140 Most

of the medications used commonly in neurorehabil

140 Most

of the medications used commonly in neurorehabilitative practices are mechanistically pleotropic.The several possible neurochemical effects of a given medication in the neurometabolic and neurochemical milieu into which it is introduced therefore are necessary considerations during treatment selection and will guide treatment response expectations. For example, early post-injury administration of uncompetitive NMDA receptor antagonists such as amantadine (or, perhaps, memantinc) may attenuate the adverse effects of early glutamate excesses and facilitate progression from posttraumatic Inhibitors,research,lifescience,medical coma to higher stages of PTE. In the subacute or late post-injury period, the clinical benefits of amantadine141 on post-traumatic disorders of consciousness (ie, vegetative or minimally conscious states after severe TBI) may reflect its NMDA receptor function-stabilizing Inhibitors,research,lifescience,medical properties, indirect facilitation of dopamine release by NMDA antagonism, other synapse-related effects on dopamine neurotransmission, or some combinations of these pharmacologic effects. When this same agent is used to treat the cognitive Inhibitors,research,lifescience,medical and other neuropsychiatric manifestations of the post-traumatic dysexecutive syndrome, especially after mild or moderate TBI,

the beneficial effects of amantadine most likely reflect enhanced frontal function via indirect augmentation of cerebral dopaminergic activity.36,119,120 Zolpidem provides another example

of the differential neuropsychiatric Inhibitors,research,lifescience,medical effects on a specific cognitive target, based on the context (ie, initial injury severity, stage of PTE, time Inhibitors,research,lifescience,medical post-injury) in which it is administered. Zolpidem binds to GABAA receptors and thereby potentiates the effect, of G ABA, the principal inhibitory neurotransmitter in the central nervous system. Among persons with relatively intact arousal systems and minimal disturbances in other modulator}’ neurotransmitter systems (ie, persons in post-traumatic dysexecutive syndrome stage of PTE. during the subacute or late postinjury periods following mild TBI), Zolpidem is likely to impair arousal – hence its common use as an agent, with which to treat insomnia. However, when administered to individuals with severely Thalidomide altered arousal and attentional systems in the subacute or late post-injury period following severe TBI (ie, persons with persistent post traumatic disorders of consciousness), Zolpidem may reciprocally disinhibit arousal systems among persons in the lower stages of PTE.141,142 Whether this reflects a direct of U0126 supplier effect of its action at GABAA receptors or a secondary effect, of those actions on the function of other modulatory neurotransmitter systems remains uncertain.

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