TBI
Emma Adkins, n/a
Resident Physician
Memorial Healthcare System
Miami, Florida, United States
Ian Miller, DO
Attending Physician
Memorial Healthcare System
Hollywood, Florida, United States
Emma Adkins, n/a
Resident Physician
Memorial Healthcare System
Miami, Florida, United States
Severe traumatic brain injury secondary to a motorcycle versus car accident. Imaging showed subdural hematoma, subarachnoid hemorrhage, intraventricular hemorrhage, and multiple skull fractures.
He was discharged from acute care requiring total assistance for all functional measures. He then spent three months in an acute inpatient rehab and seven months in a transitional living facility. He then presented to our outpatient clinic on levetiracetam, valproic acid, dantrolene, methylphenidate, amantadine, mirtazapine, and quetiapine.
Case Description:
Three years after his initial injury he was admitted to the hospital due to COVID-19. During this hospitalization palliative care was consulted and aside from a nightly low dose of quetiapine he was taken off of all anti-seizure, neuostimulant, and spasticity medications.
Over the next six months he and his family reported improved speech, short term memory, attention, alertness, participation in therapies, and requiring less assistance with activities of daily living. Ultimately he was able to go on a cruise with his family without aide assistance.
Discussions:
Following his traumatic brain injury he was placed on various medications in an attempt to maximize functional improvement and limit unwanted side effects of his injury. He remained on these medications while continuing therapies without significant functional improvement. Rather than having a functional decline following this acute care hospitalization patient had significant functional improvements leading to more patient independence and an overall improved quality of life.
Conclusions:
When treating traumatic brain injury patients we often look for negative sequela of the brain injury to treat with medications to try and improve their ability to participate in therapy and improve their quality of life. While these medications are often advantageous, it is important to consider when they may actually be disadvantageous to functional improvement. This case provides an example of polypharmacy in traumatic brain injury patients in a rehabilitative setting.
