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A meta-analysis of the effect of different neuroprotective drugs in management of patients with traumatic brain injury

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Abstract

Traumatic brain injury is a major problem worldwide. Our objective is to synthesize available evidence in the literature concerning the effectiveness of neuroprotective drugs (cerebrolysin, citicoline, and piracetam) on Glasgow outcome score (GOS), cognitive performance, and survival in traumatic brain injury patients. Comprehensive search of electronic databases, search engines, and conferences proceedings; hand search journals; searching reference lists of relevant articles, theses, and local publications; and contact of authors for incomplete data were performed. Studies included patients in all age groups regardless of severity of trauma. There was no publication date restriction. Two reviewers independently extracted data from each study. Fixed effect or random effects model selection depends on results of statistical tests for heterogeneity. The literature search yielded 13 studies. Patients treated with cerebrolysin (n = 112) had favorable GOS three times more than controls (OR 3.019; 95 % CI 1.76 to 5.16; p = 0.003*). The odds of cognition improvement in the treatment group was 3.4 times more than controls (OR 3.4; 95 % CI 1.82 to 5.21; p < 0.001*). Survival of cerebrolysin-treated patients did not differ from controls (103 patients; OR = 2.81; 95 % CI 0.905 to 8.76). Citicoline did not improve GOS (1355 patients; OR 0.96; 95 % CI 0.830 to 1.129; p = 0.676), cognitive performance (4 studies; 1291 patients; OR 1.35; 95 % CI 0.58 to 3.16; p = 0.478), and survival (1037 patients; OR = 1.38; 95 % CI 0.855 to 2.239). One study showed a positive effect of piracetam on cognition. Further research with high validity is needed to reach a solid conclusion about the use of neuroprotective drugs in cases of brain injury.

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Authors and Affiliations

  1. Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, 165th Al Hureya Avenue, Alexandria, 21561, Egypt

    Iman El Sayed, Adel Zaki & Gihan M. Shehata

  2. Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Sultan Hussein Street, Alexandria, Egypt

    Akram M. Fayed & Sherif Abdelmonem

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  1. Iman El Sayed
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Correspondence to Iman El Sayed.

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Funding agencies had no role in the design or conduct of the study, including study identification, collection, management, analysis and interpretation of the data, or preparation, review of the final manuscript for publication. No role for institutional financial support.

The authors declare that they have no conflict of interest.

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El Sayed, I., Zaki, A., Fayed, A.M. et al. A meta-analysis of the effect of different neuroprotective drugs in management of patients with traumatic brain injury. Neurosurg Rev 41, 427–438 (2018). https://doi.org/10.1007/s10143-016-0775-y

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  • DOI: https://doi.org/10.1007/s10143-016-0775-y

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