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Volume 46 Number 6, 2009
   Pages 851 — 878

Abstract — Pharmacological management of neurobehavioral disorders following traumatic brain injury-A state-of-the-art review

Effie Chew, MD;1-2 Ross D. Zafonte, DO2-3*

1Rehabilitation Medicine, Division of Neurology, Department of Medicine, National University Hospital, National University Health System, Singapore; 2Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; 3Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; and Department of Physical Medicine and Rehabilitation, The Massachusetts General Hospital, Boston, MA

Abstract — Pharmacological management of neurobehavioral disorders following traumatic brain injury (TBI) is common practice. However, the evidence available to guide this practice remains sparse. This review summarizes, in brief, the state of knowledge, organized via a time continuum from injury as well as by symptom complex. The areas of neuroprotection, hypoarousal, attention and memory deficits, aggression, agitation, depression, and mania are reviewed. The literature was searched with PubMed on the terms "traumatic brain injury" or "brain injury" with "pharmacology" (and the symptoms according to which this review is arranged). Additional searches were conducted with the specific symptoms as search terms, crossed with the therapeutic agents or drug classes discussed. Where a paucity of prospective data exists, case reports and retrospective studies are included. Studies to date have yielded minimal positive evidence for enhancing function, memory, and behavior after TBI. No single agent likely will become sentinel in the recovery process, and combination therapy in the acute and postacute settings are required. A need exists to further define the role of psychopharmacology in postacute TBI medicine and the specific characteristics of subpopulations who might benefit.

Key words: aggression, agitation, arousal, attention, depression, mania, memory, neuroprotection, pharmacology, psychosis, traumatic brain injury.


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