Chew Effie, Zafonte Ross D
Rehabilitation Medicine, Division of Neurology, Department of Medicine, National University Hospital, National University Health System, Singapore.
J Rehabil Res Dev. 2009;46(6):851-79. doi: 10.1682/jrrd.2008.09.0120.
Pharmacological management of neurobehavioral disorders following traumatic brain injury (TBI) is common practice. However, the evidence available to guide this practice remains sparse. This review summarizes, in brief, the state of knowledge, organized via a time continuum from injury as well as by symptom complex. The areas of neuroprotection, hypo-arousal, attention and memory deficits, aggression, agitation, depression, and mania are reviewed. The literature was searched with PubMed on the terms "traumatic brain injury" or "brain injury" with "pharmacology" (and the symptoms according to which this review is arranged). Additional searches were conducted with the specific symptoms as search terms, crossed with the therapeutic agents or drug classes discussed. Where a paucity of prospective data exists, case reports and retrospective studies are included. Studies to date have yielded minimal positive evidence for enhancing function, memory, and behavior after TBI. No single agent likely will become sentinel in the recovery process, and combination therapy in the acute and postacute settings are required. A need exists to further define the role of psychopharmacology in postacute TBI medicine and the specific characteristics of subpopulations who might benefit.
创伤性脑损伤（TBI）后神经行为障碍的药物治疗是常见的做法。然而，可用于指导这种治疗的证据仍然很少。本综述简要总结了相关知识状况，按照从损伤开始的时间顺序以及症状复合体进行组织。对神经保护、低觉醒、注意力和记忆缺陷、攻击行为、激越、抑郁和躁狂等领域进行了综述。使用PubMed以“创伤性脑损伤”或“脑损伤”以及“药理学”（以及根据本综述所安排的症状）为关键词进行文献检索。还以特定症状为检索词进行了额外检索，并与所讨论的治疗药物或药物类别进行交叉检索。在缺乏前瞻性数据的情况下，纳入了病例报告和回顾性研究。迄今为止的研究在改善TBI后的功能、记忆和行为方面几乎没有产生积极证据。在恢复过程中，可能没有单一药物会成为主导药物，在急性期和急性后期需要联合治疗。有必要进一步明确精神药理学在急性后期TBI医学中的作用以及可能受益的亚人群的具体特征。
