Traumatic brain injury pharmacological treatment: recommendations

Abstract

This article presents the recommendations on the pharmacological treatment employed in traumatic brain injury (TBI) at the outpatient clinic of the Cognitive Rehabilitation after TBI Service of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. A systematic assessment of the consensus reached in other countries, and of articles on TBI available in the PUBMED and LILACS medical databases, was carried out. We offer recommendations of pharmacological treatments in patients after TBI with different symptoms.

The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic Review

“…Translated into clinical practice, a framework could be provided with factors or combinations of factors that should be considered when prescribing medications for post-TBI aggression, and how these might increase or decrease the likely efficacy of specific medications. This idea is consistent with growing support within the literature of a need for an individualized approach to medication in TBI patients (34, 38, 44, 45, 69). The concept of considering a range of pertinent factors in drug choice is hardly novel.…”

“…Although this topic has attracted a number of previous reviews, many are outdated and their conclusions are limited by methodological issues, for example, lack of key systematic review components (no comprehensive search for published and unpublished data; lack of comprehensive evidence tables; no methodological assessment for risk of bias) (36, 38–43), failure to examine harms (40), and absence of a clear delineation between studies in which participants were in or out of PTA (34, 36, 44, 45). With respect to the findings from previous reviews, all have agreed that no strong conclusions could be drawn due to the limited number of studies and overall weakness of the evidence for each class of medication (34, 39, 41).…”

“…With respect to the findings from previous reviews, all have agreed that no strong conclusions could be drawn due to the limited number of studies and overall weakness of the evidence for each class of medication (34, 39, 41). Notwithstanding this, there was a general consensus that the current best evidence for treatment of aggression post TBI supports the use of amantadine and beta-blockers, with typical neuroleptics only to be prescribed with caution due to concern regarding adverse events (34, 36, 38, 41, 42, 44–47). Many other drugs have also been listed as possible options including anticonvulsants (mostly carbamazepine, valproic acid), specific serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCA), atypical antipsychotics, methylphenidate, and lithium (40–42, 44, 46, 47).…”

The ketone ester, 3-hydroxybutyl-3-hydroxybutyrate, attenuates neurobehavioral deficits and improves neuropathology following controlled cortical impact in male rats

“…Many TBI patients survive the initial incident, but frequently develop long-term sensory, motor, cognitive and emotional dysfunction, a burden on the individual, their family and their community. Current pharmacological interventions for TBI, such as anticonvulsants, antidepressants, antipsychotics and psychostimulants are ineffective in fully preventing and/or ameliorating TBI-related consequences, and contribute to unwanted side effects [2,3]. Therefore, new, effective and well-tolerated therapies are needed to reduce the long-term impact of TBI on individual and public health.…”

Estudo randomizado, duplo cego, placedo controlado da ação da rivastigmina no desempenho cognitivo de pacientes crônicos pós traumatismo crânio encefálico

“…Anualmente 700 mil a 1,1 milhões de pessoas são hospitalizadas com lesão cerebral adquirida após traumatismo crânio encefálico no Brasil (Anghinah et. al, 2018).…”