Postconcussive Syndrome Follow-up
- Author: Eric L Legome, MD; Chief Editor: Trevor John Mills, MD, MPH more...
Further Outpatient Care
Outpatient care is the cornerstone of treatment of patients with postconcussive syndrome (PCS) and involves multidisciplinary teams that provide testing and treatment, including cognitive rehabilitation, psychotherapy, stress management, vocational counseling, and symptomatic treatment with medications.
No treatments have been proven effective, though neurotherapy or quantitative EEG biofeedback is a modality that has been shown in recent studies to improve symptoms of postconcussive syndrome. More controlled studies are needed at this point.
A neurologist, physical medicine specialist, primary care physician, or psychologist specializing in these disorders usually coordinates treatment.
The emergency physician should encourage the use of interventions to decrease the incidence of traumatic brain injury. This approach is particularly important in young adults, who have a higher incidence of head injury than others. Encourage patients to wear a seatbelt. Encourage patients to wear a helmet when riding bicycles or motorcycles, or playing high-risk sports.
True prognosis is difficult to define given that many patients with minor symptoms may not enter the health care system and those that participate in research appear to have more significant symptoms at baseline. In addition, a wide heterogeneity exists in patients enrolled in studies.
Most patients recover fully in less than 3 months, although some small studies suggest persistence of minor cognitive defects for asymptomatic minor traumatic brain injury patients.
Approximately 15% of patients complain of problems more than 12 months after injury. This group is likely to experience persistent and intrusive symptoms that may be refractory to treatment and impose a lifelong disability.
At least one study found the persistence of dizziness as a symptom seemed to portend a longer and more significant symptom complex. Other studies found the depression, pain, and symptom invalidity were correlated with longer and worse symptoms. Another found patients with early clinical symptoms, such as headache, dizziness, and intracranial lesions were more likely to have persistent PCS.
Educate the patient about the usual self-limited nature of postconcussive syndrome.
Education about the usual symptoms may be helpful.
Discussions concerning preparation for the graded resumption of vocational and academic routines may lessen postconcussive syndrome persistence.
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