1 / 20

Neurostimulants after a Brain Injury: What do we know

. Thank you to our federal sponsor, the National Institute on Disability and Rehabilitation Research (Department of Education)OT Department for their beautiful classroom. Effects of Traumatic Brain Injury problems with regulation. TOO MUCHIrritabilityImpulsivityMood ups/downsManiaPsychosisA

hayes
Download Presentation

Neurostimulants after a Brain Injury: What do we know

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Neurostimulants after a Brain Injury: What do we know? Kathleen R. Bell, M.D. April 14, 2010

    2. Thank you to our federal sponsor, the National Institute on Disability and Rehabilitation Research (Department of Education) OT Department for their beautiful classroom

    3. Effects of Traumatic Brain Injury – problems with regulation TOO MUCH Irritability Impulsivity Mood ups/downs Mania Psychosis Aggression Increased sexual behavior NOT ENOUGH Apathy Akinetic mutism Poor memory search Poor flexibility in thinking Problems with staying on task Memory impairment

    4. The Major Sections of the Brain

    5. Medial Frontal Cortex

    7. Neurotransmitters Dopamine Norepinephrine (noradrenaline) Acetylcholine

    8. Speed, Attention and Memory Neurostimulants can affect: How fast you think How well you can pay attention (how really awake you are) How much/well you can remember

    9. Attention Neural network Ascending reticular activating system (brain stem) working from the bottom-up Global attention Prefrontal, parietal, and limbic cortices working from the top-down Attention specific to context, motivation, significance, and conscious volition

    10. Lesions of this area result in Amotivational apathetic state Less talking and gesturing Decreased curiosity Less vocal inflection and facial expression Reduced social interest, diminished affection Reduced initiation and poor maintenance of activities

    11. Lesion in superior medial frontal cortex – slowed response time Lesion in the Dorsolateral Prefrontal Cortex – no problems initiating but lots of errors (unable to switch sets) Lesion in the caudate nucleus – Might have both slowed processing time and perseverative errors

    12. Memory Temporal lobe or diencephalon (hippocampus) – actual storage of memory Frontal lobe damage Impaired recall that depends on self-initiated cues, organization, search selection, and verification of stored information

    13. Neurostimulants amphetamine Norepinephrine (TCAs) methylphenidate, dextroamphetamine amantadine L-dopa/carbidopa bromocriptine pergolide physostigmine l donepezil selegiline apomorphine caffeine phenylpropanolamine Naltrexone atomoxetine

    14. Methylphenidate (Ritalin) Dopaminergic agent Small studies that indicate that MPH improves processing speed, and levels of attention (which may improve memory) In rats, improves dopamine transmission between nerve cells as well Probably true for amphetamines as well

    15. Rivastigmine Cholinesterase inhibitor – stops the breakdown of acetylcholine in the brain Seems to have promising results in patients with specific memory impairments (donepezil – Aricept, tacrine – Cognex, memantine – Namenda, galantamine – Razadyne)

    16. Other Dopaminergic Drugs amantadine L-dopa/carbidopa bromocriptine

    17. How to decide whether to prescribe or use? Helps to have a specific behavior in mind that you want to improve Is it speed, alertness, or memory that is the issue

    18. How to decide whether to prescribe or use? Are there any reasons NOT to take the drug? Heart problems Other medications that might interact History of addiction Irritability

    19. How to decide whether to prescribe or use? When to take the drugs? No one really knows

    20. IF you and your doctor decide to try a neurostimulant: Be your own research project Figure out what your desired results are Begin a dose of the drug Observe and keep records May need to increase the dose of the drug May need to go back off the drug to see if it was really working or not

    21. Questions?

More Related