SINEMET AND BRAIN INJURY - FUNCTIONAL VERSUS STATISTICAL CHANGE AND SUGGESTIONS FOR FUTURE-RESEARCH DESIGNS

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.