REHABILITATION OF MODERATE TO SEVERE TBI: COMA: MEDICATIONS

  • Early, critical analysis of all medications for medical problems to:
    • Assess their affect on the level of consciousness and quality of cognition
    • Identify other medications with fewer side effects
    • Adjust the dosage
    • Discontinue all unnecessary drugs

  • Avoidance of:
    • Catecholaminergic antagonists (noradrenergic and dopaminergic) which may impair motor recovery and negatively affect attention, concentration, and memory
    • Neuroleptics (major tranquilizers)
      • Metoclopramide
      • H2-receptor antagonists
    • Noradrenergic antihypertensives (e.g. methyldopa and beta- and alpha-blockers)
    • Anticholinergic agents (except possibly in the acute stage of TBI)
      • Tricyclic antidepressants (TCAs)
    • Gubaminergic agonists
      • Benzodiazepines
      • Baclofen
      • Diazepam as maintenance therapy

  • Use of:
    • Positioning and splinting, or, if necessary, motor point blocks and dantrolene sodium to control seizures
    • Environmental factors and sleep hygiene to regulate the sleep-wake cycle, e.g. establishing a 6-8 period with minimal disturbance of patient; providing 1 hour of early morning sunlight; or, administering short-acting hypnotics, such as chloral hydrate, or agents that do not alter the first 2 sleep cycles, such as zolpidem, if necessary

Based on information in Medical Rehabilitation of Traumatic Brain Injury, L.J. Horn and N.D. Zasler, eds. St. Louis, MO, Mosby, 1996, except for information where other papers are cited.