Pain management medications are used to control pain from traumatic brain injury and the symptoms and effects related to the injury. Non-opioid pain relievers, such as acetaminophen and naproxen, are generally safe for patients with TBI. Ibuprofen is also a good option, but don't take it within the first week or two after a head injury, as it can increase the risk of bleeding. Mild traumatic brain injuries usually don't require treatment other than rest and over-the-counter pain relievers to treat headache.
However, a person with a mild traumatic brain injury usually needs to be closely monitored at home for any persistent, worsening, or new symptoms. You can also have follow-up appointments with your doctor. Traumatic brain injury is common in North America and has dramatic and wide-ranging effects on the quality of life of survivors. People who survive a traumatic brain injury may experience anxiety, agitation, memory disturbances, and behavioral changes.
When managing the immediate and long-term consequences of such injuries, doctors have many pharmacological options, including psychostimulants, antidepressants, antiparkinsonian agents and anticonvulsants. These and other agents may play a role in the treatment of neuropsychiatric, neurocognitive and neurobehavioral sequelae of brain injury. Psychostimulants, antidepressants and other agents can accelerate the recovery of patients suffering from functional deficits that follow an insult to the brain. Traumatic brain injury (TBI) is commonly defined as an insult to the brain by an external force that causes a temporary or permanent impairment in functional, psychosocial or physical abilities.
1 It is a major cause of morbidity and mortality, and the leading cause of death and disability among young adults. With advances in the treatment of head injury, an increasing number of patients survive with residual neurological disorders. A panel from the National Institute of Health estimates that between 2.5 and 6.5 million Americans currently live with TBI-related disabilities. Despite the prevalence and cost of TBI-related disabilities, there is a shortage of literature reviewing modern approaches to pharmacotherapy.
However, there is growing evidence that medications can accelerate recovery by improving some neurological functions without affecting others. Pharmacotherapy is increasingly used both in the subacute phase (less than 1 month after traumatic brain injury) and in the chronic phase (more than 1 month after traumatic brain injury). Neuropsychiatric symptoms can present as mood disorders, post-traumatic stress disorder, and personality changes characterized by disinhibition and egocentrism. Neurocognitive injuries vary, but most often involve problems with attention, memory, and executive functioning.
Depending on the location of the lesion, damage can occur in a variety of neurotransmitter networks critical to cognitive processes. Research has focused on the loss of dopaminergic neurons that regulate executive functioning, as well as attention limiting norepinephrine and acetylcholine deficits, a critical function for effective rehabilitation. Fortunately, a number of pharmacological interventions hold promise to help patients cope with these losses and deficits. While there is insufficient evidence to establish guidelines for optimal pharmacotherapy, medications can be used to support recovery.
Examples are shown in the attached table, which summarizes the pharmacological approaches discussed in more detail below. When problematic symptoms of TBI are identified, physicians can use this information to determine drug options and integrate them with non-drug options, such as physical therapy, occupational therapy, physical therapy, and the patient support network. Planning a Drug Intervention Strategy The decision to use pharmacological intervention should be the result of multidisciplinary collaboration and must be made with the patient or his or her surrogate decision maker. The goals of therapy should be clarified and outcomes and adverse events should be tracked reliably, in particular so that drugs that are ineffective or cause adverse events can be discontinued and unnecessary polypharmacy can be avoided.
The selection of the most appropriate agent requires careful analysis of the neurological disabilities present, the nature of the underlying lesion and the time elapsed since the injury. Psychostimulants Psychostimulants such as methylphenidate are most commonly used to treat attention deficit hyperactivity disorder (ADHD), a condition that involves problems with executive functioning and that can be characterized as similar to brain injury both in terms of symptoms and neurotransmitters. aberrations. Although the full mechanism of action of methylphenidate remains unknown, this agent is believed to bind to dopamine transporters, thereby blocking reuptake and increasing extracellular dopamine levels, particularly in the frontal cortex.
