Veterans With Postconcussion Syndrome Resulting From Tbi May Require Long-Term Follow-up.

LOS ANGELES—Veterans with traumatic brain injury (TBI) do not show improvement in symptoms of postconcussion syndrome after eight years of follow-up, researchers reported at the 54th Annual Scientific Meeting of the American Headache Society.

“More attention must be focused on recognition and treatment of this syndrome in this group of individuals who are in the prime years of their lives,” said James R. Couch, MD, PhD, Professor of Neurology at the University of Oklahoma Medical Center and Veterans Affairs Medical Center in Oklahoma City, and his colleagues.

Evaluating Veterans With TBI
In this retrospective study, the investigators evaluated data from veterans who served between 2002 and 2010 and were seen at the Oklahoma Medical Center and Veterans Affairs Medical Center between 2008 and 2011 for a free general health screen. Of the 5,713 veterans who presented for medical care, 1,382 screened positive for combat-related TBI and were referred to the TBI clinic for specialty evaluation.

Dr. Couch and his colleagues reported on the first 500 patients evaluated in this program, all of whom underwent a second screen with a physician or a physician’s assistant and were subsequently confirmed to have combat-related TBI. The screen involved queries about the mechanism of injury, such as a blast, fall, assault, motor vehicle accident, or a combination of factors.

Patients completed the Beck Depression Inventory and answered questions about the frequency and intensity of each of their symptoms, which were scored on a five-point scale ranging from none to very severe. The symptoms were chosen to represent the major characteristics of postconcussion syndrome and included headache, dizziness, difficulty with balance, poor coordination, difficulty with decisions, and depression. The investigators evaluated the data by comparing symptom occurrence for the one- to four-year and five- to eight-year groups within each cohort.

Long-Term Impact
Results showed no significant difference in the occurrence or intensity of symptoms between patients who had a TBI within the past two years and those who experienced TBI three to eight years earlier.

After examining the prevalence of severe or very severe intensity symptom levels, the investigators found that 48% of patients had headache, 11% had dizziness, 11% had difficulty with balance, 20% had poor coordination, and 35% had difficulty making decisions. According to scores on the Beck Depression Inventory, 65% of veterans were not depressed, though 34% were mildly to moderately depressed, and 1% were severely depressed.

None of the six symptoms associated with postconcussion syndrome improved during the eight-year period. Of the six symptoms, there was a statistically significant tendency for depression to increase from the one- to four-year cohorts to the five- to eight-year cohorts, as well as an overall tendency for all symptoms to worsen from one to four years and five to eight years after TBI.

 However, this tendency was not statistically significant for symptoms other than depression, and  it was marginally significant for poor coordination.

“The study indicates that TBI while deployed may have significant, long-term consequences for the injured subject,” commented Dr. Couch. Based on the data, he suggested that veterans with postconcussion syndrome resulting from TBI may require follow-up and continual psychiatric and medical care for as long as—and possibly more than—eight years after the injury.

Dr. Couch anticipates more research in this population of patients. “The possibility of late deterioration of neurologic and mental function is an issue that will require further attention and study,” he said.   

To read an accompanying commentary, please click here.

LOS ANGELES—Veterans with traumatic brain injury (TBI) do not show improvement in symptoms of postconcussion syndrome after eight years of follow-up, researchers reported at the 54th Annual Scientific Meeting of the American Headache Society.

“More attention must be focused on recognition and treatment of this syndrome in this group of individuals who are in the prime years of their lives,” said James R. Couch, MD, PhD, Professor of Neurology at the University of Oklahoma Medical Center and Veterans Affairs Medical Center in Oklahoma City, and his colleagues.

Evaluating Veterans With TBI
In this retrospective study, the investigators evaluated data from veterans who served between 2002 and 2010 and were seen at the Oklahoma Medical Center and Veterans Affairs Medical Center between 2008 and 2011 for a free general health screen. Of the 5,713 veterans who presented for medical care, 1,382 screened positive for combat-related TBI and were referred to the TBI clinic for specialty evaluation.

Dr. Couch and his colleagues reported on the first 500 patients evaluated in this program, all of whom underwent a second screen with a physician or a physician’s assistant and were subsequently confirmed to have combat-related TBI. The screen involved queries about the mechanism of injury, such as a blast, fall, assault, motor vehicle accident, or a combination of factors.

Patients completed the Beck Depression Inventory and answered questions about the frequency and intensity of each of their symptoms, which were scored on a five-point scale ranging from none to very severe. The symptoms were chosen to represent the major characteristics of postconcussion syndrome and included headache, dizziness, difficulty with balance, poor coordination, difficulty with decisions, and depression. The investigators evaluated the data by comparing symptom occurrence for the one- to four-year and five- to eight-year groups within each cohort.

