title: Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice.
abstract: 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…
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  The choice of treatment depends on the level of evidence, target symptoms, custom objectives, clinical experience and caution strategies.
authors.affiliation: Department of Physical Medicine and Rehabilitation (PM&R), Neurological Rehabilitation, Renée-Sabran Hospital, University Hospital of Lyon, boulevard Édouard-Herriot, 83400 Hyères, France. Electronic address: david.plantier@chu-lyon.fr.
authors.forename: D
authors.initials: D
authors.lastname: Plantier
authors.affiliation: Physical Medicine and Rehabilitation, Neurological Rehabilitation, Henry-Gabrielle Hospital, University Hospital of Lyon, 69230 Saint-Genis-Laval, France; Neuroscience Research Center of Lyon (CRNL) IMPACT team, Inserm U1028, CNRS, UMR5292, 69500 Bron, France.
authors.forename: J
authors.initials: J
authors.lastname: Luauté
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000547:Amantadine / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D001930:Brain Injuries / Q000523:psychology*; D032921:Consensus; D015259:Dopamine Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005602:France; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D015259:Dopamine Agents; D001569:Benzodiazepines; D000547:Amantadine
keywords: Amantadine; Antidepressants; Behavioral disorders; Benzodiazepines; Beta-blockers; Mood stabilizers; Neuroleptics; Traumatic brain injury