Pharmacological Treatment of Agitation and/or Aggression in Patients With Traumatic Brain Injury: A Systematic Review of Reviews

@article{Rahmani2021PharmacologicalTO,
  title={Pharmacological Treatment of Agitation and/or Aggression in Patients With Traumatic Brain Injury: A Systematic Review of Reviews},
  author={Elham Rahmani and Tricia M. Lemelle and Ehsan Samarbafzadeh and Anita S Kablinger},
  journal={Journal of Head Trauma Rehabilitation},
  year={2021},
  volume={36},
  pages={E262 - E283}
}
Objective: To systematically review the available literature on the pharmacological management of agitation and/or aggression in patients with traumatic brain injury (TBI), synthesize the available data, and provide guidelines. Design: Systematic review of systematic reviews. Main Measures: A literature review of the following websites was performed looking for systematic reviews on the treatment of agitation and/or aggression among patients with TBI: PubMed, CINAHL, DynaMed, Health Business… 
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TLDR
It was demonstrated that pharmacological treatment was effective in reducing agitation post ABI; however, there was insufficient information to develop a conclusion due to the limited number of studies and overall weakness of evidence for each individual medication.
The Efficacy and Harms of Pharmacological Interventions for Aggression After Traumatic Brain Injury—Systematic Review
TLDR
It is concluded that a recommendation for use of amantadine to treat aggression and irritability in adults following TBI is appropriate, however, there is a need for further well-designed, adequately powered and controlled studies of pharmacological interventions for aggressionFollowing TBI.
Pharmacological interventions for agitated behaviours in patients with traumatic brain injury: a systematic review
TLDR
Propranolol, methylphenidate, valproic acid and olanzapine may offer some benefit; however, they need to be further studied.
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TLDR
Amantadine may be efficacious on irritability and aggression after ABI and is a safe drug in the presence of adequate creatinine clearance.
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TLDR
An evolving evidence base is demonstrated to suggest some benefits in agitation and aggression, mood and attentional deficits in traumatic brain injury and stroke patients, however, there are key limitations of the studies undertaken to date involving small numbers of participants, heterogeneous outcome measures, and variable study designs.
Impact of Pharmacological Treatments on Cognitive and Behavioral Outcome in the Postacute Stages of Adult Traumatic Brain Injury: A Meta-Analysis
TLDR
A meta-analysis of research that has investigated the cognitive and behavioral effects of pharmacological treatments administered in the later stage after TBI found that when treated in the postacute period, 1 dopaminergic agent (methylphenidate) improved behavior (anger/aggression, psychosocial function) and 1 cholinergicAgent (donepezil) improved cognition (memory, attention).
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