Noradrenergic agonists for acute traumatic brain injury

Although there have been considerable gains in understanding the cascade of events that lead to secondary injury after traumatic brain injury (TBI), efforts to translate this understanding into new therapeutic, so-called neuroprotective, approaches have so far proven disappointing. Animal models suggest an alternative strategy: agents enhancing monoaminergic transmission, particularly amphetamines, have been shown to promote motor recovery from focal brain injury and it has been suggested that this might represent a complementary means of therapeutic intervention in the later post-injury phase.

To evaluate the evidence that amphetamines improve final outcome after traumatic brain injury.

We searched MEDLINE, EMBASE, Science Citation Index, Cochrane Controlled Trials Register and the Cochrane Injuries Group's Specialised Register of Controlled Trials. Researchers and authors of published trials were also contacted.

Randomised controlled trials comparing the use of a noradrenergic agonist (together with conventional non-pharmacological rehabilitative therapy) versus conventional non-pharmacological rehabilitative therapy alone.

Two reviewers independently screened records, extracted data and assessed trial quality.

Although there is a limited clinical literature addressing this topic, none of the studies identified fully meets inclusion criteria for this review.

At present there is insufficient evidence to support the routine use of methylphenidate or other amphetamines to promote recovery from TBI.