It is also thought to increase levels of norepinephrine and serotonin. In the chronic phase following traumatic brain injury, patients have reported improvements in mood, work performance and alertness, with more limited evidence suggesting improved fluency and selective attention. Despite the accumulation of controlled clinical trials, there is no consensus on the use of stimulants in the treatment of TBI-induced alterations in excitation and motor activity. Methylphenidate has a rapid onset of action and a relatively benign side effect profile, and we believe it is useful in both the acute and chronic phases of TBI.
Antidepressants Despite potentially serious consequences, psychiatric sequelae following traumatic brain injury are underdiagnosed and treated. Fortunately, current evidence suggests that antidepressants can be used to control additional neuropsychiatric and neurological deficits that persist from brain injury. Most studies suggest that SSRIs improve neurobehavioral, neurocognitive, and neuropsychiatric deficits, specifically agitation, depression, psychomotor retardation, and recent memory loss; however, most data come from non-randomized trials. Consequently, these fibers are commonly injured in TBI, suggesting that newer antidepressants with effects on both norepinephrine and serotonin, such as mirtazapine and venlafaxine, may also be effective in treating TBI sequelae; however, there is a lack of clinical data with these agents in TBI.
Antiparkinsonian drugs The antiparkinsonian drugs amantadine, bromocriptine and levodopa combined with carbidopa (e.g. Multiple studies of amantadine at a dose of 100 to 300 mg daily have suggested its effectiveness in the acute and chronic phases of care after traumatic brain injury, particularly in diffuse, frontal or right-sided brain injury. Anticonvulsants Anticonvulsants have been used with varying results to treat the symptoms of traumatic brain injury. Valproic acid, for example, enhances inhibitory control mediated by the neurotransmitter GABA, thus promoting general stabilization of the central nervous system, but the findings so far have been contradictory.
There are also a number of animal studies that examine drugs that have the potential to adversely affect brain recovery after traumatic brain injury. These studies often use a stroke model, so it may not be possible to generalize to a traumatic brain injury. Abstract The nature of the sequelae of TBI, whether psychiatric, cognitive or behavioral, is not well understood. Similarly, the use of pharmacological interventions to improve symptoms, function and outcome is still under development.
However, there are a number of agents that inspire optimism. When treating neurological deficits medically, there is evidence to support the personalized use of these agents for particular clinical scenarios of TBI. The timing and nature of the symptoms, along with whether the agents are administered in the acute or chronic phase after a traumatic brain injury, are relevant factors in determining the appropriate use. With insufficient evidence to establish guidelines for optimal treatment, care should be taken when choosing pharmacological interventions for TBI.
If a decision is made to use medications to promote recovery from TBI or to treat concomitant disabilities, physicians should carefully document the goals of drug therapy and closely monitor side effects. Future studies will undoubtedly add to the doctor's arsenal for the care of patients with TBI. Dr. Talsky is a psychiatric resident at the University of Toronto.
Mrs. Pacione is a senior medical student at the University of Toronto. Shaw is a family medicine resident at St. Wasserman is a psychiatric resident at the University of Toronto.
Mr. Lenny is a senior medical student at the University of Toronto. Verma is a senior medical student at the University of Toronto. Hurwitz is a Bachelor of Science student at the University of Western Ontario in London.
Waxman is a psychiatric resident at the University of Toronto. Morgan is a psychiatric resident at the University of Toronto. Bhalerao is a staff psychiatrist at St. An alternative version of the ICMJE style is to additionally include the month with an edition number, but since most journals use continuous pagination, the shortest form provides enough information to locate the reference.
The NLM now lists all authors. The BC Medical Journal is a general medical journal published by Doctors of BC. Provides continuing medical education with a focus on evidence-based medicine. The Center for Neurology, Learning and Behavior provides multidisciplinary, clinical and forensic assessment, case management, trial consultations and treatment services for children and adults with brain injury and dysfunction, attention deficit hyperactivity disorder, language disorders, learning disabilities, developmental delay, emotional disorders and adjustment problems.
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