Post-concussion syndrome: Part 2. Clinical characteristics, diagnosis, and treatment

Abstract

This paper presents current data on the clinical features, diagnosis, and treatment of post-concussion syndrome (PCS) that develops after mild blast-related traumatic brain injury (mbTBI). It is emphasized that PCS is one of the most common long-term consequences of mbTBI among military personnel exposed to blast waves, which determines the clinical and social relevance of this problem. The diagnostic criteria for PCS according to the International Statistical Classification of Diseases, 10th Revision (ICD-10), and the Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV), are described, as well as the difficulty of differentiating PCS from post-traumatic stress disorder, which frequently co-occurs with PCS in combat veterans. The following symptom groups are identified: cognitive, psychoemotional, somatosensory, autonomic, and vestibular. Particular emphasis is placed on the importance of using neurophysiological methods—quantitative electroencephalography and P300 event-related potentials—to objectify the diagnosis of PCS. The therapeutic approach should be multidisciplinary and personalized, incorporating physical rehabilitation, cognitive-behavioral therapy, sleep hygiene, and pharmacological management (antidepressants, analgesics, botulinum toxin therapy, and hyperbaric oxygen therapy). Research findings indicate the importance of early physical activity.