Research Reports - Drugs for behavior disorders after traumatic brain injury

Ann Phys Rehabil Med. 2016 Feb;59(1):42-57. doi: 10.1016/j.rehab.2015.10.003.
Epub 2016 Jan 18.

Plantier D(1), Luauté J(2); SOFMER group.

OBJECTIVE: There are no handbook or recommendations for the use of
pharmacological agents to treat neurobehavioral disorders after traumatic brain
injury (TBI). This work proposes a systematic review of the literature and a user
guide on neuroleptics, antidepressants, beta-blockers, mood stabilizers and other
medications for irritability, aggressiveness, agitation, impulsivity, depression,
apathy…
METHOD: Steering, working and reading groups (62 people) were formed under the
control of the French High Authority for Health (HAS) in collaboration with the
SOFMER scientific society (French Society of Physical and Rehabilitation
Medicine). Articles were searched by HAS officers in the Medline database from
1990 to 2012, crossing TBI and pharmacological agents. The HAS method to select,
read and analyze papers is close to the PRISMA statements.
RESULTS: Out of 772 references, 89 were analyzed, covering a total of 1306 people
with TBI. There is insufficient evidence to standardize drug treatments for these
disorders. There are however some elements to establish consensus recommendations
for good clinical practice. Propranolol can improve aggression (B grade).
Carbamazepine and valproate seem effective on agitation and aggression and are
recommended as first line treatment (Expert Consensus [EC]). There is no evidence
of efficacy for neuroleptics. Their prescription is based on emergency situation
for a crisis (loxapine) but not for long-term use (EC). Antidepressants are
recommended to treat depression (EC) with a higher standard of proof for
Selective Serotonin Reuptake Inhibitors (SSRI, grade B). Other products are
described.
CONCLUSION: The choice of treatment depends on the level of evidence, target
symptoms, custom objectives, clinical experience and caution strategies. 

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