SNLF - Traumatismes crânien

Le 01/12/2022 de 15:00 à 16:30

Retour Session


Efficacité des thérapeutiques du syndrome post-commotionnel : une revue systématique de littérature

Mélanie Cogné (Rennes, France), Camille Heslot (GARCHES (92380), France), Clemence Lefevre (GARCHES (92380), France), Valérie Perdrieau (GARCHES (92380), France), Aurelie Granger (GARCHES (92380), France), Philippe Azouvi (GARCHES (92380), France)

Objective : 10-20% of patients will show persistent post-concussion symptoms (PCS) after a mild traumatic brain injury (mTBI). This systematic review aims at summarizing the level of evidence of interventions for PCS, associated or not with post-traumatic stress disorder.

Material / Patients and Methods : Following the PRISMA guidelines, we conducted a systematic review regarding interventions of PCS post-mTBI until August 2021, using the Medline, Cochrane and Embase databases. Criteria for inclusion were the following:(1)intervention studies focusing on PCS after concussion/mTBI, (2)intervention studies including a control group, (3)focusing on adult patients (18yo). Quality assessment was made using the Incog recommendation level, and the risk of bias was assessed using the Cochrane risk-of-bias tool, revised version.

Results : We identified 3,284 abstracts, then we selected 121 full-text articles. Finally, we selected 54 studies, including 35 that obtained the highest level of evidence (Grade A). Cognitive training, psycho-education, cognitive behavioural therapy, and graded return to physical activity demonstrated some effectiveness on persistent PCS. There is limited evidence of a beneficial effect of Methylphenidate. Oculomotor rehabilitation, light therapy and headache management using rTMS have also been found effective on somatic complaints and sleep disorders. The preventive effect of early (<3months) interventions remained debated.

Discussion - Conclusion : Several studies demonstrated some effectiveness in reducing PCS. However, the risk of bias of lot of studies (21/54) was high; therefore, it is important to conduct high-level controlled randomized trials in order to achieve a higher level of evidence regarding treatment of persistent PCS after mTBI.

Keywords : mild traumatic brain injury; concussion; rehabilitation