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Review of Awakening Agents

Published online by Cambridge University Press:  02 December 2014

Ryan DeMarchi ,
Vikas Bansal ,
Anthony Hung ,
Karol Wroblewski ,
Hemi Dua ,
Sanjeev Sockalingam  and
Shree Bhalerao
Ryan DeMarchi
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Vikas Bansal
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Anthony Hung
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Karol Wroblewski
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Hemi Dua
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Sanjeev Sockalingam
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Shree Bhalerao
Affiliation:
Medical Psychiatry Services, St. Michael’s Hospital, University of Toronto, Ontario, Canada
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Abstract:

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Brain injuries are a serious burden of illness to Canada and the US. Advances in managing head trauma have allowed more patients to emerge from decreased levels of consciousness and helped them cope with neurocognitive, neurobehavioural, and neuropsychiatric deficits. In this article, we review the current (1986-2002) evidence surrounding the pharmacological management of arousal states and the aforementioned neurological sequelae of head injury in either acute or chronic conditions. This article will review the evidence for the use of psychostimulants (methylphenidate), antidepressants (amitriptyline, selective serotonin reuptake inhibitors, and buproprion), Parkinson’s medications (amantadine, bromocriptine, carbidopa/levodopa), anticonvulsants (valproic acid), modafinil (Provigil), lactate, hyperbaric oxygen chamber, electroconvulsive therapy, and transmagnetic stimulation, in patients following a head injury. The review did not include all anticonvulsants, neuroleptics, beta-blockers, benzodiazepines, azospirones or cognitive enhancers. Unfortunately, the quality of the evidence is generally poor, and sometimes conflicting, which in turn results in indecisive guidelines for treating patients. Accepting the inherent flaws in the evidence we feel that this paper may serve as a stepping-stone for future researchers to improve data gathering that targets neurocognitive, neurobehavioural and neuropsychiatric symptoms following a head injury.

Résumé:

RÉSUMÉ:

Les traumatismes cÉrÉbraux constituent un lourd fardeau au Canada et aux États-Unis. Les progrès dans la prise en charge des traumatismes crâniens ont permis à plus de patients d’Émerger d’un niveau de conscience altÉrÉ et les ont aidÉ à s’adapter à des dÉficits neurocognitifs, neurocomportementaux et neuropsychiatriques. Dans cet article nous revoyons les donnÉes publiÉes depuis 1986 sur le traitement pharmacologique d’un État de conscience altÉrÉ et des sÉquelles neurologiques des traumatismes crâniens mentionnÉs prÉcÉdemment, en phase aiguë ou chronique. Cet article revoit les donnÉes appuyant l’utilisation de psychostimulants (mÉthylphÉnidate), d’antidÉpresseurs (amitriptyline, inhibiteurs sÉlectifs de la recaptation de la sÉrotonine et bupropion), d’anti-parkinsoniens (amantadine, bromocriptine, carbidopa/lÉvodopa), d’anticonvulsivants (acide valproïque) de modafinil (Provigil), de lactate, d’oxygÉnothÉrapie hyperbare, d’Électrochocs et de stimulation magnÉtique trans-crânienne chez des traumatisÉs crâniens. Nous n’avons pas inclus l’utilisation de tous les anticonvulsivants, de tous les neuroleptiques, bêtabloquants, benzodiazÉpines, azospirones ou facilitateurs cognitifs. Malheureusement, la qualitÉ des donnÉes est gÉnÉralement mÉdiocre et parfois elles sont contradictoires, ce qui donne lieu à des lignes directrices ambiguës quant au traitement de ces patients. Le fait de reconnaître les lacunes de ces donnÉes peut servir de prÉmices à une amÉlioration dans la collecte des donnÉes sur les symptômes neurocognitifs, neurocomportementaux et neuropsychiatriques chez les traumatisÉs crâniens.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 1 , February 2005 , pp. 4 - 17
Copyright
Copyright © The Canadian Journal of Neurological 2014

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