Summary

  1. There is Level 1a evidence that opioid administration results in increased intracranial pressure and in decreased mean arterial pressure. Evidence regarding cerebral perfusion pressure, however, is conflicting.
     
  2. Based on a single RCT, there is Level 2 evidence that administering an opioid prior to administering a hypnotic agent leads to more rapid arousal.
     
  3. There is Level 4 evidence that carbamazepine has no effect on cognitive performance post TBI.
     
  4. There is Level 4 evidence that carbamazepine may decrease the incidence of aggressive behaviours following a TBI.
     
  5. There is Level 4 evidence that intramuscular midazolam can be used for acute seizure cessation.
     
  6. There is Level 1b evidence to suggest levetiracetam is as safe and effective as phenytoin in treatment and prevention of seizures in individuals in the intensive care unit post ABI.
     
  7. There is Level 1b evidence that anticonvulsants given during the first 24 hours post ABI reduce the occurrence of early seizures (within the first week post injury).
     
  8. There is Level 1a evidence that anticonvulsants given shortly after the onset of injury do not reduce mortality or persistent vegetative state or the occurrence of late seizures (past the first week post injury).
     
  9. There is Level 1a evidence that seizure prophylactic treatment with phenytoin or valproate results in similar incidences of early or late seizures and similar mortality rates.
     
  10. There is Level 2 evidence indicating that phenobarbital given post ABI does not reduce the risk of late seizures.
     
  11. There is Level 4 evidence that valproic acid decreases the incidence of aggressive behaviours.
     
  12. There is Level 4 evidence that divalproex decreases the incidence of agitation post TBI.
     
  13. There is limited Level 4 evidence to suggest that lamotrigine helps to reduce inappropriate behaviours post TBI. More research is needed, with a greater number of subjects, to validate these findings.
     
  14. There is Level 4 evidence that cerebrolysin improves attention and memory function post ABI, as well as clinical outcome.
     
  15. Based on a single RCT, there is Level 1b evidence that donepezil improves attention and short-term memory post ABI.
     
  16. Based on two non-RCTs, there is Level 4 evidence that donepezil is effective in improving short-, long-term, and visual memory post ABI.
     
  17. Based on a single RCT, there is Level 1b evidence that oral physostigmine improves long-term memory in men with TBI.
     
  18. There is conflicting evidence that sertraline is effective in the treatment of major depression post TBI.
     
  19. There is Level 2 evidence that citalopram aids in the reduction of depression post ABI.
     
  20. There is Level 4 evidence that citalopram and carbamazepine may be efficacious in the treatment of depression, anxiety and mood disorders.
     
  21. There is Level 2 evidence to suggest that the administration of desipramine assists in improving mood and reducing depression.
     
  22. There is Level 4 evidence that sertraline HCl can decrease the incidence of aggression and irritability.
     
  23. There is Level 4 evidence that amitriptyline can be useful in reducing the incidence of agitated behaviour.
     
  24. There is Level 4 evidence to suggest that an antimanic agent (lithium carbonate) reduces aggressive/agitated behaviour following a brain injury.
     
  25. There is Level 4 evidence to suggest that quetiapine helps reduce aggressive behaviour.
     
  26. There is Level 4 evidence from one study to suggest that ziprasidone assists in the controlling of agitation post TBI.
     
  27. There is Level 4 evidence that haloperidol does not have a negative effect on the success of rehabilitation. 
     
  28. There is Level 4 evidence that administration of a single-dose droperidol calms agitated patients with ABI more quickly than other agents.
     
  29. There is Level 4 evidence that phenol nerve blocks reduce contractures and spasticity at the elbow, wrist and finger flexors for up to five months post injection.
     
  30. There is Level 4 evidence that oral baclofen improves lower extremity spasticity but not upper extremity spasticity.
     
  31. There is Level 2 evidence that botulinum toxin type A injections are effective in the management of localized spasticity following ABI.
     
  32. There is Level 1b evidence to suggest that patients receiving botulinum toxin type A through a single motor point or through multisite distributed injections both show a reduction in spasticity regardless of the drug administration method.
     
  33. Based on a single RCT, there is Level 1b evidence that bolus intrathecal baclofen injections produce short-term (up to six hours) reductions in upper and lower extremity spasticity.
     
  34. There is Level 4 evidence to suggest that prolonged intrathecal baclofen results in longer-term (three months, and one year) reductions in spasticity in both the upper and lower extremities following an ABI. 
     
  35. There is Level 4 evidence, from two studies, to suggest that intrathecal baclofen results in short-term improvements in walking performance, particularly gait velocity, stride length, and step width.
     
  36. There is Level 2 evidence that pentobarbital is not effective for intracranial pressure management. 
     
  37. Based on a single RCT, there is Level 2 evidence that pentobarbital is no better than mannitol for the control of elevated intracranial pressure.
     
