The subject of stimulant treatment for patients with neurobehavioural sequelae of traumatic brain injury (TBI) has received a good deal of recent attention, although there have to date been no controlled studies published. This is a description of 15 TBI patients who received treatment with the psychostimulant methylphenidate, in a double-blind, placebo-controlled cross-over study, with behavioural and neuropsychological ratings. Three subjects remained on the drug for a year after the acute study, and were subsequently studied in a double-blind, placebo-controlled reversal. The results support the idea that at least some symptomatic improvement may be gained from low-dose stimulant treatment, although the statistical analysis of the data was compromised by the occurrence of carryover effects from one drug condition to another. This, in itself, is an interesting discovery, because such effects have never been observed in stimulant studies of other patient groups. There are clear implications for the design of further studies in this area. The long-term effects of methylphenidate treatment were not at all impressive, however. Although the findings presented below may be subject to differing interpretation, it is conceivable that stimulants act to advance the course of cortical recovery following TBI.

In experiment 1, subjects judged time by duration production under no-counting instructions. The productions were made following intravenous injection of atropine sulfate or saline, and after smoking cigarettes with and without (–)-Δ⁹-tetrahydrocannabinol (THC). THC increased the subjective time rate (STR); i.e., the rate at which subjective time passes relative to clock time, whereas atropine had no effect on STR. Thus, reduction in central acetylcholine activity is not a sufficient explanation of THC’s effect on STR. Experiment 2 replicated the THC effect on STR when subjects were counting subjective seconds. This result indicates that THC affects the experience of time as it is passing, and not solely the memory for duration experience after a time period.

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Recent advances in clinical neuropharmacology are likely to improve the treatment and rehabilitation of traumatic brain injury (TBI) patients. Treatment may be directed to alleviate specific symptoms, to improve function in certain areas, or even to enhance the cortical recovery process. The author reviews pertinent issues in clinical neuropharmacology for the following drug classes: stimulants, other dopamine agonists, antidepressants, lithium, cholinergics, neuroleptics, anticonvulsants, beta-blockers, calcium channel blockers, nootropes, opiates and neuropeptides. Since the relevant research literature in TBI is so sparse, information and recommendations are extrapolated from some other patient groups, especially developmentally handicapped children and adults, and patients with dementia.