Clinical efficacy of 1‐desamino‐8‐d‐arginine‐vasopressin (DDAVP) in short‐term recovery from minor head injury

Abstract

The purpose of the study was to investigate whether 1-desamino-8-D-arginine-vasopressin (DDAVP) has a positive effect on mental performance in patients recovering from minor head injury. Seventeen inpatients with simple closed-head injury were included in the trial within 16-40 h after the accicent. DDAVP (Adiuretin SPOFA 10 pg b i d . or placebo were administered intranasally for 4 days under double-blind conditions. The test battery, consisting of several tests of memory and information processing, was administered at pretreatment and at the end of the trial. All patients completed the protocol, nine in the DDAVP group and eight in the placebo group. No adverse reactions to treatment were observed. In the first and second series of PASAT (an information processing test) and in the Story Memory (a test of verbal logical memory) DDAVP was significantly @<0.05) superior to placebo according to t-tests and/or ANCOVA with age as covariate. The results indicate a positive influence of DDAVP on information processing and short-term verbal logical memory during recovery from minor head injury.

A systematic review of treatments for mild traumatic brain injury

“…Only eight of the 22 studies were considered to have used either Strong methodology [37-39, 51, 57] or Moderately Strong methodology [40,41,45,56]. In contrast, 12 were deemed to have used Weak methodology [42-44, 46-50, 52-55].…”

“…Finally, one RCT [45] assessed whether the anti-diuretic medication DDAVP (Desmopressin Acetate) would improve mental performance post-MTBI. The authors reported that that the MTBI group showed a minor improvement on information processing rate and on immediate recall.…”

“…One study [41] failed to provide an operational definition of MTBI, while others [49,50,[55][56][57] employed loose, idiosyncratic definitions that lacked reference to common brain injury markers such as GCS, PTA or LOC. Of the studies reviewed, four referred to a GCS score of 13-15 [39,46,51,52], four referred to PTA less than 24 hours [39,40,51,52], six used LOC less than 60 minutes [40,42,45,[52][53][54] and one used LOC equal to 24 hours [48] to define MTBI in study participants. Only four studies adhered to the consensus definition put forth by the ACRM [37,38,43,44,47].…”

“…Definition of MTBI [37,38] The American Congress of Rehabilitation Medicine (ACRM) 1993 MTBI Criteria [39] Partial ACRM criteria [40] Partial ACRM criteria [41] Not specified [42] LOC <20 minutes; Hospitalized <3 days; Negative neurological exam [43] Full ACRM criteria [44] Full ACRM criteria [45] LOC 1 hour; Intact skeleton of skull; Any retro-grade amnesia; Absence of clinical neurological or EEG symptoms of a topic brain lesion [46] At least one ACRM criterion [47] Full ACRM criteria [48] Diagnosis of cerebral concussion or suspected cerebral concussion; LOC 24 hours; Lack of contusion of the brain or intra-cerebral haematoma [49] Diagnosed with MTBI by neurologists or psychiatrists [50] Concussive head injury with or without LOC [51] Partial ACRM criteria [52] Partial ACRM criteria [53] LOC 20 minutes; Hospitalization 48 hours; Absence of any clinical, physical or neurological sequelae from closed head injury except for a few scar marks; Absence of any significant abnormality in EEG and CT scans [54] LOC 20 minutes; Hospitalization 48 hours; Absence of any clinical, physical or neurological sequelae from closed head injury except for a few scar marks; Absence of any significant abnormality in EEG and CT scans [55] No evidence of anatomic cerebral injury such as focal signs or obvious organic brain syndrome; History of unconsciousness not necessary; Trauma may be without signs of injury to the face, scalp or jaw [56] Any blow to the head causing a clinical diagnosis of head injury to be made, even if insufficient to cause definite loss of consciousness [57] Any blow to the head causing a clinical diagnosis of head injury to be made symptoms were not successfully managed with amitriptyline in patients with MTBI [54]. In fact, while 100% of patients in the depressed non-MTBI group exhibited headache improvement following 4 weeks of amitriptyline, none of the patients in the depressed MTBI group improved ( p < 0.001).…”

Ondansetron for pediatric concussion; a pilot study for a randomized controlled trial

“…24 The review identified 15 randomized controlled trials. Among them, one evaluated a pharmacological intervention (DDAVP), 27 two evaluated activity restriction (full bed rest, 28 hospitalization 29 ), one evaluated head tomodensitometry v. admission, 30 four evaluated an information intervention (pamphlet, information session at the ED) [31][32][33][34] and seven evaluated diverse followup interventions (in neuropsychology, phone follow-up, etc.). 33,[35][36][37][38][39][40] Since the publication of the last systematic review, a small randomized controlled trial reported fewer headaches associated with hypertonic intravenous saline v. normal saline for 44 concussed children who needed intravenous access for CT-scan.…”