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Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice / David Plantier in Annals of physical and rehabilitation medicine, Vol. 59 n° 1 (February 2016)
[article] Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice [texte imprimé] / David Plantier, Auteur ; Jacques Luauté, Auteur . - 2016 . - p. 42-57.
Langues : Anglais (eng) Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 59 n° 1 (February 2016) . - p. 42-57
Catégories : SANTÉ PHYSIQUE
Antidépresseur , Neuroleptique
Trouble comportement social , Trouble humeur
Tags : Traumatic brain injury Behavioral disorders Neuroleptics Antidepressants Beta-blockers Mood stabilizers Benzodiazepines Amantadine Résumé : 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.
En ligne : http://www.em-consulte.com/produit/rehab Permalink : [article]GABAergic drug use and global, cognitive, and motor functional outcomes after stroke / Adrien Schwitzguébel in Annals of physical and rehabilitation medicine, Vol. 59 n° 6 (December 2016)
[article] GABAergic drug use and global, cognitive, and motor functional outcomes after stroke [texte imprimé] / Adrien Schwitzguébel, Auteur ; Charles Benaïm, Auteur ; Stefano Carda, Auteur . - 2016 . - p. 320-325.
Langues : Anglais (eng) Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 59 n° 6 (December 2016) . - p. 320-325
Catégories : THÉRAPEUTIQUE
Tags : Recovery Rehabilitation Stroke GABA-A receptor agonists Benzodiazepines Minimal clinically important difference Functional independence measure Résumé : Background: In animal models and healthy volunteers, the use of GABA A receptor agonists (GABA-AGs) seem deleterious for functional recovery. The agents are widely used for subacute stroke, but their effect on functional recovery remains unclear.
Objectives: We aimed to evaluate the association between GABA-AG use and functional recovery after stroke.
Methods: We retrospectively recruited 434 survivors of subacute stroke admitted for inpatient rehabilitation between 2000 and 2013 in our institution (107 with and 327 without GABA-AG use). We used multivariate regression to assess the association of GABA-AG use and successful functional recovery, defined as reaching, between admission and discharge, the minimal clinically important difference (MCID) of 22 points on the global Functional Independence Measure (FIM). Secondary analyses were the associations of GABA-AG with cognitive and motor FIM MCID and constant GABA-AG exposure (24h/24 GABA-AG) with global, cognitive and motor FIM MCID. A new estimation of the MCID was performed with the standard error of measurement.
Results: Reaching the global FIM MCID was associated with GABA-AG use (adjusted odds ratio [aOR] 0.54 [95% CI 0.310.91], P =0.02) as well as 24h/24 GABA-AG use (aOR 0.25 [0.080.83]; P =0.02). Furthermore, GABA-AG and 24h/24 GABA-AG use was inversely but not always significantly associated with reaching the cognitive FIM MCID (aOR 0.56, P =0.07; aOR 0.26, P =0.06, respectively) and motor FIM MCID (aOR 0.51, P =0.07; aOR 0.13, P =0.01, respectively). The estimated MCID was 19 for global FIM, 4 for cognitive FIM, and 16 for motor FIM.
Conclusions: GABA-AG use is associated with not reaching successful functional recovery during stroke rehabilitation. Randomised trials are needed to formally establish the potential deleterious effect of GABA-AG use on functional recovery.
En ligne : http://www.em-consulte.com/produit/rehab Permalink : [article]