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Neurosurgery:
doi: 10.1227/NEU.0b013e31824cebe8
Review

From the Field of Play to the Field of Combat: A Review of the Pharmacological Management of Concussion

Petraglia, Anthony L. MD*; Maroon, Joseph C. MD; Bailes, Julian E. MD§

SANS CME
CNS University of Neurosurgery
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Abstract

Traditionally, the medical management of concussion has involved close observation and physical and cognitive rest. Most postconcussive symptoms resolve spontaneously and require only conservative treatment. However, some patients have prolonged recoveries and may benefit from treatment with medications. Some naturally occurring compounds demonstrate multimechanistic neuroprotective properties and may be potential treatment considerations. For the most part, however, current treatments are symptom based for those with persistent postconcussive symptoms. The evidence supporting the various pharmacologic treatments in concussion is equivocal. The choice of which medication to use for a patient depends on the symptom characteristics, and each decision should be made on an individual-case basis. There is a need for well-designed trials investigating the efficacy of various medical therapies.

ABBREVIATIONS: PCS, postconcussion syndrome

PPCS, prolonged postconcussion syndrome

PTSD, posttraumatic stress disorder

SSRI, selective serotonin reuptake inhibitor

TBI, traumatic brain injury

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