From the Research
Introduction to Traumatic Brain Injury (TBI) Medications
Traumatic Brain Injury (TBI) is a complex condition that requires a multifaceted approach to management, including the use of various medications to address different aspects of the injury and its sequelae.
Medications for Seizure Prophylaxis
Antiepileptics
Following a TBI, patients are at risk of developing posttraumatic seizures (PTS). According to guidelines issued by the Brain Trauma Foundation and the American Academy of Neurology (AAN) 1, antiepileptics are recommended for seizure prophylaxis during the first seven days after TBI.
- Phenytoin has been extensively studied and is recommended by the AAN and Brain Trauma Foundation guidelines for early PTS prophylaxis 1.
- Levetiracetam has demonstrated comparable efficacy to phenytoin for early PTS prophylaxis and may be a reasonable alternative, considering its fewer adverse effects and monitoring considerations 1.
- Other antiepileptics like phenobarbital, valproate, and carbamazepine have not been as extensively researched for this indication and may have adverse-effect profiles that make them less favorable options compared to phenytoin 1.
Pharmacologic Therapies in TBI Care
Acute Phase
In the acute phase of TBI, several pharmacologic therapies are utilized, including:
- Tranexamic acid
- Antiepileptics (as discussed for seizure prophylaxis)
- Hyperosmolar agents
- Anesthetics 2
Post-Acute Phase
In the post-acute phase, medications are used to manage various neuropsychological problems and complications, such as:
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for depression and anxiety
- Antipsychotics for psychiatric symptoms
- Zolpidem and amantadine for sleep disorders and cognitive issues, respectively
- Muscle relaxants and botulinum toxin for spasticity management 2, 3
Considerations for Psychotropic Medication Use
Psychotropic medication use is common among TBI survivors, with antidepressants, antipsychotics, and anxiolytics being frequently prescribed 4. The decision to use these medications should be based on individual patient needs and the severity of their TBI, as higher TBI severity is associated with increased odds of psychotropic medication use 4. Additionally, new psychotropic medication use after TBI has been associated with increased odds of late mortality, highlighting the need for careful consideration and monitoring 4.
Neurostimulants for Neurobehavioral Sequelae
Neurostimulants, such as amantadine, methylphenidate, modafinil, and donepezil, may be used to ameliorate symptoms of cognitive deficits, depression, anxiety, and sleep-wake disorders in post-TBI patients 3. However, the use of these agents is guided by patient-specific factors due to the lack of large, well-powered studies validating their use in TBI patients 3.
Conclusion
The management of TBI involves a range of medications aimed at preventing complications, such as seizures, and treating neuropsychological sequelae. The choice of medication should be guided by evidence-based recommendations, patient-specific factors, and careful consideration of potential benefits and risks.