title: Challenging behaviour and sleep cycle disorder following brain injury: a preliminary response to agomelatine treatment.
abstract: BACKGROUND
  Sleep disturbances are common after acquired brain injury. Sedatives can exacerbate behavioural disorders.
  
  
  OBJECTIVE
  This study reports the case of a severely brain damaged man (TM) who developed a non-24 hour sleep cycle disorder that was effectively managed by the administration of a melatonin receptor agonist, agomelatine.
  
  
  METHODS
  TM suffered significant brain damage as a result of a large subarachnoid haemorrhage of his right anterior cerebral artery complicated by midline shift and subsequent infarction of his left middle cerebral artery. In addition to challenging behaviour and cognitive impairment, TM presented with a recurrent disturbed sleep-wake pattern that significantly worsened his quality-of-life. He was diagnosed as suffering of non-24 hour sleep-wake disorder. Challenge was recorded using the Overt Aggression Scale Modified for Neuro-Rehabilitation (OASMNR).
  
  
  RESULTS
  Typical hypnotics had no or ill effects. Agomelatine prescription (25 mg) led to significant OASMNR and sleep efficiency change with effects apparent at 1.5 years later.
  
  
  CONCLUSIONS
  Administration of the melatonin receptor (MT₁ and MT₂) agonist agomelatine each night resulted in an immediate and sustained improvement on sleep and on indices of challenging behaviour.
authors.affiliation: Brain Injury Rehabilitation Trust , Glasgow , UK .
authors.forename: B
authors.initials: B
authors.lastname: O'Neill
authors.forename: M
authors.initials: M
authors.lastname: Gardani
authors.forename: G
authors.initials: G
authors.lastname: Findlay
authors.forename: T
authors.initials: T
authors.lastname: Whyte
authors.forename: T
authors.initials: T
authors.lastname: Cullen
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D001930:Brain Injuries / Q000523:psychology*; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008550:Melatonin / Q000819:agonists*; D001523:Mental Disorders / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D011788:Quality of Life; D020178:Sleep Disorders, Circadian Rhythm / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D009281:Naphthalenes
chemical_list: D000081:Acetamides; D006993:Hypnotics and Sedatives; D008550:Melatonin; C084711:agomelatine; D009281:Naphthalenes