There is currently a lack of evidence-based guidelines to guide the pharmacological treatment of neurobehavioral problems that commonly occur after traumatic brain injury (TBI). It was our objective to review the current literature on the pharmacological treatment of neurobehavioral problems after traumatic brain injury in three key areas: aggression, cognitive disorders, and affective disorders/anxiety/ psychosis. Three panels of leading researchers in the field of brain injury were formed to review the current literature on pharmacological treatment for TBI sequelae in the topic areas of affective/anxiety/ psychotic disorders, cognitive disorders, and aggression. A comprehensive Medline literature search was performed by each group to establish the groups of pertinent articles. Additional articles were obtained from bibliography searches of the primary articles. Group members then independently reviewed the articles and established a consensus rating. Despite reviewing a significant number of studies on drug treatment of neurobehavioral sequelae after TBI, the quality of evidence did not support any treatment standards and few guidelines due to a number of recurrent methodological problems. Guidelines were established for the use of methylphenidate in the treatment of deficits in attention and speed of information processing, as well as for the use of beta-blockers for the treatment of aggression following TBI. Options were recommended in the treatment of depression, bipolar disorder/mania, psychosis, aggression, general cognitive functions, and deficits in attention, speed of processing, and memory after TBI. The evidence-based guidelines and options established by this working group may help to guide the pharmacological treatment of the person experiencing neurobehavioral sequelae following TBI. There is a clear need for well-designed randomized controlled trials in the treatment of these common problems after TBI in order to establish definitive treatment standards for this patient population.

CC was associated with a three times greater concussion risk and 4 with a 40% lower risk.

ObjectiveTo investigate associations ofAPOEandTaugene polymorphisms with sports-related acute concussions and baseline to post-concussion neuropsychological test score changes.DesignMulti-center prospective cohort study.SettingScholarship athletes at 21 universities and 4 high schools Participants: 3218 athletes playing football (70%) or soccer (23%).Assessment of Risk FactorsAPOE,APOEG-219T promoter (APOEProm),Tauexon 6 Ser53Pro (TauSer), andTauexon 6 Hist47Tyr (TauHis) genetic polymorphisms.Main Outcome Measurements(1) Acute concussions and (2) differences between baseline and 24–72 h post-concussion Headminder Neuropsychological Test Scores of Simple and Complex Reaction Time (SRT and CRT, respectively) and Processing Speed.ResultsThere were a total of 131 athletes with incident concussions and genetic data and neuropsychological test scores. There were no statistically significant differences in frequencies of acute concussions according to genotypes by χ2test. By t-test, the mean baseline to post-concussion neuropsychological changes were statistically significantly greater for CRT and SRT in those with the TauSer ‘TT’ genotype and for CRT in those with the APOEProm ‘TT’ genotype, and borderline significantly greater in those with the TauSer ‘TT’ genotype (p=0.09).ConclusionsThe statistically significantly worse mean baseline to post-concussion neuropsychological test scores in those with the APOEProm and TauSer polymorphisms suggests a possible genetic influence on post-concussion neurocognitive recovery. These preliminary findings provide no evidence for associations of the fourAPOEandTaugene polymorphisms investigated with acute concussions, although the small sample size and lack of control for confounders are limitations.AcknowledgementsGrant funding was provided through the NOCSAE (National Operating Committee for Safety Athletic Equipment) and the American Medical Society for Sports Medicine (AMSSM) Foundations. The opinions expressed in this abstract are not those of NOCSAE or AMSSM.Competing interestsNone.