Long-Term Impact
Results showed no significant difference in the occurrence or intensity of symptoms between patients who had a TBI within the past two years and those who experienced TBI three to eight years earlier.

After examining the prevalence of severe or very severe intensity symptom levels, the investigators found that 48% of patients had headache, 11% had dizziness, 11% had difficulty with balance, 20% had poor coordination, and 35% had difficulty making decisions. According to scores on the Beck Depression Inventory, 65% of veterans were not depressed, though 34% were mildly to moderately depressed, and 1% were severely depressed.

None of the six symptoms associated with postconcussion syndrome improved during the eight-year period. Of the six symptoms, there was a statistically significant tendency for depression to increase from the one- to four-year cohorts to the five- to eight-year cohorts, as well as an overall tendency for all symptoms to worsen from one to four years and five to eight years after TBI.

 However, this tendency was not statistically significant for symptoms other than depression, and  it was marginally significant for poor coordination.

“The study indicates that TBI while deployed may have significant, long-term consequences for the injured subject,” commented Dr. Couch. Based on the data, he suggested that veterans with postconcussion syndrome resulting from TBI may require follow-up and continual psychiatric and medical care for as long as—and possibly more than—eight years after the injury.

Dr. Couch anticipates more research in this population of patients. “The possibility of late deterioration of neurologic and mental function is an issue that will require further attention and study,” he said.   

To read an accompanying commentary, please click here.

LOS ANGELES—Veterans with traumatic brain injury (TBI) do not show improvement in symptoms of postconcussion syndrome after eight years of follow-up, researchers reported at the 54th Annual Scientific Meeting of the American Headache Society.

“More attention must be focused on recognition and treatment of this syndrome in this group of individuals who are in the prime years of their lives,” said James R. Couch, MD, PhD, Professor of Neurology at the University of Oklahoma Medical Center and Veterans Affairs Medical Center in Oklahoma City, and his colleagues.

Evaluating Veterans With TBI
In this retrospective study, the investigators evaluated data from veterans who served between 2002 and 2010 and were seen at the Oklahoma Medical Center and Veterans Affairs Medical Center between 2008 and 2011 for a free general health screen. Of the 5,713 veterans who presented for medical care, 1,382 screened positive for combat-related TBI and were referred to the TBI clinic for specialty evaluation.

Dr. Couch and his colleagues reported on the first 500 patients evaluated in this program, all of whom underwent a second screen with a physician or a physician’s assistant and were subsequently confirmed to have combat-related TBI. The screen involved queries about the mechanism of injury, such as a blast, fall, assault, motor vehicle accident, or a combination of factors.

Patients completed the Beck Depression Inventory and answered questions about the frequency and intensity of each of their symptoms, which were scored on a five-point scale ranging from none to very severe. The symptoms were chosen to represent the major characteristics of postconcussion syndrome and included headache, dizziness, difficulty with balance, poor coordination, difficulty with decisions, and depression. The investigators evaluated the data by comparing symptom occurrence for the one- to four-year and five- to eight-year groups within each cohort.

Long-Term Impact
Results showed no significant difference in the occurrence or intensity of symptoms between patients who had a TBI within the past two years and those who experienced TBI three to eight years earlier.

After examining the prevalence of severe or very severe intensity symptom levels, the investigators found that 48% of patients had headache, 11% had dizziness, 11% had difficulty with balance, 20% had poor coordination, and 35% had difficulty making decisions. According to scores on the Beck Depression Inventory, 65% of veterans were not depressed, though 34% were mildly to moderately depressed, and 1% were severely depressed.

None of the six symptoms associated with postconcussion syndrome improved during the eight-year period. Of the six symptoms, there was a statistically significant tendency for depression to increase from the one- to four-year cohorts to the five- to eight-year cohorts, as well as an overall tendency for all symptoms to worsen from one to four years and five to eight years after TBI.

 However, this tendency was not statistically significant for symptoms other than depression, and  it was marginally significant for poor coordination.

“The study indicates that TBI while deployed may have significant, long-term consequences for the injured subject,” commented Dr. Couch. Based on the data, he suggested that veterans with postconcussion syndrome resulting from TBI may require follow-up and continual psychiatric and medical care for as long as—and possibly more than—eight years after the injury.

Dr. Couch anticipates more research in this population of patients. “The possibility of late deterioration of neurologic and mental function is an issue that will require further attention and study,” he said.   

To read an accompanying commentary, please click here.