Ap. Wolf et Ad. Gleckman, SINEMET AND BRAIN INJURY - FUNCTIONAL VERSUS STATISTICAL CHANGE AND SUGGESTIONS FOR FUTURE-RESEARCH DESIGNS, Brain injury, 9(5), 1995, pp. 487-493
During the past decade the usage of dopaminergic agonists for the brai
n-injured population has become a more common treatment option during
both the acute and subacute phases of recovery. We attempted to use Si
nemet to address the functional limitations of a 74-year-old woman who
was 7 months status post-traumatic brain injury secondary to a motor
vehicle accident. The patient was administered a S-month trial of Sine
met while continuing to receive structured sensory stimulation. Her ba
seline performance using Rappaport's Coma/Near-Coma (CNC) scale yielde
d a score in the moderate coma range. Weekly evaluations were conducte
d throughout the drug trial period using the CNC scale. Although the p
atient displayed modest improvement in her total score, functional cha
nge was negligible. Long-term follow-up suggested an absence of retent
ion of earlier gains obtained on the CNC scale. The authors suggest th
at flawed research methodologies, heterogeneous patient populations, a
nd potential difficulties obtaining reliable dependent measures makes
the interpretation of brain injury research findings equivocal. Howeve
r, given the many limitations, the current research design suggested t
hat the long-term practical utility of Sinemet was unremarkable. Sugge
stions for future pharmacological research designs with the brain-inju
red population are discussed.