Stimulating consciousness and cognition following severe brain injury: a new potential clinical use for lamotrigine.
No medications clearly enhance consciousness or cognition following severe brain injury. This series (n = 13) suggests that lamotrigine may stimulate improvement of patients with impairment equivalent to level I-III on the Rancho Los Amigos Cognitive Scale. After a serendiptious clinical result, severely brain injured patients who were taking an anticonvulsant had an opportunity to start lamotrigine. This cohort had been transferred to this rehabilitation unit 14-304 (mean 73.9) days and started lamotrigine 20-310 (mean 87.5) days after acute brain injury. Compared to this unit's experience with patients with similar severe brain injuries, more patients (n = 10) were discharged to the conmmunity and fewer to skilled nursing facilities (n = 3) than were expected. This preliminary and provocative case series corresponds to basic science results, and further investigation of lamotrigine is warranted.
Showalter
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Department of Brain Rehabilitation, Good Shepherd Rehabilitation Hospital, Allentown, PA 18103-3296, USA. TGirton@gsrh.org
Kimmel
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D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy* / Q000523:psychology / Q000534:rehabilitation*; D003071:Cognition / Q000187:drug effects*; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D020127:Recovery of Function; D012640:Seizures / Q000209:etiology / Q000517:prevention & control*; D015599:Trauma Severity Indices; D014227:Triazines / Q000008:administration & dosage / Q000627:therapeutic use*
D000927:Anticonvulsants; D018691:Excitatory Amino Acid Antagonists; D014227:Triazines; D000077213:Lamotrigine