Cheng Jeffrey P, Leary Jacob B, O'Neil Darik A, Meyer Elizabeth A, Free Kristin E, Bondi Corina O, Kline Anthony E
Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, 15213, United States.
Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, 15213, United States; Neurobiology, University of Pittsburgh, Pittsburgh, PA, 15213, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, 15213, United States.
Behav Brain Res. 2018 Feb 26;339:215-221. doi: 10.1016/j.bbr.2017.11.039. Epub 2017 Dec 2.
Agitation and aggression are common sequelae of traumatic brain injury (TBI) and pose a challenge to physicians and other health providers during acute patient care and subsequent neurorehabilitation. Antipsychotic drugs (APDs) are routinely administered to manage TBI patients displaying such maladaptive behaviors despite several clinical and preclinical studies demonstrating that they hinder recovery. A potentially viable alternative to APDs may be the benzodiazepines, which have differing mechanisms of action. Hence, the aim of the study was to test the hypothesis that lorazepam (LOR) would not impede recovery after TBI. Anesthetized adult male rats received a cortical impact or sham injury and then were intraperitoneally administered LOR (0.1mg/kg, 1.0mg/kg, or 2.0mg/kg) or vehicle (VEH; 1mL/kg) commencing 24-h after surgery and once daily for 19days. Motor and cognitive outcomes were assessed on post-operative days 1-5 and 14-19, respectively. No differences were revealed among the four sham control groups and thus they were pooled into one inclusive SHAM group. The SHAMs performed better than all TBI groups on all assessments (p<0.05). Regarding TBI, the 2.0mg/kg LOR group performed better than the VEH and 0.1mg/kg or 1.0mg/kg LOR groups on every task (p<0.05); no differences were observed among the latter three groups on any endpoint (p>0.05). Overall, these preclinical behavioral data support the hypothesis and reveal a therapeutic benefit with the higher dose of LOR. The findings suggest that LOR may be an alternative, to APDs, for controlling agitation without compromising spontaneous recovery and perhaps could afford a dual benefit by also promoting therapeutic efficacy.
躁动和攻击行为是创伤性脑损伤(TBI)常见的后遗症,在急性患者护理及后续神经康复过程中,给医生和其他医疗服务提供者带来了挑战。尽管多项临床和临床前研究表明抗精神病药物(APD)会阻碍恢复,但在治疗表现出此类适应不良行为的TBI患者时,仍经常使用这类药物。苯二氮卓类药物可能是APD的一种潜在可行替代方案,其作用机制不同。因此,本研究的目的是验证氯硝西泮(LOR)不会妨碍TBI后恢复这一假设。成年雄性大鼠在麻醉状态下接受皮层撞击或假手术损伤,然后在术后24小时开始腹腔注射LOR(0.1mg/kg、1.0mg/kg或2.0mg/kg)或赋形剂(VEH;1mL/kg),每天一次,持续19天。分别在术后第1 - 5天和第14 - 19天评估运动和认知结果。四个假手术对照组之间未发现差异,因此将它们合并为一个综合假手术组(SHAM)。在所有评估中,假手术组的表现均优于所有TBI组(p<0.05)。对于TBI组,2.0mg/kg LOR组在各项任务中的表现均优于赋形剂组以及0.1mg/kg或1.0mg/kg LOR组(p<0.05);后三组在任何终点指标上均未观察到差异(p>0.05)。总体而言,这些临床前行为学数据支持了该假设,并揭示了高剂量LOR的治疗益处。研究结果表明,LOR可能是一种替代APD的药物,用于控制躁动且不影响自发恢复,或许还能通过提高治疗效果带来双重益处。