Wolf A P, Gleckman A D
Connecticut Subacute Corporation, Waterbury, CT, USA.
Brain Inj. 1995 Jul;9(5):487-93. doi: 10.3109/02699059509008208.
During the past decade the usage of dopaminergic agonists for the brain-injured population has become a more common treatment option during both the acute and subacute phases of recovery. We attempted to use Sinemet to address the functional limitations of a 74-year-old woman who was 7 months status post-traumatic brain injury secondary to a motor vehicle accident. The patient was administered a 3-month trial of Sinemet while continuing to receive structured sensory stimulation. Her baseline performance using Rappaport's Coma/Near-Coma (CNC) scale yielded a score in the moderate coma range. Weekly evaluations were conducted throughout the drug trial period using the CNC scale. Although the patient displayed modest improvement in her total score, functional change was negligible. Long-term follow-up suggested an absence of retention of earlier gains obtained on the CNC scale. The authors suggest that flawed research methodologies, heterogeneous patient populations, and potential difficulties obtaining reliable dependent measures makes the interpretation of brain injury research findings equivocal. However, given the many limitations, the current research design suggested that the long-term practical utility of Sinemet was unremarkable. Suggestions for future pharmacological research designs with the brain-injured population are discussed.
在过去十年中，多巴胺能激动剂在脑损伤患者康复的急性期和亚急性期的应用已成为一种更为常见的治疗选择。我们尝试使用息宁来解决一名74岁女性的功能受限问题，该女性在因机动车事故导致创伤性脑损伤后已处于7个月的恢复状态。患者在持续接受结构化感觉刺激的同时，接受了为期3个月的息宁试验。她使用拉帕波特昏迷/近昏迷（CNC）量表的基线表现得分为中度昏迷范围。在整个药物试验期间，每周使用CNC量表进行评估。尽管患者的总分有适度改善，但功能变化微乎其微。长期随访表明，在CNC量表上早期获得的改善并未持续。作者认为，有缺陷的研究方法、异质性患者群体以及获得可靠的相关测量指标的潜在困难，使得脑损伤研究结果的解释模棱两可。然而，鉴于诸多局限性，目前的研究设计表明息宁的长期实际效用并不显著。文中还讨论了针对脑损伤患者未来药理学研究设计的建议。
