Early polyneuropharmacologic intervention in brain injury agitation.

Abstract

To evaluate clinical outcomes observed in the treatment of posttraumatic brain injury agitation with multiple medications. Longitudinal evaluation of effect of treatment intervention on patients admitted to a level 1 trauma center with traumatic brain injury. Eleven adult patients referred for physiatry consultation to manage posttraumatic brain injury agitation were treated with a combination of medications and other agents (antipsychotics and sedatives) were discontinued. The Rancho Los Amigos scale was rated on initial consultation and follow-up, ranging from 1 to 3 wk. All 11 patients demonstrated an average improvement of three Rancho Los Amigos levels within an average treatment duration of 10 days. Simultaneously, 9 of 11 patients were discontinued from treatment and prescribed antipsychotic and sedative agents. The findings suggest that administration of multiple neuropharmacologic agents used early in the treatment of posttraumatic brain injury agitation may be an effective therapeutic intervention in which behavioral and, possibly, cognitive benefits occur. These results were noted as patients were discontinued from other agents more commonly employed in the acute care setting for the treatment of posttraumatic brain injury agitation. Further research is needed to determine the most effective medication combinations and the best time to initiate treatment.