Miller Avery L, Evanson Nathan K, Taylor J Michael
University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
Neural Regen Res. 2024 Aug 1;19(8):1686-1695. doi: 10.4103/1673-5374.389628. Epub 2023 Dec 11.
There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients. Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult patients after traumatic brain injury, but relatively less is known about the effect in pediatric populations. The goal of this review is to identify knowledge gaps in the efficacy and safety of acetylcholinesterase inhibitors as a potential adjuvant treatment for neurocognitive decline in pediatric patients with traumatic brain injury. Investigators queried PubMed to identify literature published from database inception through June 2023 describing the use of donepezil in young adult traumatic brain injury and pediatric patients with predefined conditions. Based on preselected search criteria, 340 unique papers were selected for title and abstract screening. Thirty-two records were reviewed in full after eliminating preclinical studies and papers outside the scope of the project. In adult traumatic brain injury, we review results from 14 papers detailing 227 subjects where evidence suggests donepezil is well tolerated and shows both objective and patient-reported efficacy for reducing cognitive impairment. In children, 3 papers report on 5 children recovering from traumatic brain injury, showing limited efficacy. An additional 15 pediatric studies conducted in populations at risk for cognitive dysfunction provide a broader look at safety and efficacy in 210 patients in the pediatric age group. Given its promise for efficacy in adults with traumatic brain injury and tolerability in pediatric patients, we believe further study of donepezil for children and adolescents with traumatic brain injury is warranted.
对于治疗小儿创伤性脑损伤相关的认知缺陷，药物选择很少。像多奈哌齐这样的乙酰胆碱酯酶抑制剂已在成年创伤性脑损伤患者中进行了评估，但对于其在儿科人群中的效果了解相对较少。本综述的目的是确定乙酰胆碱酯酶抑制剂作为小儿创伤性脑损伤神经认知衰退潜在辅助治疗的疗效和安全性方面的知识空白。研究人员查询了PubMed，以确定从数据库建立到2023年6月发表的描述多奈哌齐在年轻成年创伤性脑损伤和患有预定义疾病的儿科患者中使用情况的文献。根据预先选定的搜索标准，选择了340篇独特的论文进行标题和摘要筛选。在排除临床前研究和项目范围外的论文后，对32篇记录进行了全文审查。在成年创伤性脑损伤方面，我们回顾了14篇论文的结果，这些论文详细介绍了227名受试者，证据表明多奈哌齐耐受性良好，在减轻认知障碍方面显示出客观和患者报告的疗效。在儿童方面，3篇论文报告了5名从创伤性脑损伤中恢复的儿童，显示疗效有限。另外15项针对有认知功能障碍风险人群的儿科研究，对210名儿科年龄组患者的安全性和疗效进行了更广泛的观察。鉴于其在成年创伤性脑损伤患者中的疗效前景以及在儿科患者中的耐受性，我们认为有必要对多奈哌齐用于儿童和青少年创伤性脑损伤进行进一步研究。
