Key result
Persistent post-concussion symptoms linked to quantifiable autonomic nervous system dysfunction.
Why the study?
Preliminary evidence suggests individuals with persistent post-concussion symptoms have a dysfunctional stress response, but the extent of evidence across quantifiable markers of the autonomic nervous system and hypothalamic pituitary adrenal-axis required exploration.
Is there evidence of quantifiable dysfunction of the stress response (ANS and HPA-axis) in individuals with persistent post-concussion symptoms?
Is there evidence of quantifiable dysfunction of the stress response (ANS and HPA-axis) in individuals with persistent post-concussion symptoms?
This scoping review highlights evidence of autonomic nervous system dysfunction in individuals with persistent post-concussion symptoms, while identifying a gap in research regarding HPA-axis dysfunction.
Supports ANS evaluation in persistent post-concussion symptoms; confirms associations across most studies while leaving HPA-axis role open.
Background Preliminary evidence suggests that individuals with persistent post-concussion symptoms (PPCS) have a dysfunctional stress response, consisting of the autonomic nervous system (ANS) and hypothalamic pituitary adrenal-axis (HPA-axis).Objectives This review aims to explore the extent of evidence for dysfunction of the stress response in individuals with PPCS by individually mapping the literature surrounding quantifiable changes of the (1) ANS and (2) HPA-axis using non-invasive and clinical tools, and highlighting any (3) knowledge gaps.Methods Nine electronic databases and grey literature were searched on the 1st of June 2021 and 4th of October 2021. Studies were included if their population was classified with PPCS, and their study stated at least one quantifiable marker of the ANS or HPA-axis using non-invasive and clinical tools. Relevant studies were screened, and data extracted.Results A total of 37 articles were included in this scoping review. The majority of studies assessed quantifiable markers of the ANS (n = 34), in comparison to the HPA-axis (n = 2), and ANS and HPA-axis (n = 1). The most common quantifiable markers of the ANS included heart rate (n = 20), blood pressure (n = 16), and heart rate variability (n = 10). Cortisol was the only included quantifiable marker of the HPA-axis (n = 2).Conclusions Most of the evidence in this review supports quantifiable dysfunction of the ANS in those with PPCS. Further research is required investigating quantifiable dysfunction of the HPA-axis, and subsequently ANS and HPA-axis in unison, in those with PPCS.
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Farrell et al. (2022) conducted a review in Persistent post-concussion symptoms (PPCS). Persistent post-concussion symptoms are associated with quantifiable dysfunction of the autonomic nervous system, as supported by the majority of 37 reviewed articles.
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