Research Reports - The effectiveness of dopamine agonists for treatment of neuropsychiatric symptoms post brain injury

Acta Neuropsychiatr. 2015 Apr 8:1-11

Sami MB(1), Faruqui R(2)

OBJECTIVE: Traumatic brain injury and stroke are among the leading causes of
neurological disability worldwide. Although dopaminergic agents have long been
associated with improvement of neuropsychiatric outcomes, to date much of the
evidence to date has been in case reports and case series or open label trials.
METHODS: We undertook a systematic review of double-blinded randomised controlled
trials (RCT) to determine the effect of dopaminergic agents on pre-defined
outcomes of (a) apathy; (b) psychomotor retardation; (c) behavioural management
and (d) cognitive function. Databases searched were: Medline, EMBASE, and
PsychInfo for human studies. The Cochrane Clinical Trials Database and the TRIP
Medical database were also searched. All identified studies, were further
hand-searched.
RESULTS: We identified six studies providing data on 227 participants, 150 of
whom received dopaminergic therapy. Trials were compromised by cross-over design,
inadequate wash out period, small numbers and heterogeneous outcome measures.
However one good quality RCT demonstrates the efficacy of amantadine in
behavioural management. One further RCT shows methylphenidate-levodopa is
efficacious for mood post-stroke. One study shows rotigotine to improve
hemi-inattention caused by prefrontal damage.
CONCLUSION: Our systematic review demonstrates an evolving evidence base to
suggest some benefits in agitation and aggression, mood and attentional deficits.
However, there are key limitations of the studies undertaken to date involving
small numbers of participants, heterogeneous outcome measures, and variable study
designs. There is a need for on-going large prospective double-blind RCTs in
these medications using standardised criteria and outcomes to fully understand
their effectiveness in this patient group.

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