DeMarchi Ryan, Bansal Vikas, Hung Anthony, Wroblewski Karol, Dua Hemi, Sockalingam Sanjeev, Bhalerao Shree
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Can J Neurol Sci. 2005 Feb;32(1):4-17. doi: 10.1017/s0317167100016826.
Brain injuries are a serious burden of illness to Canada and the US. Advances in managing head trauma have allowed more patients to emerge from decreased levels of consciousness and helped them cope with neurocognitive, neurobehavioural, and neuropsychiatric deficits. In this article, we review the current (1986-2002) evidence surrounding the pharmacological management of arousal states and the aforementioned neurological sequelae of head injury in either acute or chronic conditions. This article will review the evidence for the use of psychostimulants (methylphenidate), antidepressants (amitriptyline, selective serotonin reuptake inhibitors, and buproprion), Parkinson's medications (amantadine, bromocriptine, carbidopa/levodopa), anticonvulsants (valproic acid), modafinil (Provigil), lactate, hyperbaric oxygen chamber, electroconvulsive therapy, and transmagnetic stimulation, in patients following a head injury. The review did not include all anticonvulsants, neuroleptics, beta-blockers, benzodiazepines, azospirones or cognitive enhancers. Unfortunately, the quality of the evidence is generally poor, and sometimes conflicting, which in turn results in indecisive guidelines for treating patients. Accepting the inherent flaws in the evidence we feel that this paper may serve as a stepping-stone for future researchers to improve data gathering that targets neurocognitive, neurobehavioural and neuropsychiatric symptoms following a head injury.
脑损伤给加拿大和美国带来了沉重的疾病负担。头部创伤管理方面的进展使更多患者从意识水平下降中苏醒过来，并帮助他们应对神经认知、神经行为和神经精神方面的缺陷。在本文中，我们回顾了当前（1986 - 2002年）关于在急性或慢性情况下，对觉醒状态以及上述头部损伤的神经后遗症进行药物治疗的证据。本文将回顾使用精神兴奋剂（哌醋甲酯）、抗抑郁药（阿米替林、选择性5-羟色胺再摄取抑制剂和安非他酮）、帕金森病药物（金刚烷胺、溴隐亭、卡比多巴/左旋多巴）、抗惊厥药（丙戊酸）、莫达非尼（普罗维吉尔）、乳酸盐、高压氧舱、电休克疗法和经磁刺激治疗头部受伤患者的证据。该综述未涵盖所有抗惊厥药、抗精神病药、β受体阻滞剂、苯二氮䓬类药物、氮杂螺酮或认知增强剂。不幸的是，证据质量普遍较差，有时甚至相互矛盾，这反过来导致治疗患者的指南犹豫不决。鉴于证据中存在的固有缺陷，我们认为本文可作为未来研究人员改进针对头部受伤后神经认知、神经行为和神经精神症状的数据收集工作的垫脚石。
