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Medications for TBI Victims by Charles Watson


Posted on March 30, 2020

 TBI has a dramatic and wide-ranging effect on the quality of life of the survivor. Those who do survive TBI often experience anxiety, agitation, memory impairments as well as behavioral changes. The management of immediate and long term consequences of such injuries requires physicians to usually rely on a variety of pharmacological options.

These include psychostimulants, anticonvulsants, motor system medications, antidepressants and pain management medications. These and other rehab therapies can help in managing the neurocognitive, neurobehavioral and neuropsychiatric sequelae of injury to the brain. 

With the advancement in the management of TBIs, an estimated 2.5 to 6.5 million Americans survive and are living with residual neurological impairments. Neuropsychiatric symptoms present as mood disorders, PTSD and personality changes characterized by egocentricity and disinhibition. Neurocognitive injuries vary but frequently involve impaired memory skills, attention span and executive functioning. Neurobehavioral deficits may present as irritability, nervousness, poor impulse control, hyperexcitability, aggression, restlessness and agitation. 

Depending on the area of the brain affected, damage can occur in a variety of neurotransmitter networks that regulate the release of two important chemicals mainly acetylcholine and norepinephrine. Selecting the most appropriate medications involves a careful study of the underlying lesion, the neurological disabilities presented and the time elapsed since the injury.

Anticonvulsants

These medications are used to suppress the rapid and excessive firing of neurons that start a seizure. 

Examples include Sodium Valproate, gabapentin, topiramate and carbamazepine has been demonstrated to control generalized tonic-clonic seizures, bipolar disorder, panic attacks, aggression and can act as mood stabilizers.

Anti-Depressants

These work by restoring the brain’s natural chemical messengers, called, neurotransmitters, and adjust the brain’s response to them. Examples: citalopram, amitriptyline, paroxetine and sertraline. 

Antidepressants can help with OCD, panic disorders, depression, agitation, Bulimia (eating disorder) and anxiety. 

Anti-psychotic medications

This class of drugs are used to treat psychosis and other emotional and mental conditions. The most frequently used drug in this class is quetiapine. 

It is effective in treating symptoms like agitation and aggression, psychotic disorders, sleep disturbances, Schizophrenia and Tourette syndrome.

Motor system Medications or Anti-Parkinsonian drugs

This class of drugs act on the motor system to affect the chemical balance in the brain to control bodily movement. Amantadine and levodopa, combined with carbidopa, serve to increase the dopamine levels in the brain. 

Examples baclofen, tizanidine or cyclobenzaprine has a positive effect in controlling muscle spasms, muscle spasticity leading to improvement in motivation levels, increased alertness and functioning, reduced anxiety.

Memory and Cognition Medications

These medications act by blocking enzymes in the brain to treat conditions like dementia, Alzheimer’s, AHDH and hyperactivity. The drugs may help improve awareness, memory, mood, work performance, alertness and take part in everyday life.

Examples include donepezil, modafinil and methylphenidate.

Pain management medications

Pain stemming from TBI and the symptoms and effects related to the injury can be treated by analgesics like acetaminophen, ibuprofen, and naproxen sodium. 

This can be used to treat Arthralgia- joint pain, myalgia- muscle pain, and mild to moderate headaches and fever. Narcotics should be avoided in TBI cases for managing pain.

However, overuse or misuse of any of the above drugs can have serious side effects. Also, these drugs should not be discontinued abruptly without the knowledge of your health care provider.