Noradrenergic agonists for acute traumatic brain injury.
BACKGROUND
Although there have been considerable gains in understanding the cascade of events that lead to secondary injury after traumatic brain injury (TBI), efforts to translate this understanding into new therapeutic, so-called neuroprotective, approaches have so far proven disappointing. Animal models suggest an alternative strategy: agents enhancing monoaminergic transmission, particularly amphetamines, have been shown to promote motor recovery from focal brain injury and it has been suggested that this might represent a complementary means of therapeutic intervention in the later post-injury phase.


OBJECTIVE
To evaluate the evidence that amphetamines improve final outcome after traumatic brain injury.


METHODS
We searched MEDLINE, EMBASE, Science Citation Index, Cochrane Controlled Trials Register and the Cochrane Injuries Group's Specialised Register of Controlled Trials. Researchers and authors of published trials were also contacted.


METHODS
Randomised controlled trials comparing the use of a noradrenergic agonist (together with conventional non-pharmacological rehabilitative therapy) versus conventional non-pharmacological rehabilitative therapy alone.


METHODS
Two reviewers independently screened records, extracted data and assessed trial quality.


RESULTS
Although there is a limited clinical literature addressing this topic, none of the studies identified fully meets inclusion criteria for this review.


CONCLUSIONS
At present there is insufficient evidence to support the routine use of methylphenidate or other amphetamines to promote recovery from TBI.
Forsyth
R
R
Department of Child Health, University of Newcastle upon Tyne, Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, Tyne & Wear, UK, NE1 4LP. r.j.forsyth@newcastle.ac.uk
Jayamoni
B
B
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000662:Amphetamines / Q000627:therapeutic use*; D001930:Brain Injuries / Q000188:drug therapy* / Q000534:rehabilitation; D006801:Humans; D009638:Norepinephrine / Q000819:agonists*; D016032:Randomized Controlled Trials as Topic
D000316:Adrenergic alpha-Agonists; D000662:Amphetamines; D009638:Norepinephrine