患者提供量身定制的治疗，并可能鼓励开展更大规模人群的进一步研究。
