title: For veterans with mild traumatic brain injury, improved posttraumatic stress disorder severity and sleep correlated with symptomatic improvement.
abstract: This was an observational study of a cohort of 63 Operation Iraqi Freedom/Operation Enduring Freedom veterans with mild traumatic brain injury (mTBI) associated with an explosion. They had headaches, residual neurological deficits (NDs) on neurological examination, and posttraumatic stress disorder (PTSD) and were seen on average 2.5 years after their last mTBI. We treated them with sleep hygiene counseling and oral prazosin. We monitored headache severity, daytime sleepiness using the Epworth Sleepiness Scale, cognitive performance using the Montreal Cognitive Assessment test, and the presence of NDs. We quantitatively measured olfaction and assessed PTSD severity using the PTSD Checklist-Military Version. Nine weeks after starting sleep counseling and bedtime prazosin, the veterans' headache severity decreased, cognitive function as assayed with a brief screening tool improved, and daytime sleepiness diminished. Six months after completing treatment, the veterans demonstrated additional improvement in headache severity and daytime sleepiness and their improvements in cognitive function persisted. There were no changes in the prevalence of NDs or olfaction scores. Clinical improvements correlated with reduced PTSD severity and daytime sleepiness. The data suggested that reduced clinical manifestations following mTBI correlated with PTSD severity and improvement in sleep, but not the presence of NDs or olfaction impairment.
authors: Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA. robert.ruff1@va.gov
authors: Robert L
authors: RL
authors: Ruff
authors: Ronald G
authors: RG
authors: Riechers
authors: Xiao-Feng
authors: XF
authors: Wang
authors: Traci
authors: T
authors: Piero
authors: Suzanne S
authors: SS
authors: Ruff
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use; D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D037001:Directive Counseling; D020920:Dyssomnias / Q000150:complications / Q000628:therapy*; D005260:Female; D006261:Headache / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000150:complications; D000857:Olfaction Disorders / Q000150:complications; D010147:Pain Measurement; D004856:Postural Balance; D011224:Prazosin / Q000627:therapeutic use; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D011224:Prazosin