Role of bromocriptine in multi-spectral manifestations of traumatic brain injury

Abstract

PurposeDespite the prevalence and cost of traumatic brain injury related disabilities, there is paucity in the literature on modern approaches to pharmacotherapy. Medications may promote recovery by enhancing some neurological functions without impacting others. Herein we discussed the role of bromocriptine in neurorehabilitation for patients with traumatic brain injury.MethodsA cohort comprising of 36 selective nonsurgical cases of traumatic brain injury in minimally conscious state were enrolled in the study. After hemodynamic stability, bromocriptine was given at paediatric dose of 3.75 mg/d and adult dose of 7.5 mg/d. It was administered through a naso-gastric (NG) feeding tube in the patients with minimally conscious state, then changed to oral route after proper swallowing and good gag reflex were ensured in the patient. The drug was slowly reduced over three weeks after neurological improvement in the patients. Positive result was determined by improved GCS score of 2 and motor power by at least 1 British Medical Council (BMC) motor score. Improvement of deficits was evaluated in terms of fluency of speech for aphasia, task switching, digit span double tasking and trail-making test for cognition and attention, and functional independence measure score for motor functioning and self-independence.ResultsAccelerated arousal was seen in 47.0% of cases (8/17) in 4–40 days. In 41.2% of cases (7/17), Glasgow outcome score (GOS) was improved to 4/5 in 90 days. Improvement in hemiparesis by at least 1 BMC score was seen in 55.6% of cases (5/9) in 40 days. Aphasia was improved in 80% of cases (4/5) in 7–30 days. Moderate improvement in cognitive impairment was seen in 66.7% of cases (2/3) in 14–20 days. Improvement in memory was observed in 50% of cases (1/2) in over 30 days. No cases were withdrawn from the study because of adverse reactions of the drug. There was no mortality in the study group.ConclusionBromocriptine improves neurological sequelae of traumatic brain injury as well as the overall outcome in the patients. If medication is given to promote recovery and treat its associated disabilities, clinicians should thoroughly outline the goals and closely monitor adverse effects.

Role of the Dopaminergic System in the Striatum and Its Association With Functional Recovery or Rehabilitation After Brain Injury

“…The literature supports the beneficial effects of dopaminergic drugs in patients with TBI, confirming that they accelerate functional recovery and rehabilitation after brain injury ( Harmon and Boyeson, 1997 ; Bales et al, 2009 ; Frenette et al, 2011 , 2012 ; Osier and Dixon, 2016a ; Carrillo-Mora et al, 2017 ; Munakomi et al, 2017 ; Duong et al, 2018 ; Plummer et al, 2018 ; Loggini et al, 2020 ). The mechanisms of action of dopaminergic drugs administered to patients with TBI include blockade of the DA transporter (DAT), inhibition of DA reuptake and facilitation of DA synthesis, and the drugs most highly recommended by the Neurotrauma Foundation are methylphenidate (MPD), amantadine, and bromocriptine ( Bales et al, 2009 ).…”

“…Administration of methamphetamine, which is highly addictive and is of limited usefulness due to its potential for abuse and dependence, to patients with TBI improves Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores, whereas in injured rats, it improves motor and cognitive performance in a dose-dependent manner ( Duong et al, 2018 ). Bromocriptine enhances arousal in patients with TBI who are in a minimally conscious state and improves neurological sequelae associated with hemiparesis (56% of cases), aphasia (80%), memory (50%), and cognitive impairment (67%) ( Munakomi et al, 2017 ). Administration of MPD at a dose of 0.3 mg/kg (∼2.5 mg) exerts positive effects on attention deficits after TBI ( Whyte et al, 2004 ).…”

A Review of Pharmacologic Neurostimulant Use During Rehabilitation and Recovery After Brain Injury

“…55 In a prospective cohort study of 36 consecutive patients with TBI and minimally conscious state, bromocriptine 2.5 to 20 mg daily was associated with accelerated arousal and improvements in GCS, aphasia, and cognitive function. 56 These studies do not support the routine use of bromocriptine after TBI, but there may be some benefit in patients in minimally conscious or vegetative states after TBI.…”

“…Bromocriptine has also been used to enhance cognition after TBI. [53][54][55][56] In a retrospective review of 5 patients treated with bromocriptine after TBI, all 5 patients improved from vegetative state to minimally conscious states. Over the 12-month treatment period, patients improved steadily, with decreased disability each month (characterized using the Disability Rating Scale).…”

Bromocriptine in Central Hyperthermia after Severe Traumatic Brain Injury

“…In a recent study, bromocriptine was found to improve neurological sequelae of TBI and the overall outcome in the patients. but T. Zakhary, A. Sabry central hyperthermia was not assessed in the trial [33].…”