Sami Musa Basseer, Faruqui Rafey
1Canterbury and Coastal Community Mental Health Team,41 Old Dover Road,Canterbury,Kent,CT1 3HU,UK.
2Consultant Neuropsychiatrist,St Andrew's Healthcare,Northampton,UK.
Acta Neuropsychiatr. 2015 Dec;27(6):317-26. doi: 10.1017/neu.2015.17. Epub 2015 Apr 8.
Traumatic brain injury and stroke are among the leading causes of neurological disability worldwide. Although dopaminergic agents have long been associated with improvement of neuropsychiatric outcomes, to date much of the evidence to date has been in case reports and case series or open label trials.
We undertook a systematic review of double-blinded randomised controlled trials (RCT) to determine the effect of dopaminergic agents on pre-defined outcomes of (a) apathy; (b) psychomotor retardation; (c) behavioural management and (d) cognitive function. Databases searched were: Medline, EMBASE, and PsychInfo for human studies. The Cochrane Clinical Trials Database and the TRIP Medical database were also searched. All identified studies, were further hand-searched.
We identified six studies providing data on 227 participants, 150 of whom received dopaminergic therapy. Trials were compromised by cross-over design, inadequate wash out period, small numbers and heterogeneous outcome measures. However one good quality RCT demonstrates the efficacy of amantadine in behavioural management. One further RCT shows methylphenidate-levodopa is efficacious for mood post-stroke. One study shows rotigotine to improve hemi-inattention caused by prefrontal damage.
Our systematic review demonstrates an evolving evidence base to suggest some benefits in agitation and aggression, mood and attentional deficits. However, there are key limitations of the studies undertaken to date involving small numbers of participants, heterogeneous outcome measures, and variable study designs. There is a need for on-going large prospective double-blind RCTs in these medications using standardised criteria and outcomes to fully understand their effectiveness in this patient group.
创伤性脑损伤和中风是全球神经功能残疾的主要原因之一。尽管多巴胺能药物长期以来一直与神经精神预后的改善相关，但迄今为止，大部分证据来自病例报告、病例系列或开放标签试验。
我们对双盲随机对照试验（RCT）进行了系统评价，以确定多巴胺能药物对以下预定义结局的影响：（a）冷漠；（b）精神运动迟缓；（c）行为管理；（d）认知功能。检索的数据库包括：用于人类研究的Medline、EMBASE和PsychInfo。还检索了Cochrane临床试验数据库和TRIP医学数据库。对所有识别出的研究进行了进一步的手工检索。
我们识别出六项研究，涉及227名参与者，其中150名接受了多巴胺能治疗。试验因交叉设计、洗脱期不足、样本量小和结局测量指标异质性而受到影响。然而，一项高质量的RCT证明金刚烷胺在行为管理方面的疗效。另一项RCT表明甲基苯丙胺-左旋多巴对中风后的情绪有效。一项研究表明罗替戈汀可改善前额叶损伤引起的半侧空间忽视。
我们的系统评价表明，越来越多的证据表明在激越、攻击、情绪和注意力缺陷方面有一些益处。然而，迄今为止所进行的研究存在关键局限性，包括参与者数量少、结局测量指标异质性以及研究设计多变。需要使用标准化标准和结局对这些药物进行持续的大型前瞻性双盲RCT，以充分了解它们在该患者群体中的有效性。
