A Double Blind Trial of Divalproex Sodium for Affective Lability and Alcohol Use Following Traumatic Brain Injury

Beresford, Thomas P.

doi:10.21236/ada549156

Cited by 3 publications

(2 citation statements)

References 8 publications

(9 reference statements)

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“…Of the identified studies, two were conference abstracts that remained unpublished 33 37. The studies evaluated propranolol,31 amantadine,33–35 methylphenidate,32 valproic acid37 and olanzapine38 in comparison to placebo. Five used a randomised controlled parallel design,31 33–35 37 one used a randomised pretest posttest control group design,32 one was a prospective double blind observational study38 and, one was a retrospective observational study 36.…”

Section: Resultsmentioning

confidence: 99%

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Pharmacological interventions for agitated behaviours in patients with traumatic brain injury: a systematic review

et al. 2019

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ObjectiveThe aim of this systematic review was to assess the efficacy and safety of pharmacological agents in the management of agitated behaviours following traumatic brain injury (TBI).MethodsWe performed a search strategy in PubMed, OvidMEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Google Scholar, Directory of Open Access Journals, LILACS, Web of Science and Prospero (up to 10 December 2018) for published and unpublished evidence on the risks and benefits of 9 prespecified medications classes used to control agitated behaviours following TBI. We included all randomised controlled trials, quasi-experimental and observational studies examining the effects of medications administered to control agitated behaviours in TBI patients. Included studies were classified into three mutually exclusive categories: (1) agitated behaviour was the presenting symptom; (2) agitated behaviour was not the presenting symptom, but was measured as an outcome variable; and (3) safety of pharmacological interventions administered to control agitated behaviours was measured.ResultsAmong the 181 articles assessed for eligibility, 21 studies were included. Of the studies suggesting possible benefits, propranolol reduced maximum intensities of agitation per week and physical restraint use, methylphenidate improved anger measures following 6 weeks of treatment, valproic acid reduced weekly agitated behaviour scale ratings and olanzapine reduced irritability, aggressiveness and insomnia between weeks 1 and 3 of treatment. Amantadine showed variable effects and may increase the risk of agitation in the critically ill. In three studies evaluating safety outcomes, antipsychotics were associated with an increased duration of post-traumatic amnesia (PTA) in unadjusted analyses. Small sample sizes, heterogeneity and an unclear risk of bias were limits.ConclusionsPropranolol, methylphenidate, valproic acid and olanzapine may offer some benefit; however, they need to be further studied. Antipsychotics may increase the length of PTA. More studies on tailored interventions and continuous evaluation of safety and efficacy throughout acute, rehabilitation and outpatient settings are needed.PROSPERO registration numberCRD42016033140

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Section: Resultsmentioning

confidence: 99%

“…Unfortunately, no statistical comparison with the placebo group was provided. The efficacy of valproic acid in reducing agitated behaviours among mild and moderate TBI outpatients was evaluated in an unpublished randomised controlled study (n=50) 37…”

Section: Resultsmentioning

confidence: 99%