Article

OBJECTIVE: There are no handbook or recommendations for the use of
pharmacological agents to treat neurobehavioral disorders after traumatic brain
injury (TBI). This work proposes a systematic review of the literature and a user
guide on neuroleptics, antidepressants, beta-blockers, mood stabilizers and other
medications for irritability, aggressiveness, agitation, impulsivity, depression,
apathy... METHOD: Steering, working and reading groups (62 people) were formed
under the control of the French High Authority for Health (HAS) in collaboration
with the SOFMER scientific society (French Society of Physical and Rehabilitation
Medicine). Articles were searched by HAS officers in the Medline database from
1990 to 2012, crossing TBI and pharmacological agents. The HAS method to select,
read and analyze papers is close to the PRISMA statements. RESULTS: Out of 772
references, 89 were analyzed, covering a total of 1306 people with TBI. There is
insufficient evidence to standardize drug treatments for these disorders. There
are however some elements to establish consensus recommendations for good
clinical practice. Propranolol can improve aggression (B grade). Carbamazepine
and valproate seem effective on agitation and aggression and are recommended as
first line treatment (Expert Consensus [EC]). There is no evidence of efficacy
for neuroleptics. Their prescription is based on emergency situation for a crisis
(loxapine) but not for long-term use (EC). Antidepressants are recommended to
treat depression (EC) with a higher standard of proof for Selective Serotonin
Reuptake Inhibitors (SSRI, grade B). Other products are described. CONCLUSION:
The choice of treatment depends on the level of evidence, target symptoms, custom
objectives, clinical experience and caution strategies.
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Langue : ANGLAIS