Medications and Brain injury

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

Some medications can be extremely helpful for persons with a brain injury. Depending on the stage of child's brain injury they may require many or a few or no medications at all. During intensive care unit admission, children are often on many medications however these medications are stopped as soon as they are able to. The aim is for children to be on as few medications as they need.

Intensive care /early stages medications

In the acute/early stages after a brain injury children may need to be sedated. (anaesthetics, morphine, midazolam) This is to protect their brains from agitation and restlessness. Agitation raises intracranial pressure and is not good for the injured brain.

Some children require medications to control their blood pressure (beta blockers, clonidine) as their internal control mechanisms (located in the brain) are temporarily out of order, see dysautonomia.

If a child has seizures soon after their brain injury, then they may be commenced on anticonvulsants (usually phenytoin or carbemazepine) and these medications may be continued for a number of months. The child may be weaned off the medication after a period of time provided no seizures have occurred. Other children have anticonvulsant medication in the early days after a brain injury to protect the child against having a seizure. This is usually stopped before the children go home provided no seizures have occurred.

If a child has a lot of difficulty with muscle stiffness or spasticity then oral medications such as diazepam, baclofen or dantrolene sodium may be used. In rare instances, botulinum toxin injections can also be used to relieve focal areas of extreme stiffness. See spasticity, oral baclofen & intrathecal baclofen.

After discharge

Once discharged from hospital only a few children will need ongoing medications related to the impact of their brain injury. Before commencing any medication check with your doctor (GP or specialist)

1. What the side effects could be
2. What positive or negative effects you should look out for

Problems that may respond to medication

Attentions and concentration problems

Some children after a brain injury will have difficulty with attention, concentration and distractability with difficulty staying on task. Many strategies can be used at home and in the classroom to help children with these problems before you consider medication.

Some children respond to stimulant medications such as dexamphetamine or methylphenidate. This should be trialed with careful assessments to ensure that your child responds favourably to the medication. Involving your child's teacher in this medication trial is also important.

If your child's attention and concentration improve on stimulant medication then it is worth staying on the medication for a reasonable amount of time - eg 12 months - to make the most of this benefit. Some children take stimulant medication for years with no long-term side effects.

Common side effects include nausea, abdominal pain, anorexia (poor appetite) sometimes weight loss, and difficulty sleeping. The side effects are minimised by increasing the dose slowly and not giving the medication in the evening.

Irritability/ Moodiness

Some children are extremely irritable with a "short fuse" and explosive and sometimes dangerous behaviours after a brain injury. Determining that this is due to an inability to control their impulses and not due to depression is important.

In this situation some of the anticonvulsant medications have an additional beneficial effect as being a mood stabiliser. Carbemazepine or sodium valproate are the most commonly used drugs. Both of these medications can be very effective and are worth trying when behavioural, psychological and environmental adjustments have not helped. The children commence on a lower dose than what is used for seizures, this also minimises the side effects and if the medication is helpful it should be continued for at least 6 months.

These medications are usually very well tolerated by children. Side effects are varied and may include rash, nausea, weight loss/gain, vomiting.

If behavioural difficulties continue or you suspect depression as a cause for their irritability then consultation with a child Psychiatrist is often required. The Antidepressant medications (Amitryptiline) or the SSRI'S such as (Zoloft or Fluoxetrene (Prozac) may be useful.

Hormonal problems / Pituitary failure

All of the following conditions are best investigated and treatment commenced by an endocrinologist.

• Precocious (early onset) puberty can occur if a child has had a significant brain injury prior to the onset of puberty.
• Diabetes insipidus - excessive drinking and passing of urine - this requires hormone replacement to restore the body's ability to conserve water.
• Thyroid problems can occur early on and are best detected with a blood test.
• Short stature or growth failure becomes apparent with time and regular height and with measurements.

Headache

See headache.

Post traumatic seizures / Epilepsy

See seizures.

Who to see

Start by seeing your local doctor or paediatrician who is the best person to rule out other causes for the irritability, headache, pain etc.

You may need to consult with a rehabilitation specialist, neurologist or psychiatrist before commencing specific medications.

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/