What is the Cephalon (head)

From the Guidelines

The CCHR is the most appropriate clinical decision tool for managing adult patients presenting to the emergency department with mild traumatic brain injury, as it has been shown to have high sensitivity and specificity for predicting the need for neurosurgical intervention and clinically important brain injury 1.

Key Points

• The CCHR has been validated in multiple studies, including a Class II study by Stiell et al, which demonstrated a sensitivity of 100% and specificity of 68.7% for predicting the need for neurologic intervention 1.
• The CCHR has been compared to other clinical decision tools, such as the NOC and NEXUS Head CT, and has been shown to have improved specificity and similar sensitivity for predicting clinically important brain injury 1.
• The use of the CCHR can help reduce unnecessary CT scans and improve patient outcomes by identifying high-risk patients who require neurosurgical intervention or close monitoring 1.

Clinical Decision Making

• The CCHR should be used in conjunction with clinical judgment and patient history to determine the need for CT imaging in patients with mild traumatic brain injury 1.
• Patients with a GCS score of 15 and no high-risk factors, as defined by the CCHR, can be safely discharged without CT imaging, while those with high-risk factors should undergo CT imaging to rule out clinically important brain injury 1.
• The CCHR can also be used to identify patients who are at high risk for significant intracranial injury, such as those on anticoagulant or antiplatelet medications, and who may require closer monitoring or more aggressive management 1.

From the Research

Cephalon and Modafinil

• Cephalon is a pharmaceutical company that developed modafinil, a wake-promoting agent used to treat excessive daytime sleepiness (EDS) in various conditions, including narcolepsy, shift work sleep disorder, and obstructive sleep apnea/hypopnea syndrome 2, 3.
• Modafinil has been shown to be effective in reducing EDS in patients with narcolepsy, with studies demonstrating significant improvements in symptoms such as sleep attacks and somnolence 4, 5.
• The drug has also been used off-label to treat fatigue and EDS associated with other neurological disorders, including Parkinson's disease, multiple sclerosis, and traumatic brain injury, although the evidence for its effectiveness in these conditions is inconsistent 6.

Mechanism of Action and Safety

• Modafinil's mechanism of action is thought to involve the modulation of hypocretin, histamine, epinephrine, gamma-aminobutyric acid, and glutamate, although the exact mechanisms are not fully understood 3.
• The drug has been shown to be well-tolerated, with a low propensity for abuse and a favorable side-effect profile compared to other stimulants 2, 3.
• Common adverse events associated with modafinil include nausea, insomnia, and headache, although these are generally mild and transient 6, 5.

Clinical Uses and Efficacy

• Modafinil has been approved by the US Food and Drug Administration (FDA) for the treatment of narcolepsy, shift work sleep disorder, and obstructive sleep apnea/hypopnea syndrome 3.
• The drug has also been used to treat attention-deficit disorder, postanesthetic sedation, and cocaine dependence and withdrawal, although the evidence for its effectiveness in these conditions is limited 3.
• Modafinil's efficacy in reducing EDS and improving quality of life has been demonstrated in several clinical trials, including a systematic review and meta-analysis of its use in narcolepsy 5.