STEP 2: Concussion Live Course - November 5-6, 2024, in San Diego, CA-Pharmacotherapy and Nutritional Supplement Use in Mild Traumatic Brain Injury

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The document outlines updated strategies for managing mild traumatic brain injury (TBI) or concussion using nutraceuticals and pharmacological approaches. Dr. Ross D. Zafonte, an expert in physical medicine and rehabilitation, emphasizes the need for a tailored approach, considering underlying causes such as pre-existing conditions, psychiatric disorders, or medication side effects.<br /><br />The document reports that current neuroprotection and brain health interventions for mild TBI lack robust clinical trials, with most nutraceuticals and pharmaceuticals being used off-label. It mentions specific substances like Citicoline, Omega-3 fatty acids, melatonin, and NAC (N-acetyl cysteine), noting some potential benefits but requiring further research.<br /><br />For symptom management, the document suggests nutraceutical approaches to alleviate headaches by utilizing substances like riboflavin, CoQ10, magnesium, and butterbur, mainly based on migraine studies. Sleep dysregulation is addressed through melatonin and various medications including trazodone and ramelteon, although efficacy data is limited.<br /><br />Regarding attention and cognitive functions, some studies support the use of stimulants like methylphenidate and dopaminergic agents such as amantadine for improving attention and alertness. Other potential treatments include using dopaminergic and noradrenergic agents like modafinil, armodafinil, and lisdexamfetamine, each with varying degrees of efficacy and side-effect profiles.<br /><br />A consistent theme is the cautious use of these substances, stressing that if they are potent enough to assist, they could also pose harm. Dr. Zafonte advocates for identifying symptom causes, reconsidering possibly harmful medications, and employing non-pharmacological interventions when viable, alongside symptom-focused treatment. Overall, the document underlines the current gap in definitive evidence, advocating for more robust, multi-center studies to inform treatment pathways for mild TBI and concussions.

Asset Subtitle

Ross D. Zafonte, DO

Keywords

mild traumatic brain injury

concussion

nutraceuticals

pharmacological approaches

Dr. Ross D. Zafonte

neuroprotection

brain health

symptom management

cognitive functions

clinical trials