Awn Abdulmohsen Alessa

Background: Traumatic brain injury (TBI) is an injury resulting from external force exerted directly or indirectly on the skull. This is presently the major cause of mortality and disability among youth globally. Repetitive transcranial magnetic stimulation (rTMS) was proposed for the treatment of various neurological disorders such as TBI. We conducted the current systematic review and meta-analysis to investigate the efficacy of rTMS in TBI patients. Methods: We conducted our database searching on PubMed, Scopus, and Web of Science from inception till August 2024 to look for articles that fulfil our aim. The search strategy was based on two main keywords: “Transcranial magnetic stimulation” AND “Traumatic brain injury.” We conducted the pooled analysis of continuous variables using standardized mean difference (SMD) due to difference in measurement scales. Results: Seven randomized controlled trials were included. A statistically significant improvement in cognitive function was observed after rTMS compared to control group with SMD of 0.7 (95% confidence interval [CI]: 0.25, 1.14, P = 0.002) with non-significant heterogeneity, and pain with SMD of −0.57 (95% CI: −1.02, −0.11, P = 0.01), I² = 64%, P = 0.04. However, no difference was observed between the two groups regarding depression with SMD of −0.1 (95% CI: −0.54, 0.35, P = 0.67). Conclusion: The use of rTMS is associated with improved cognitive functions and reduction in pain. No effect was observed regarding depression but future studies are still warranted in this important clinical field.

Background: Chronic subdural hematoma (CSDH) is a prevalent neurological disorder, especially among the elderly, where blood accumulates between the brain and its outer covering. The primary treatment for CSDH involves surgical intervention, such as burr-hole craniotomy, with or without irrigation of the subdural space. The efficacy of irrigation versus no irrigation in reducing recurrence, mortality, and postoperative complications remains debated. The study aimed to compare the effectiveness and safety of irrigation versus no irrigation in the surgical management of CSDH through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library, targeting RCTs published in English comparing irrigation with no irrigation in CSDH management. Four RCTs with a total of 843 patients met the inclusion criteria. Two reviewers extracted data independently, and the risk of bias 2 tool was used for quality assessment. The primary outcome was recurrence; secondary outcomes included mortality and postoperative complications. Statistical analyses were performed using RevMan 5.3. Results: The meta-analysis included four RCTs with 843 patients, revealing that irrigation significantly reduces the recurrence of CSDH compared to no irrigation (odds ratios [OR] = 0.66, 95% confidence interval [CI]: 0.44–0.98, P = 0.04), with no observed heterogeneity (I² = 0%). Mortality rates showed no significant difference between the irrigation and no irrigation groups (OR = 1.10, 95% CI: 0.59–2.06, P = 0.77), also with no heterogeneity (I² = 0%). Postoperative complications initially showed no significant difference (OR = 0.39, 95% CI: 0.09–1.69, P = 0.21) and moderate heterogeneity (I² = 52%). However, sensitivity analysis resolving the heterogeneity indicated a significant reduction in complications favoring the irrigation group (P = 0.03). Conclusion: This meta-analysis suggests that irrigation during burr-hole drainage significantly reduces CSDH recurrence without increasing mortality or postoperative complications, supporting its use in clinical practice. Further, high-quality RCTs are necessary to confirm these findings and assess long-term outcomes.

Background: Proton beam radiation therapy (PBRT) is an advanced cancer treatment modality that utilizes the distinctive physical properties of protons to precisely deliver radiation to tumor targets while sparing healthy tissue. This cannot be obtained with photon radiation. In this systematic review and meta-analysis, we aimed to comprehensively assess the risk of brainstem toxicity in pediatric brain tumor patients undergoing PBRT. Methods: With adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a predetermined search strategy was used to identify eligible articles from PubMed, Web of Science, Scopus, and Cochrane Library through July 2024. Results: The current study included a total of 11 eligible articles. The pooled prevalence of patients who suffered from brainstem toxicity was 1.8% (95% CI: 1%, 2.6%). The pooled prevalences of patients with Grade 1 to Grade 5 brainstem toxicity were found to be 10.6% (95% CI: 8.8%, 30%), 1.5% (95% CI: 0.6%, 2.5%), 0.7% (95% CI: 0.3%, 1.1%), 0.4% (95% CI: 0.1%, 0.7%), and 0.4% (95% CI: 0.1%, 0.8%), respectively, with an overall pooled prevalence of 0.7% (95% CI: 0.4%, 1%). Conclusions: This study revealed a relatively low incidence of symptomatic brainstem toxicity and its related mortality in the pediatric population undergoing PBRT. However, further research is encouraged to study the broader effects of PBRT and to explore various factors that may influence the risk of brainstem toxicity in patients treated with PBRT.

Background: Traumatic brain injury (TBI) represents a significant global health burden, often leading to significant morbidity and mortality. Mounting evidence underscores the intricate involvement of dysregulated immune responses in TBI pathophysiology, highlighting the potential for immunomodulatory interventions to mitigate secondary injury cascades and enhance patient outcomes. Despite advancements in treatment modalities, optimizing therapeutic strategies remains a critical challenge in TBI management. To address this gap, this systematic review and meta-analysis aimed to rigorously evaluate the efficacy and safety of emerging immunomodulatory therapies in the context of TBI. Methods: We searched electronic databases such as PubMed, Scopus, Web of Science and CENTRAL for relevant studies investigating the efficacy of immunomodulatory therapies in TBI that were meticulously selected for inclusion. Two independent reviewers meticulously performed data extraction and quality assessment, adhering to predefined criteria. Both randomized controlled trials (RCTs) and observational studies reporting clinically relevant outcomes, such as mortality rates, the Glasgow coma scale, and adverse events, were meticulously scrutinized. Meta-analysis techniques were employed to assess treatment effects across studies quantitatively and analyzed using the Review Manager software (version 5.2). Results: Fourteen studies (n = 1 observational and n = 13 RCTs) were included in our study. Meta-analysis showed no significant overall mortality difference, but erythropoietin (EPO) significantly reduced mortality (odds ratio = 0.49; 95% confidence interval: 0.31–0.78, P = 0.002). The adverse event meta-analysis revealed no significant differences. Conclusion: Immunomodulatory therapies did not significantly affect overall mortality, but EPO demonstrated promising results. Adverse events did not significantly differ from controls. Further research is warranted to refine TBI treatment protocols.