Persistent post-concussion syndrome: pathophysiology, diagnosis, current and evolving treatment strategies

Introduction: Persistent post-concussion syndrome (PCS) following mild traumatic brain injury (mTBI) represents a growing global health challenge that significantly impacts patients’ quality of life. Despite advances in acute concussion management, there remains a critical need for effective, evidence-based treatments for chronic PCS, as current interventions show limited success in addressing both symptoms and underlying pathophysiology. Areas covered: In this review, the authors examine recent advances in PCS pathophysiology, diagnostic approaches, and therapeutic interventions. The authors evaluate epidemiological trends, advanced neuroimaging findings, validated biomarkers, and emerging treatment modalities such as hyperbaric oxygen therapy, neuromodulation techniques, and biomarker-guided therapeutic approaches. Expert opinion: Integration of recent evidence suggests a paradigm shift toward personalized, multimodal treatment approaches for PCS, combining targeted physiological interventions with symptom-specific therapies. Future management strategies should focus on early identification of at-risk patients and implementation of evidence-based treatment protocols that address both neurobiological and psychological aspects of recovery.