Article

OBJECTIVE: To conduct a systematic review of the evidence on interventions for
posttraumatic brain injury fatigue (PTBIF). METHODS: Systematic searches of
multiple databases for peer-reviewed studies published in English on
interventions targeting PTBIF as a primary or secondary outcome through January
22, 2014. Reference sections were also reviewed to identify additional articles.
Articles were rated using the 2011 American Academy of Neurology Classification
of Evidence Scheme for therapeutic studies. RESULTS: The searches yielded 1526
articles. Nineteen articles met all inclusion criteria: 4 class I, 1 class
II/III, 10 class III, and 4 class IV. Only 5 articles examined fatigue as a
primary outcome. Interventions were pharmacological and psychological or involved
physical activity, bright blue light, electroencephalographic biofeedback, or
electrical stimulation. Only 2 interventions (modafinil and cognitive behavioral
therapy with fatigue management) were evaluated in more than 1 study.
CONCLUSIONS: Despite areas of promise, there is insufficient evidence to
recommend or contraindicate any treatments of PTBIF. Modafinil is not likely to
be effective for PTBIF. Piracetam may reduce it, as may bright blue light.
Cognitive behavioral therapy deserves additional study. High-quality research
incorporating appropriate definition and measurement of fatigue is required to
explore the potential benefits of promising interventions, evaluate fatigue
treatments shown to be effective in other populations, and develop new
interventions for PTBIF.

Langue : ANGLAIS