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Brain injury rehabilitation in adults
3.3.7 BLOOD MARkERS
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One systematic review identified no evidence to support use of any specific blood chemistry markers as a
prognostic tool for the assessment of individuals with mild brain injury. 27
3.4 TREATMENT of MIlD TRAuMATIC BRAIN INjuRy
No evidence was identified that uncomplicated symptoms should be treated differently in the MTBI population
from the general population. For example, SIGN guideline 107 makes recommendations on diagnosis and
management of headache in adults. 4
3.4.1 EDUCATIONAL INTERVENTIONS
A systematic review did not find strong evidence that any non-surgical treatment has a clinically important
effect on symptoms or disability after MTBI. 38 The review identified a small number of studies on early
intervention which provided some evidence that early, limited, educational intervention and providing
reassurance about the lack of brain damage and the high probability of a good recovery, coupled with advice
and encouragement on gradual return to regular activities, reduce long term complaints. Routine provision
of intensive assessment and treatment is not additionally beneficial.
Another two systematic reviews which considered some of the same evidence noted that of 10 RCTs
identified concerning educational interventions, six showed no benefit and only three showed improvement
in symptoms. These trials were generally of poor quality and the authors note that the effectiveness of
such interventions has been previously overstated. Nevertheless, non-randomised studies also included
in the reviews supported a potential benefit for information provision, reassurance and educational
approaches. 39,40
C All patients should be offered reassurance about the nature of their symptoms and advice on
gradual return to normal activities after uncomplicated mild traumatic brain injury.
3.4.2 PHARMACOLOGICAL INTERVENTIONS
One systematic review identified eight studies of pharmacological interventions in patients with MTBI. 41 The
indications for pharmacotherapy were diverse including headache, cognitive dysfunction and post-MTBI
depression. Four involved amitryptyline and two included sertraline. Three of the four studies involving
amitriptyline showed either no benefit in the symptoms of patients with MTBI, or poorer performance than
patients without MTBI. In two studies patients without MTBI exhibited greater improvement of depressive
symptoms than patients with MTBI. 42,43 In an evaluation of amitriptyline as a treatment for headaches
associated with depression 100% of patients in the depressed group without MTBI reported headache
improvement following four weeks of amitriptyline while none of the patients in the group with depression
and MTBI improved (p