Philip A Defina
ABSTRACT: Recent prevalence estimates of pseudobulbar affect (PBA) symptomatology secondary to traumatic brain injury (TBI) exceed 55%. Treatment with dextromethorphan/quinidine (DMQ) has been shown to robustly diminish the frequency and severity of PBA episodes associated with different neurological conditions. Objective. This retrospective case study aims to demonstrate the efficacy of DMQ to minimize PBA symptoms in a series of patients with traumatic brain injury (TBI) and describe unforeseen evidence of its additional therapeutic potential to mitigate diverse neuropsychiatric sequelae. Methods. The case histories of five patients were reviewed according to the clinical observations of their neurologist (JLF). Five patients sustained TBI an average of nine years prior, presenting with a stable history of PBA and frequent suicidal ideation. DMQ therapy was indicated for all five patients to ameliorate paroxysmal episodes of laughter, crying or both. Results. The results of this clinical case study confirm DMQ as a potent treatment for PBA and reveal its potential to ameliorate additional neuropsychiatric behaviors associated with TBI. Surprisingly, concomitant suicidal ideation and associated impulsivity were discovered to rapidly resolve following treatment with DMQ. Conclusions. The rapid onset and sustained tolerability of DMQ suggest it deserves consideration as an alternative to conventional pharma-cotherapies for managing PBA, suicidal ideation and associated impulsivity. DMQ therapy holds promise to significantly reduce morbidity and mortality, profoundly enhance quality of life and fundamentally improve longterm outcome for TBI survivors.
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