Articles: traumatic-brain-injuries.
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Curr Opin Crit Care · Apr 2021
ReviewThe features of the typical traumatic brain injury patient in the ICU are changing: what will this mean for the intensivist?
To describe the key features and epidemiology of traumatic brain injury (TBI) and how they may be changing, with an emphasis on how this may affect care in the intensive care unit. ⋯ This review highlights the urgent need to develop more age-inclusive TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing TBI population. Being elderly does not necessarily portend a poor outcome, and more research is needed to better triage, guide management and prognosticate on these patients.
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Traumatic brain injury (TBI) is a risk factor for the later development of dementia, but although the evidence dates back to the early 20th century, the nature of any association and its mechanistic pathways remain unclear. There has been greater focus on this subject over recent years, in part because of increasing reports around sports related TBIs, especially in the USA. ⋯ In addition, TBI has been reported to initiate a cascade of pathological processes related to several neurodegenerative disorders, and as such, it is likely that the risks vary between individuals. Given the evidence that dementia risk may increase with injury severity and frequency, a detailed account of age and type of injury, as well as lifetime TBI exposure is essential to document in future studies, and further longitudinal research with biomarker assessments are needed.
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Diagnostics (Basel) · Mar 2021
ReviewThe Effect of Non-Invasive Brain Stimulation (NIBS) on Executive Functioning, Attention and Memory in Rehabilitation Patients with Traumatic Brain Injury: A Systematic Review.
In recent years, the potential of non-invasive brain stimulation (NIBS) for therapeutic effects on cognitive functions has been explored for populations with traumatic brain injury (TBI). However, there is no systematic NIBS review of TBI cognitive impairment with a focus on stimulation sites and stimulation parameters. The purpose of this study was to conduct a systematic review examining the effectiveness and safety of NIBS for cognitive impairment after a TBI. ⋯ In all studies, dorsolateral prefrontal cortex (DLPFC) was selected as the stimulation site, along with the stimulation pattern promoting the activation of the left DLPFC. In some studies, there was a significant improvement compared to the control group, but neither rTMS nor tDCS had sufficient evidence of effectiveness. To the establishment of evidence we need the evaluation of brain activity at the stimulation site and related areas using neuroimaging on how NIBS acts on the neural network.
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Brain death, or death by neurological criteria (BD/DNC), has been accepted conceptually, medically and legally for decades. Nevertheless, some areas remain controversial or understudied, pointing to a need for focused research to advance the field. Multiple recent contributions have increased our understanding of BD/DNC, solidified our practice and provided guidance where previously lacking. ⋯ Various legal challenges have required formal responses from national societies, and the American Academy of Neurology has filled this void with much needed guidance. Questions remain regarding concepts such as 'whole brain' versus 'brainstem' death, and the intersection of BD/DNC and rubrics of medical futility. These concepts are the subject of this review.
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Journal of neurotrauma · Mar 2021
Meta AnalysisThe Efficacy and Harms of Pharmacological Interventions for Anxiety after Traumatic Brain Injury - Systematic Review.
After a traumatic brain injury (TBI), many persons experience significant and debilitating problems with anxiety. The aim of this systematic review was to critically evaluate the evidence regarding efficacy of pharmacological interventions for anxiety after TBI. We reviewed studies published in English before July 2020 and included original research on pharmacological interventions for anxiety after TBI in adults ≥16 years of age. ⋯ The methodological quality of the study was difficult to assess because of the lack of detail. No recommendations could be drawn from this review. There is a critical need for adequately powered and controlled studies of pharmacological interventions for anxiety after TBI across all severities that examine side-effect profiles and consider issues of comorbidity and effects of long-term pharmacotherapy.