Role of bromocriptine in multi-spectral manifestations of traumatic brain injury.
OBJECTIVE
Despite the prevalence and cost of traumatic brain injury related disabilities, there is paucity in the literature on modern approaches to pharmacotherapy. Medications may promote recovery by enhancing some neurological functions without impacting others. Herein we discussed the role of bromocriptine in neurorehabilitation for patients with traumatic brain injury.


METHODS
A cohort comprising of 36 selective nonsurgical cases of traumatic brain injury in minimally conscious state were enrolled in the study. After hemodynamic stability, bromocriptine was given at paediatric dose of 3.75 mg/d and adult dose of 7.5 mg/d. It was administered through a naso-gastric (NG) feeding tube in the patients with minimally conscious state, then changed to oral route after proper swallowing and good gag reflex were ensured in the patient. The drug was slowly reduced over three weeks after neurological improvement in the patients. Positive result was determined by improved GCS score of 2 and motor power by at least 1 British Medical Council (BMC) motor score. Improvement of deficits was evaluated in terms of fluency of speech for aphasia, task switching, digit span double tasking and trail-making test for cognition and attention, and functional independence measure score for motor functioning and self-independence.


RESULTS
Accelerated arousal was seen in 47.0% of cases (8/17) in 4-40 days. In 41.2% of cases (7/17), Glasgow outcome score (GOS) was improved to 4/5 in 90 days. Improvement in hemiparesis by at least 1 BMC score was seen in 55.6% of cases (5/9) in 40 days. Aphasia was improved in 80% of cases (4/5) in 7-30 days. Moderate improvement in cognitive impairment was seen in 66.7% of cases (2/3) in 14-20 days. Improvement in memory was observed in 50% of cases (1/2) in over 30 days. No cases were withdrawn from the study because of adverse reactions of the drug. There was no mortality in the study group.


CONCLUSIONS
Bromocriptine improves neurological sequelae of traumatic brain injury as well as the overall outcome in the patients. If medication is given to promote recovery and treat its associated disabilities, clinicians should thoroughly outline the goals and closely monitor adverse effects.
Department of Neurosurgery, College of Medical Sciences, Bharatpur, Nepal. Electronic address: sunilmunakomi@gmail.com.
Sunil
S
Munakomi
Department of Neurosurgery, College of Medical Sciences, Bharatpur, Nepal.
Binod
B
Bhattarai
Department of Neurosurgery, College of Medical Sciences, Bharatpur, Nepal.
Bijoy
B
Mohan Kumar
D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000188:drug therapy*; D001971:Bromocriptine / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D015600:Glasgow Coma Scale; D006801:Humans; D009017:Morbidity; D015599:Trauma Severity Indices
D001971:Bromocriptine
Brain injuries, traumatic; Bromocriptine; Rehabilitation