Department of Pediatrics, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.
Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
J Neurotrauma. 2024 Jan;41(1-2):161-170. doi: 10.1089/neu.2023.0113. Epub 2023 Aug 10.
Although there is significant variability in the manifestations of persisting post-concussive symptoms (PPCS), autonomic dysfunction has been reported to contribute to PPCS and could serve as a biomarker of recovery. The objective of this study was to evaluate cardiac autonomic reflexes and autonomic function after concussion injury comparing those with prolonged concussion symptoms to those without. This is a case-control study where a non-referred population of concussed children or adolescent participants were enrolled from the Emergency Department (ED) of the Stollery Children's Hospital, a tertiary pediatric hospital in Edmonton, Alberta, Canada. Children and adolescents 8 through <18 years of age who presented with mild traumatic brain injury were diagnosed with concussion. Our study reported concussion symptoms and standardized clinical cardiac autonomic reflex testing at 4 and 12 weeks after injury. Our findings showed that 28 participants with concussion completed the 4-week follow-up questionnaires, and that 17 (61%) were diagnosed with PPCS. Difficulty concentrating, fatigue, noise sensitivity, light sensitivity, and headache were most commonly reported at baseline among those who were later diagnosed with PPCS. The mean change in heart rate (HR) with head-up tilt was 44.2 bpm (standard deviation [SD] 9.1) in the non-PPCS group and 46.6 bpm (SD 14.1) in the PPCS group at 4 weeks and was not significant in the unadjusted (p = 0.2) or adjusted analysis for age and female sex (p = 0.2). Overall, 70% (19/27) had significant orthostatic tachycardia >40 bpm, but PPCS and non-PPCS groups were similar. Similar results were observed among 23 participants at 12-week follow-up. The median maximum decrease in systolic blood pressure (SBP) with head-up tilt was -26.9 mm Hg (interquartile range [IQR] -32.6, -22.3) in the non-PPCS group and -25.1 mm Hg (IQR -32.2, -18.2) in the PPCS group, and was not significantly different in the unadjusted (p = 0.8) or adjusted (p = 0.8) analysis. Overall, 19 of 26 participants (73%) demonstrated orthostatic hypotension (SBP change >20 mm Hg) with no significant difference between the PPCS and non-PPCS groups. Similar results were observed at 12-week follow-up. In conclusion, cardiac autonomic reflex responses are abnormal in most children and adolescents with a concussion injury at 4- and 12-week follow-up and may reflect ongoing autonomic dysfunction. However, autonomic function did not differentiate PPCS, indicating that reported symptoms are not sensitive to autonomic abnormalities.
虽然持续性脑震荡后症状（PPCS）的表现存在很大差异，但自主神经功能障碍已被报道与 PPCS 有关，并可作为恢复的生物标志物。本研究的目的是比较持续脑震荡症状和无持续脑震荡症状患者的脑震荡损伤后的心脏自主反射和自主功能。这是一项病例对照研究，在加拿大阿尔伯塔省埃德蒙顿的三级儿科医院斯特罗利儿童医院的急诊部（ED）招募了患有脑震荡的非转诊儿童或青少年参与者。患有轻度创伤性脑损伤的 8 岁至<18 岁的儿童和青少年被诊断为脑震荡。我们的研究报告了 4 周和 12 周后损伤的脑震荡症状和标准化临床心脏自主反射测试。我们的研究结果表明，28 名患有脑震荡的参与者完成了 4 周的随访问卷，其中 17 名（61%）被诊断为 PPCS。在后来被诊断为 PPCS 的患者中，基线时最常报告注意力集中困难、疲劳、对噪音敏感、对光敏感和头痛。在非 PPCS 组中，4 周时直立倾斜试验后心率（HR）的平均变化为 44.2bpm（标准差[SD]9.1），在 PPCS 组中为 46.6bpm（SD 14.1），在未调整（p=0.2）或调整年龄和性别（p=0.2）分析中均无显著差异。总体而言，70%（19/27）有显著的直立性心动过速>40bpm，但 PPCS 和非 PPCS 组相似。在 23 名 12 周随访的参与者中也观察到了类似的结果。在非 PPCS 组中，直立倾斜试验后收缩压（SBP）最大下降中位数为-26.9mmHg（四分位距[IQR] -32.6，-22.3），在 PPCS 组中为-25.1mmHg（IQR -32.2，-18.2），在未调整（p=0.8）或调整（p=0.8）分析中均无显著差异。总体而言，26 名参与者中有 19 名（73%）表现出直立性低血压（SBP 变化>20mmHg），PPCS 和非 PPCS 组之间无显著差异。在 12 周随访时也观察到了类似的结果。总之，大多数患有脑震荡损伤的儿童和青少年在 4 周和 12 周随访时心脏自主反射反应异常，可能反映出持续的自主神经功能障碍。然而，自主功能并未区分 PPCS，表明报告的症状对自主异常不敏感。
