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Analyzing the Spectrum of mTBI Subgroups
Joshua A Beitchman1, Nyaz Didehbani2,3, Shane M Miller4,5,6
1Pediatric Neurology Residency Program, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Abstract:
Patients who sustain a mild traumatic brain injury (mTBI) experience a variety of clinical trajectories. Recent efforts to identify mTBI subtypes have begun to describe observed phenotypic variability. Clinical applicability of these subtypes is limited due to critical variations in each subtype's defining characteristics and limited inclusion of objective data. Here, we review mTBI literature that describes subtypes at various timepoints following injury. We describe five predominately symptom-based subtypes (cognitive, somatosensory, vestibular-ocular, headache, and neuropsychiatric [affective/behavioral]). Each of these subgroups has been reported at separate timepoints postinjury, with the majority of studies describing symptom clusters in the acute and subacute recovery period. Analysis of each subgroup indicates significant overlap and ambiguity within the currently described symptom-based subtypes of mTBI. Additionally, inconsistent terminology within symptom description and subtyping nomenclature limit the ability to compare among one another. We suggest that improved understanding of possible biological processes that contribute to certain clinical trajectories may be identified by incorporating objective assessments, biomarkers, neuroimaging, and genetic analysis into future mTBI subtyping analysis. In doing so, advancements toward individualized symptom management, recovery, and improved care for our mTBI community are possible.
Insights
Mild traumatic brain injury (mTBI) patients show varied recovery paths. Current symptom-based subtypes lack objective data and show overlap, hindering effective treatment for mTBI recovery.
Area of Science:
- Neuroscience
- Neurology
- Traumatology
Background:
- Mild traumatic brain injury (mTBI) presents diverse clinical outcomes.
- Existing mTBI subtypes are primarily symptom-based and lack objective validation.
- Variability in defining characteristics and limited objective data restrict clinical applicability of current mTBI subtypes.
Purpose of the Study:
- To review existing literature on mTBI subtypes.
- To analyze the characteristics and limitations of current symptom-based mTBI classifications.
- To propose a more objective and integrated approach for mTBI subtyping.
Main Methods:
- Systematic literature review of mTBI studies.
- Analysis of reported mTBI subtypes based on symptoms and recovery timepoints.
- Evaluation of terminology consistency and overlap in symptom-based subtyping.
Main Results:
- Five predominant symptom-based mTBI subtypes identified: cognitive, somatosensory, vestibular-ocular, headache, and neuropsychiatric.
- Subtypes are predominantly reported in the acute and subacute recovery phases post-injury.
- Significant overlap and ambiguity exist among current symptom-based mTBI subtypes, compounded by inconsistent terminology.
Conclusions:
- Current symptom-based mTBI subtyping lacks clinical utility due to heterogeneity and lack of objective measures.
- Future mTBI subtyping should integrate objective assessments, biomarkers, neuroimaging, and genetic analysis.
- Advancing mTBI subtyping can lead to personalized symptom management and improved patient care.
