摘要:

The choice of pharmacologic treatment for cognitive, behavioral, or affective disorders following TBI depends upon an accurate assessment of the underlying disorder responsible for the clinical picture presented. However there are a myriad of possible causes for each sign or symptom, and often several contributing factors. A differential diagnostic approach is presented that structures the search for etiology into several categories: preinjury diagnosis, neuropsychological disorders, sensorimotor disorder, medical disorders, adverse effects of medications, reactive mood and anxiety disorders, and sleep disorders.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background:Psychostimulants are used commonly in the rehabilitation of individuals with traumatic brain injury (TBI), despite the dearth of well-controlled studies of their effects. The available literature suggests that these drugs predominantly affect the speed of cognitive processing and certain observational ratings of mood and behavior. Effects on sustained attention, distractibility, and memory are less clear.Objective:This article reviews the controlled research literature on the use of these drugs in TBI and presents preliminary data from the authors' laboratory that extends these findings. Some of the common research pitfalls that have limited progress in research on these drugs are discussed.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background:Traumatic brain injury (TBI) caused by a high-speed transportation accident results in a mechanism of injury commonly described as diffuse axonal injury (DAI), which is associated with a reduction in dopamine turnover in the brain. Because of its affect on both dopamine andN-methyl-D-aspartate (NMDA) channels, amantadine has been the subject of considerable interest and clinical use in acute TBI.Participants:In this study, 35 subjects, who had a TBI in a transportation accident and were initially seen with a Glasgow Coma Scale score of 10 or less within the first 24 hours after admission, were randomly assigned to a double-blind, placebo-controlled, crossover design trial.Main Outcome Measures:Amantadine, 200 mg, or placebo was each administered for 6 weeks (12 weeks total) to patients who were recruited consecutively.Results:There was an improvement in the Mini-Mental Status (MMSE) scores of 14.3 points (P= .0185), Disability Rating Scale (DRS) score of 9.8 points (P= .0022), Glasgow Outcome Scale (GOS) score of 0.8 points (P= .0077), and in the FIM Cognitive score (FIM-cog)™ of 15.1 points (P= .0033) in the group that received amantadine during the first 6 weeks (group 1), but there was no improvement in the second 6 weeks on placebo (P> .05). In group 2 (active drug second 6 weeks), there was an improvement in the MMSE of 10.5 points, in the DRS of 9.4 points (P= .0006), in the GOS of 0.5 points (P= .0231), and in the FIM-cog of 11.3 points (P= .0030, Wilcoxon signed rank) spontaneously in the first 6 weeks on placebo (P= .0015). However, group 2 gained a statistically significant additional 6.3 points of recovery in the MMSE (P= .0409), 3.8 points in the DRS (P= .0099), 0.5 points in the GOS (P= .4008), and 5.2 points in the FIM-cog (P= .0173, Wilcoxon signed rank) between the sixth week and the twelfth week of treatment on the active drug.Conclusions:There was a consistent trend toward a more rapid functional improvement regardless of when a patient with DAI-associated TBI was started on amantadine in the first 3 months after injury.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background:There are many agents in clinical use that manipulate central nervous system levels of epinephrine, dopamine, and serotonin. However, development of pharmacological options to manipulate central acetylcholine systems has lagged behind because of poor penetration of the blood–brain barrier and significant peripheral nervous system side effects. Newer agents have demonstrated some efficacy in the management of behavioral and cognitive side effects in Alzheimer's disease, and preliminary data in traumatic brain injury suggest acetylcholine esterase inhibitors may play a significant role in the treatment of this patient population as well.Conclusions:In this article, the basic neuroanatomy and pharmacology of the central acetylcholine system are reviewed, along with agents currently available for clinical use.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background:The development of novel serotonin agents has led to an increased use of these medications throughout medical practice. An understanding of the basic pharmacological function of these agents is key to understanding their usefulness. Among persons with brain injury, serotonin agents have been used for the treatment of depression, panic disorder, obsessive-compulsive disorders, agitation, sleep disorders, and motor dysfunction.Conclusion:This article will review the mechanisms, efficacy, and side effects of serotonin agents with a focus on persons with brain injury.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objectives:Sleep disturbances in people with brain injuries, although quite common, remain a problematic management issue for caregivers. This article will review the architecture of sleep, the assessment of insomnia, and discussion of common medications that may exacerbate the problem. Nonpharmacological management techniques, including stimulus control, sleep restriction, and relaxation therapy, will also be discussed.Main Outcome Measures:An intensive analysis of pharmacological agents used in treatment, including descriptions of the positive and negative effects of the various classes of drugs (e.g., sedative/hypnotics, antihistamines, dopamine agonists, and stimulants) will be provided.Conclusions:These discussions will hopefully assist in the decision-making processes of caregivers managing this unique group of persons with sleep difficulties.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective:Given the limitations of the literature, a structured approach to helping families after brain injury is clearly needed.Main Outcome Measures:On the basis of considerable clinical experience and research review, this article describes the Brain Injury Family Intervention (BIFI), developed to address common issues, concerns, and challenges. The foundation of the BIFI is a curriculum that includes 16 intervention topics, self-evaluation tools, and treatment strategies.Conclusions:Despite individual differences, families often encounter similar problems in their attempts to resume normal lives. A structured approach to family intervention can help mitigate commonly encountered problems.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID