The use of bupropion in the treatment of restlessness after a traumatic brain injury

Abstract

The occurrence of restlessness after a traumatic brain injury (TBI) is common. Severe restlessness can be a barrier in the multidisciplinary treatment of patients with TBI. The following case describes a patient with restlessness after a head-on motor vehicle accident. The patient was tachycardic, diaphoretic, demonstrating decerebrate posturing and a Rancho Los Amigos Stage II--III. Significant left lower leg restlessness was severe enough to cause bruising and ulceration. A multidisciplinary look was taken at the effects of using different neurotransmitter modulators in the treatment of restlessness after a TBI. Current biology treatment options include the use of medications that either modulate dopamine or noradrenaline alone. Bupropion effects both the dopaminergic and noradrenergic pathways. In the following case, the patient's restlessness was resistant to almost every medication employed. The only medication that proved to be effective in significantly reducing the patient's restlessness was bupropion. The evidence for the use of bupropion in the treatment of restlessness after a TBI has never been discussed previously, aside from anecdotal accounts. It is hoped that this case will prove insight into another treatment option for patients who have severe restlessness.

Positive behavioural disturbances in the rehabilitation phase after severe traumatic brain injury: an historic cohort study

“…If the above-mentioned considerations are valid, for the majority of patients showing PBD in the rehabilitation phase after TBI the use of suppressive medication would be contra-indicated. Nonetheless, neuroleptic medication is still frequently prescribed to TBI patients for inhibiting PBD, even when they have become medically stable and have regained some volition and communication to understand and respond to simple questions and instructions [5,[27][28][29].…”

Executive dysfunction following traumatic brain injury: Neural substrates and treatment strategies

“…Individuals whose cognition and behavior become increasingly disorganized under stress may benefit from treatment with neuroleptic medications, though the po-tential cognitive and other side effects of these drugs may outweigh their benefits in terms of reduced agitation [4]. Those with amotivational symptoms typical of executive dysfunction may benefit from the activating effects of treatment with dopaminergic agents [58], while motor restlessness has been reported to improve with medications acting on both dopaminergic and noradrenergic pathways [56]. Tricyclic antidepressants have also been noted to improve arousal and initiation in some cases of severe TBI [51].…”

Review of Awakening Agents

“…Two studies looked at the use of sertraline, at an average dose of 100 mg/day. 19,44 In one study the treatment was only continued for two weeks and it failed to show any benefits (Grade C). 19 In the second study the treatment was continued for eight weeks.…”

“…1 8 S i m i l a r l y, in addition to increasing dopamine levels, buproprion has also been used to increase serotonin levels. 19 Medications used to treat Parkinson's syndrome also help with brain injury, such as amantadine (Symmetrel), 2 0 bromocriptine and carbidopa/levodopa. Amantadine acts presynaptically to enhance dopamine release or inhibit its reuptake, and can act postsynaptically to increase the number of receptors, or to alter the receptor's configuration.…”