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The Effect of Osteopathic Manipulative Medicine on Oxidative Stress Following Mild Traumatic Brain Injury: A Pilot Study
Angelo, N. [8]
Mazzeo, S. [2]
Oommen, T. [2]
Zwibel, H. [10]
Mancini, J. [25]
Leheste, J. [5]
Yao, S. C. [54]

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e170-e171. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

brain injury [20]
concussion [29]
OMT [2951]
osteopathic manipulative treatment [2973]
oxidative stress [5]
pilot study [104]
randomized controlled trial [710]
trauma [100]

Abstract:

Introduction/Specific Aims: Concussion, a form of mild traumatic brain injury, occurs after a primary mechanical injury to the head or body. Secondary nonmechanical damage follows, including changes in cerebral perfusion and metabolism. Hypoperfusion results in accumulation of toxic mediators, including reactive oxygen species, leading to the breakdown of the blood-brain barrier and progression of neuroinflammation. This secondary process is thought to lead to the emergence and perpetuation of concussion symptoms after injury. Previous studies have found osteopathic manipulative medicine (OMM) to be effective in improving concussion-like symptoms, including dizziness, nausea, and imbalance. OMM uses manual techniques to address musculoskeletal restrictions, or somatic dysfunctions, which can arise after injury. By removing biomechanical barriers in mTBI patients, OMM could lead to improvements in cerebral glymphatic circulation increasing clearance of oxidative stressors. 8-hydroxy-2’-deoxyguanosine (8-OHdG) is a urine biomarker produced by the oxidative damage of DNA by reactive oxygen and nitrogen species. OMM has the potential to address 8-OHdG and other toxic mediators present in the nonmechanical phase of mTBI. Through randomized controlled trials, the effect of OMM on the markers of oxidative stress can be investigated, allowing for a better understanding of its role in the management of concussion. Research Question/Hypotheses: To determine the effect of OMM, as compared with a control group receiving concussion education, on cerebral oxidative stress, as measured by levels of 8-OHdG. Methods: This study is NYIT Institutional Review Board approved, BHS-1139, and is registered at clinicaltrials.gov (NCT02750566). This randomized controlled trial investigates the effectiveness of OMM in treating mild concussion symptoms over a 1-week period after diagnosis. Subjects presenting at the NYITCOM Academic Health Care Center for concussion evaluation were recruited for this study. Subjects aged 18 to 50 years, with a diagnosis of concussion, cleared of life-threatening injuries by a neurologist, were included in the study. Exclusion criteria included subjects with contraindications to OMM, history or current diagnosis of spinal cord injury, or a neurodegenerative condition, pregnancy, inability to complete assessments, as well as loss of consciousness for greater than 2 minutes, witnessed seizures, or intractable vomiting following head injury. Following informed consent, subjects were randomly assigned to an OMM or control group receiving concussion education. All subjects received intervention on the initial visit (visit 1) after enrollment and at follow-up 48 to 72 hours later during visit 2. A third visit, 1 week after visit 1, was used for final data collection. Subjects in the OMM group received physician-directed osteopathic manipulative treatment. Physicians were directed to assess and treat somatic dysfunctions potentially contributing to concussion symptoms, with focus on the cranium, thoracic and lumbar spine, ribs, and pelvis/sacrum. The OMM group subjects all received key techniques to decrease craniocervical restriction and improve lymph drainage in the head and neck. Control subjects received concussion education, standardizing 30 minutes of face-to-face time with a physician between groups. Data collected included urine samples taken from groups prior to intervention on visits 1, 2, and 3, as well as after intervention on visit 1. Urine samples were analyzed through competitive enzyme-linked immunosorbent assay using colorimetric detection for levels of 8-OHdG. Data Analysis: Analysis included 5 subjects, 4 who received OMM and 1 control. Statistics were performed on IBM SPSS Statistics 24 and α was set at .05. Independent t tests were performed to determine any differences in initial 8-OHdG levels between groups. Mann Whitney U testing was performed to analyze mean differences between pre- and postintervention 8-OHdG levels over visits 1, 2, and 3. Results: No significant differences in initial preintervention 8-OHdG levels were found between the OMM group and control subject (P=0.936). From pre- to postintervention on visit 1, an average increase in 8-OHdG levels was seen in both the OMM group (0.20 ng/gCr) and control subject (0.03 ng/gCr). A further average increase in 8-OHdG levels was seen from visit 1 to visit 2, OMM group (1.57 ng/gCr) and control subject (0.06 ng/gCr). The control subject on visit 3 had a further increase in 8-OHdG from visit 2 of 0.17 ng/gCr, resulting in an overall increase of 0.26 ng/gCr from preintervention on visit 1. The OMM group on visit 3 had an average decrease in 8-OHdG from visit 2 of 0.11 ng/gCr, resulting in an overall average decrease of 0.02 ng/gCr from preintervention on visit 1. Mann Whitney U testing revealed no significant differences in the average changes of 8-OHdG over the 3 visits between groups (P=1.000). Conclusion: The results of this pilot study demonstrate an interaction between OMM and 8-OHdG levels. While no significant difference in 8-OHdG levels were found between the OMM group and control subject over time, an average decrease in 8-OHdG was seen in the OMM group while the control subject had an overall increase. Owing to these results, further study with larger populations including moderate and severe concussions is warranted. Included in further study, the correlation between 8-OHdG levels and symptom number and severity should also be implemented. The implications of certain OMM techniques, such as dural venous sinus drainage, known to address specific therapeutic models and their relationship to oxidative stressors, can also be investigated. Through this process, the mechanism behind OMM's role in management of concussion can be established, allowing for the understanding of specific techniques addressing mTBI pathophysiology, which will supplement the body's innate capacity to heal itself.

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