Pharmacotherapy for treatment of attention deficits after non-progressive acquired brain injury. A systematic review

Sivan, Manoj; Neumann, Vera; Kent, Ruth; Stroud, Amanda; Bhakta, Bipin

doi:10.1177/0269215509343234

Cited by 40 publications

(28 citation statements)

References 33 publications

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“…More recently, some investigators have suggested that SPECT imaging could even assist clinicians in developing treatment strategies. For example, decreased prefrontal cortex perfusion, which can be associated with executive dysfunction arguably may be helped with psychostimulants [23], [24] or other interventions to enhance the function of the frontal lobes. Temporal lobe hypoperfusion has been associated with irritability and mood instability that may be improved with anticonvulsant or antidepressant medication.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Comparison of 99mTc Exametazime and 123I Ioflupane SPECT in Patients with Chronic Mild Traumatic Brain Injury

et al. 2014

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BackgroundThis study evaluated the clinical interpretations of single photon emission computed tomography (SPECT) using a cerebral blood flow and a dopamine transporter tracer in patients with chronic mild traumatic brain injury (TBI). The goal was to determine how these two different scan might be used and compared to each other in this patient population.Methods and FindingsTwenty-five patients with persistent symptoms after a mild TBI underwent SPECT with both 99mTc exametazime to measure cerebral blood flow (CBF) and 123I ioflupane to measure dopamine transporter (DAT) binding. The scans were interpreted by two expert readers blinded to any case information and were assessed for abnormal findings in comparison to 10 controls for each type of scan. Qualitative CBF scores for each cortical and subcortical region along with DAT binding scores for the striatum were compared to each other across subjects and to controls. In addition, symptoms were compared to brain scan findings. TBI patients had an average of 6 brain regions with abnormal perfusion compared to controls who had an average of 2 abnormal regions (p<0.001). Patient with headaches had lower CBF in the right frontal lobe, and higher CBF in the left parietal lobe compared to patients without headaches. Lower CBF in the right temporal lobe correlated with poorer reported physical health. Higher DAT binding was associated with more depressive symptoms and overall poorer reported mental health. There was no clear association between CBF and DAT binding in these patients.ConclusionsOverall, both scans detected abnormalities in brain function, but appear to reflect different types of physiological processes associated with chronic mild TBI symptoms. Both types of scans might have distinct uses in the evaluation of chronic TBI patients depending on the clinical scenario.

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Section: Introductionmentioning

confidence: 99%

“…Another line of evidence regarding the dopaminergic effect of TBI is that dopamine receptor agonists often benefit patients via the promotion of central dopaminergic transmission [23], [24]. This could be a sign that dopamine release is suppressed after injury, that dopamine uptake by the DAT is increased, or some combination of the two.…”

Section: Introductionmentioning

confidence: 99%

Clinical Comparison of 99mTc Exametazime and 123I Ioflupane SPECT in Patients with Chronic Mild Traumatic Brain Injury

et al. 2014

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“…13,22,23,58–65 There is evidence, including randomized controlled trials, to support the use of methylphenidate in the setting of traumatic brain injury. 13,22,58–60,66 It is recommended to treat deficits in attention and speed of processing, and as an option for treating deficiencies in general cognitive functioning. 51 …”

Section: Cognitivementioning

confidence: 99%

Medical Therapies for Concussion

Meehan

2011

Clinics in Sports Medicine

114

113

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“…A recent study (Gorgoraptis et al, 2012) found that the administration of rotigotine improved performance on the cancellation task, and another found that treatment with carbidopa-levodopa significantly improved BIT scores in three of four patients (Mukand et al, 2001). Although the results appear promising, other studies have not replicated these findings (Buxbaum et al, 2007), highlighting the need for further clinical trials (Sivan et al, 2010). The efficacy of pharmacological interventions in neglect is also often hampered by patients' lack of insight, self-monitoring and motivation, all of which lower compliance.…”

Section: Anatomymentioning

confidence: 99%

Hemispatial neglect: clinical features, assessment and treatment

Gallagher

Wilkinson

Sakel

2013

British Journal of Neuroscience Nursing

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Hemispatial neglect is a disorder of attention which commonly follows from damage to the right side of the brain. Patients with neglect show symptoms of lateralised inattention, failing to acknowledge or report information on the left side. Neglect is a poor prognostic indicator for general functional recovery from stroke, and is associated with a range of co-morbid conditions including denial or indifference to the brain injury, hemiplegia and visual field loss. Mild to moderate cases can be over-shadowed by the more gross symptoms that accompany brain injury, however assessment and diagnosis is relatively quick and simple.Current treatment guidelines suggest that patients should be taught compensatory strategies, but these are largely ineffective. Although recent research has identified more promising treatment approaches, investigations are still preliminary. Given the prevalence and debilitating nature of neglect, there is a clear need to raise awareness and understanding of the condition amongst carers and healthcare professionals.

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Pharmacotherapy for treatment of attention deficits after non-progressive acquired brain injury. A systematic review

Abstract: Although there is lack of robust evidence to recommend the routine use of medication to improve attention after traumatic brain injury and stroke, the existing evidence indicates potential for benefit in some patents and therefore further research is warranted.

Cited by 40 publications

References 33 publications

Clinical Comparison of 99mTc Exametazime and 123I Ioflupane SPECT in Patients with Chronic Mild Traumatic Brain Injury

Clinical Comparison of 99mTc Exametazime and 123I Ioflupane SPECT in Patients with Chronic Mild Traumatic Brain Injury

Medical Therapies for Concussion

Hemispatial neglect: clinical features, assessment and treatment

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