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The effectiveness of dopamine agonists for treatment of neuropsychiatric symptoms post brain injury and stroke

Published online by Cambridge University Press:  08 April 2015

Musa Basseer Sami  and
Rafey Faruqui
Musa Basseer Sami*
Affiliation:
Canterbury and Coastal Community Mental Health Team, 41 Old Dover Road, Canterbury, Kent, CT1 3HU, UK
Rafey Faruqui
Affiliation:
Consultant Neuropsychiatrist, St Andrew’s Healthcare, Northampton, UK
*
Musa Basseer Sami, Canterbury and Coastal Community Mental Health Team, 41 Old Dover Road, Canterbury, Kent, CT1 3HU, UK. Tel: +01227 597100; Fax: +01227 597120; E-mail: musasami@doctors.org.uk
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Abstract

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.

Keywords

agitationapathydopaminestroketraumatic brain injury
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 27 , Issue 6 , December 2015 , pp. 317 - 326
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Copyright
© Scandinavian College of Neuropsychopharmacology 2015 

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