TBI-ANTICONVULSANTS (MOOD STABILIZERS)

SUMMARY

1. Valproate: various studies have shown it to reduce behavioural outbursts and agitation (two case reports and one case series). SE: sedation, alopecia, tremor, ataxia, GI upset, weight gain, hepatotoxicity & thrombocytopenia.

2. Carbamazepine (Tegretol): can improve irritability, disinhibition and aggression, though evidence is limited. SE: hyponatremia, renal failure, aplastic anaemia/agranulocytosis, Stevens-Johnson syndrome, balance disorders, and sedation. Inducer of CYP450 3A4. Rapid onset. May cause some cognitive decline.

3. Gabapentin (Neurontin): helpful in modulating agitation from dementia, but one TBI case study showed increased anxiety and restlessness.

4. Lamotrigine (Lamictal): little weight gain or sedation. High rate of benign rashes; serious rashes have been known to occur. Interacts with valproic acid.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.