Amanda R Rabinowitz1, Thomas K Watanabe. 1. Moss Rehabilitation Research Institute, MossRehab, Albert Einstein Healthcare Network, Elkins Park, Pennsylvania, and Department of Physical Medicine and Rehabilitation, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Rabinowitz); and Drucker Brain Injury Center, MossRehab, Albert Einstein Healthcare Network, Elkins Park, Pennsylvania, and Department of Physical Medicine and Rehabilitation, Temple University School of Medicine, Philadelphia, Pennsylvania (Dr Watanabe).
Abstract
OBJECTIVES: Cognitive and neuropsychiatric symptoms are extremely common following mild traumatic brain injury (TBI), also known as concussion. Although most patients will recovery rapidly, a significant minority go on to experience persistent symptoms. There are currently no FDA-approved medications for treatment of cognitive and neuropsychiatric problems in the context of mild TBI, yet a number of agents are prescribed "off-label" for these complaints. Rigorous trials are lacking, but there are a number of open-label studies, and some small randomized controlled trials that support the safety and possible efficacy of pharmacotherapies in this population. Clinical trials conducted in samples with more severe brain injuries can also serve as a guide. METHODS: Review of the literature. RESULTS & CONCLUSIONS: There is the most support in the literature for the neurostimulant methylphenidate for treatment of mild TBI-related cognitive dysfunction, and the selective serotonin reuptake inhibitor, sertraline, for the treatment of postinjury depression. There is clearly a need for more well-designed studies to guide clinicians in selecting the appropriate medication and dose. Without clear guidance from the literature, a cautious approach of starting low and titrating slowly is recommended.
OBJECTIVES: Cognitive and neuropsychiatric symptoms are extremely common following mild traumatic brain injury (TBI), also known as concussion. Although most patients will recovery rapidly, a significant minority go on to experience persistent symptoms. There are currently no FDA-approved medications for treatment of cognitive and neuropsychiatric problems in the context of mild TBI, yet a number of agents are prescribed "off-label" for these complaints. Rigorous trials are lacking, but there are a number of open-label studies, and some small randomized controlled trials that support the safety and possible efficacy of pharmacotherapies in this population. Clinical trials conducted in samples with more severe brain injuries can also serve as a guide. METHODS: Review of the literature. RESULTS & CONCLUSIONS: There is the most support in the literature for the neurostimulant methylphenidate for treatment of mild TBI-related cognitive dysfunction, and the selective serotonin reuptake inhibitor, sertraline, for the treatment of postinjury depression. There is clearly a need for more well-designed studies to guide clinicians in selecting the appropriate medication and dose. Without clear guidance from the literature, a cautious approach of starting low and titrating slowly is recommended.
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