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A Man Made Manic: Levodopa-Carbidopa-Induced Mania in Traumatic Brain Injury
Ibrahim M Sablaban1,2, Mauran Sivananthan2
1Department of Psychiatry, Henry Ford Hospital, 1 Ford Pl, 1C, Detroit, MI 48202. isablab1@hfhs.org.
The Primary Care Companion for CNS Disorders
|January 25, 2019
Summary
Traumatic brain injury (TBI) patients may experience mania when treated with levodopa-carbidopa for Parkinson disease. Discontinuing this medication resolved manic symptoms in a TBI patient, highlighting a need for revised treatment guidelines.
Area of Science:
- Neuroscience
- Psychiatry
- Neurology
Background:
- Traumatic brain injury (TBI) is increasingly recognized, particularly concerning chronic traumatic encephalopathy in athletes.
- Mood disorders are prevalent in TBI populations, yet management strategies remain underexplored.
- TBI is linked to Parkinson disease, necessitating dopaminergic agent use and complicating patient management.
Observation:
- A 58-year-old male with a history of TBI presented with mania 15 years post-injury.
- The patient had multiple psychiatric admissions for mood disorders, including bipolar disorder.
- Levodopa-carbidopa, prescribed for an unconfirmed Parkinson disease diagnosis, was identified as a potential trigger for mania.
Findings:
- Discontinuation of levodopa-carbidopa led to the resolution of manic symptoms.
- Literature review indicates a potential link between dopaminergic agents and manic symptoms in TBI patients.
- A biological hypothesis suggests TBI may increase susceptibility to mania with levodopa-carbidopa use.
Implications:
- This case highlights the critical need for careful consideration of dopaminergic agent use in TBI patients with mood disorders.
- Current treatment guidelines for Parkinson disease may require review for patients with a history of TBI.
- Further research is essential to understand and manage the interaction between TBI, dopaminergic agents, and mood disturbances.
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