title: Guidelines for the pharmacologic treatment of neurobehavioral sequelae of traumatic brain injury.
abstract: There is currently a lack of evidence-based guidelines to guide the pharmacological treatment of neurobehavioral problems that commonly occur after traumatic brain injury (TBI). It was our objective to review the current literature on the pharmacological treatment of neurobehavioral problems after traumatic brain injury in three key areas: aggression, cognitive disorders, and affective disorders/anxiety/ psychosis. Three panels of leading researchers in the field of brain injury were formed to review the current literature on pharmacological treatment for TBI sequelae in the topic areas of affective/anxiety/ psychotic disorders, cognitive disorders, and aggression. A comprehensive Medline literature search was performed by each group to establish the groups of pertinent articles. Additional articles were obtained from bibliography searches of the primary articles. Group members then independently reviewed the articles and established a consensus rating. Despite reviewing a significant number of studies on drug treatment of neurobehavioral sequelae after TBI, the quality of evidence did not support any treatment standards and few guidelines due to a number of recurrent methodological problems. Guidelines were established for the use of methylphenidate in the treatment of deficits in attention and speed of information processing, as well as for the use of beta-blockers for the treatment of aggression following TBI. Options were recommended in the treatment of depression, bipolar disorder/mania, psychosis, aggression, general cognitive functions, and deficits in attention, speed of processing, and memory after TBI. The evidence-based guidelines and options established by this working group may help to guide the pharmacological treatment of the person experiencing neurobehavioral sequelae following TBI. There is a clear need for well-designed randomized controlled trials in the treatment of these common problems after TBI in order to establish definitive treatment standards for this patient population.
authors.affiliation: Defense and Veterans Brain Injury Center, Department of Neurology and Neurosurgery, Walter Reed Army Medical Center, USA.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Warden
authors.forename: Barry
authors.initials: B
authors.lastname: Gordon
authors.forename: Thomas W
authors.initials: TW
authors.lastname: McAllister
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Silver
authors.forename: Jeffery T
authors.initials: JT
authors.lastname: Barth
authors.forename: John
authors.initials: J
authors.lastname: Bruns
authors.forename: Angela
authors.initials: A
authors.lastname: Drake
authors.forename: Tony
authors.initials: T
authors.lastname: Gentry
authors.forename: Andy
authors.initials: A
authors.lastname: Jagoda
authors.forename: Douglas I
authors.initials: DI
authors.lastname: Katz
authors.forename: Jess
authors.initials: J
authors.lastname: Kraus
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Labbate
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Ryan
authors.forename: Molly B
authors.initials: MB
authors.lastname: Sparling
authors.forename: Beverly
authors.initials: B
authors.lastname: Walters
authors.forename: John
authors.initials: J
authors.lastname: Whyte
authors.forename: Ashley
authors.initials: A
authors.lastname: Zapata
authors.forename: George
authors.initials: G
authors.lastname: Zitnay
mesh_terms: D000374:Aggression; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000209:etiology; D001930:Brain Injuries / Q000523:psychology*; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D019964:Mood Disorders / Q000188:drug therapy* / Q000209:etiology; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000209:etiology