Serotonergic and Dopaminergic Agents Facilitate Rehabilitation Following Hypoxic Brain Injury

Patients with hypoxic brain injury are susceptible to a variety of neurobehavioural disorders with manifestations that may include apathy, difficulties in initiation and deficits in arousal and attention. In some patients these manifestations are disabling enough to impede rehabilitation and on their own may prevent a return to independent community living. Aim: To illustrate the use of serotonergic and dopaminergic agents to facilitate rehabilitation by treatment of deficits in initiation and arousal following hypoxic brain injury. Method: Retrospective review of two case histories. Clinical Features: Two young men had required long‐term hospitalisation following hypoxic brain injury secondary to failed hanging attempts. One was mute, chair bound, incontinent of urine and faeces, grossly adynamic and with almost vegetative features. The other was grossly adynamic but able to walk with a broad‐based shuffling gait and had limited verbal communication. Standard methods of rehabilitation, including the use of traditional pharmacotherapy such as tricyclic antidepressants and antipsychotics were ineffective. Outcome: Both patients showed substantial improvement in alertness, initiation and attention following treatment with fluoxetine, amantadine and bromocriptine. They became more active, participated in more activities and, most importantly, were able to make use of the rehabilitation program. These previously institutionalised patients have returned to the community with some degree of independence. Conclusion: Clinical observations, experience and anecdotal reports suggest that serotonergic and dopaminergic agents may facilitate rehabilitation following hypoxic brain injury. Controlled studies are required to assess the efficacy of these agents.