Pharmacological enhancement of cognitive and behavioral deficits after traumatic brain injury

To provide the clinician with a reasonable overview of the modern pharmacological alternatives to treat the cognitive and behavioral sequels of traumatic brain injury.

Original research in this area is sparse and more than half of the articles published on the subject recently have been reviews. Of the three randomized controlled trials, one studied methylphenidate (n = 18), one methylphenidate and sertraline (n = 30) and one amantadine (n = 27). All these studies reported beneficial effects on various cognitive measures, but because of the study protocols, the evidence provided may be questioned. The various reviews, uncontrolled studies and case reports suggest that at least psychostimulants, cholinergic agents, dopaminergic agents and antidepressants may be beneficial in treating the cognitive and behavioral symptoms of traumatic brain injury.

The clinician trying to ameliorate the cognitive and behavioral symptoms of traumatic brain injury has to make decisions about pharmacotherapy that are still based mainly on clinical experience. Large randomized controlled trials giving high-quality evidence are so far missing. This review discusses the problems facing both the clinician and the scientist treating the cognitive and behavioral sequels of traumatic brain injury. A symptom-based approach is suggested for current practice.