  38. Based on two case control studies, there is Level 3 evidence that barbiturate therapy may lead to adrenal insufficiency, reversible leukopenia and granulocytopenia.
     
  39. Based on a single prospective controlled study, there is Level 2 evidence that barbiturates confer metabolic benefits.
     
  40. Based on a single prospective controlled study, there is Level 2 evidence that a combination of barbiturate therapy and hypothermia may result in improved clinical outcomes up to 1 year post injury.
     
  41. There is Level 2 evidence that Disodium Etidronate reduces the development of heterotopic ossification in patients with severe head injury.
     
  42. There is Level 1b evidence, based on a large RCT, that dexanabinol does not provide improvements in intracranial pressure during the acute phase or in long-term clinical benefits post ABI; however, this conflicts with Level 1b evidence from a small RCT that has shown its effectiveness.
     
  43. There is Level 1b evidence that treatment with KN38-7271 provides some aid in managing acute ABI by increasing cerebral perfusion pressure levels.
     
  44. Based on a single RCT, there is Level 1b evidence that pindolol decreases aggression following brain injury.
     
  45. There is Level 1b evidence that propranolol reduces the intensity of agitated symptoms following brain injury.
     
  46. Based on a single RCT, there is Level 1b evidence that sodium lactate is more effective than mannitol for the management of acute elevations in intracranial pressure post ABI.
     
  47. There is Level 2 evidence that higher dose mannitol is superior to conventional dose mannitol in improving acute control, mortality rates and clinical outcomes.
     
  48. There is Level 1b evidence that early out-of-hospital administration of mannitol does not adversely affect blood pressure.
     
  49. There is Level 4 evidence that mannitol is effective in diminishing intracranial hypertension only when initial intracranial pressure values are elevated.
     
  50. There is Level 1b evidence that pramipexole, and Level 1a evidence that amantadine, are effective in improving levels of consciousness in children with ABI.
     
  51. Based on a single RCT, there is Level 1b evidence that amantadine improves levels of consciousness and cognitive function in adult patients in various stages of coma.
     
  52. There is Level 2 evidence that Amantadine does not help to improve learning and memory deficits.
     
  53. There is Level 4 evidence that dopamine-enhancing drugs may accelerate the rate of recovery from a low response state for children post TBI.
     
  54. Based on two RCTs, there is conflicting evidence supporting the use of bromocriptine to enhance cognitive functioning. 
     
  55. There is Level 4 evidence that bromocriptine improves all motivational deficits except mood.
     
  56. There is Level 2 evidence based on three RCTs that administration of dexamethasone inhibits endogenous production of glucocorticoids and has no proven impact on recovery post brain injury.
     
  57. There is Level 4 evidence that Depo-Provera and counselling reduces sexually aggressive behaviour.
     
  58. Based on four RCTs, there is conflicting evidence as to the effectiveness of progesterone on functional outcomes post ABI.
     
  59. There is conflicting evidence whether progesterone improves mortality in patients with ABI.
     
  60. There is conflicting evidence regarding the effectiveness of the administration of methylphenidate following brain injury for the improvement of cognitive functioning.
     
  61. There is Level 1a evidence that methylphenidate improves reaction time of working memory.
     
  62. Based on a single RCT, there is Level 1b evidence that an individual’s response to methylphenidate therapy may be dependent on his/her genotype of the catechol-O-methyltransferase gene.
     
  63. Based on one prospective controlled trial, there is Level 2 evidence that methylphenidate does not have an adverse effect on the sleep-wake cycle of those who have sustained a TBI.
     
  64. Based on two small and conflicting RCTs, there is inconclusive evidence whether methylphenidate improves cognitive behavioural function in children post ABI.
     
  65. There is Level 1a evidence that modafinil is not effective in treating fatigue but has been shown to be effective short-term in treating excessive daytime sleepiness post ABI.
     
  66. There is Level 1b evidence that propofol may help to reduce intracranial pressure and the need for other sedative interventions when used in conjunction with morphine.
     
  67. There is Level 2 evidence that midazolam has no effect on intracranial pressure but conflicting evidence regarding its effect on mean arterial pressure and cerebral perfusion pressure.
     
  68. There is Level 1b evidence that methylprednisolone increases mortality rates in patients with ABI and should not be used.
     
  69. There is Level 1b evidence that triamcinolone can improve outcomes in patients with both a Glasgow Coma Scale <8 and a focal lesion.
     
  70. There is Level 2 evidence that dexamethasone does not improve intracranial pressure.
     
  71. There is Level 1b evidence that dexamethasone does not improve outcomes and Level 2 evidence that it can worsen outcomes in patients with levels >20mmHg.
     
  72. There is Level 2 evidence that glucocorticoid administration within the first day post injury only, increases the risk of developing first late seizures.