Clinical Course

Clinical Course

ESSENTIAL FEATURE: The essential feature of postconcussional disorder is the occurrence of a head injury that has caused a cerebral concussion otherwise known as a mild traumatic brain injury (mTBI). The DMS-IV-TR states that the defining characteristic of a mTBI involves 1) a period of unconsciousness lasting more than 5 minutes, 2) a period of posttraumatic amnesia that lasts more than 12 hours after the closed head injury, or 3) a new onset of seizures (or marked worsening of a preexisting seizure disorder). There must also be documented deficits in physical, cognitive, and/or psychological/behavioral areas.

SYMPTOMS:

Physical symptoms:

The main symptom of postconcussional disorder is a headache that occurs more severely or frequently than experienced prior to the incident. Dizziness is the second most common symptom that occurs in about half of the people. Also, about 10% develop sensitivity to light or noise, 5% experience a decrease in taste or smell, and 14% have blurred vision (Yeates & Taylor, 2005). Disordered sleep and fatigue may also be present.

Cognitive symptoms:

Some of the cognitive symptoms can include decreased concentration, memory problems, increased confusion, and impaired judgment.

Psychological and behavioral symptoms:

Psychological and behavioral symptoms of postconcussional disorder may include irritability, change in personality, anxiety, and depression. There may also be significant impairment in social or occupational functioning.

According to the DSM-IV-TR, these symptoms must be present for three months after the injury and must have been absent or less severe prior to the injury.

TREATMENT:

Postconcussional disorder is normally not treated pharmacologically. Medications may be used to treat the symptoms that are commonly associated with the disorder, i.e. antidepressants, and headache medications. In some of the population that suffer a mTBI, diagnostic imaging techniques can be used to identify structural brain abnormalities and functioning. However, neurotherapy (EEG feedback) has been shown to be superior to structural neuroimaging techniques in detecting brain dysfunction related to postconcussional disorder (Duff, 2004). Neurotherapy examines and treats the attention and concentration deficits associated with postconcussional disorder. MTBI patients tend to have an excess of slow-wave brain electrical activity and coherence abnormalities. Neurotherapy uses operant conditioning of the EEG to give patients audio/visual rewards for producing more normal patterns of brainwave activity. Counseling Rehabilitation have also shown to be effective in the treatment of postconcussional disorder. When the person who has experienced a mTBI is educated about the symptoms that may follow the injury, they may be able to better deal with the problems that may occur. For example, counseling may help the individual understand the need to control their impulses or anger. Another treatment used is Cognitive Behavioral Therapy (CBT). The goals of psychotherapy aim to help in the gradual return to daily life activities by influencing disturbed emotions by improving thoughts and behaviors.

PROGNOSIS:

The prognosis of recovery after mild brain injury is good for most patients. Most symptoms go away within weeks to a year after the event has occurred. It may be assumed that mTBI is not severe enough to result in long term disability. However, research suggests that 10-20% of people with postconcussional disorder have not recovered by a year after the injury (Iverson, Zasler, & Lange, 2006)