Easy or Light;Mild CHMT

[Pustoshch]

I not the physician. 35 years. Has fallen from three-meter height navznich. The diagnosis - a brain concussion of an easy or a light;a mild degree + various bruises. In the same clinic two nevropotologa have appointed or nominated various treatments (besides, naturally, obezbolevajushchego and somnolent): 1-tsinarizin + Pyracetamum, and 2-glitsin (and categorically against tsinarizina and Pyracetamum). In a week the trip by plane is necessary to me. What treatment, in your opinion correct or predlozhete another. Thankful in advance. Konstantin.

:confused:

[toshi]

Therefore I offer you 3-rd type of treatment - if nothing disturbs you except for headaches except for analgetics accept nothing. If something disturbs, inform more in detail problems.



Flight by the plane in a week after easy or light;mild CHMT can aggravate your complaints in connection with *quot; Oa??OON???Oy?*quot; from for traumas of systems autoreguljatsii intracranial pressure. Something to make in this direction, except for how to refuse flight it is impossible.



Yours faithfully,

[Iran]

Thanks for advice or council. But me any more before flights.

Problem such - while 3 days Sibazonum + pricked reception tabl somnolents fenobarbetal and tsinarizin - slept and recovered. As soon as has stopped nyxes - I do not sleep. Yes should I sleep - from tablets to sleep it would be desirable constantly but as soon as I am switched off, at once heart gives strong impact and arms/legs or arms/foots;hand/legs sharp sudrogu and as somnolent tablets-strong - there was it *quot; ?a?Ua??N*quot; time ten for a day heart also began to hurt or be ill;be sick. While tablets to itself has cancelled, has gone to the doctor, has taken still nyxes (ampoules ++). As a result a third day I do not sleep at all. The doctor while advises to increase doses of somnolent. To tell the truth mood in down. Doses certainly can be increased or enlarged, but so I zazombirus up to chertikov.

If will help or assist advice or council I shall be very grateful.

: (

[galina_h]

I, certainly, the expert insignificant, but nevertheless am interesting, what for at CHMT a combination of Sibazonum to Fenobarbitalum...

[Malgbv]

I do not know what for Sibazonum. But barbiturates, (Diazepamum), those that apply more shortly. Three years ago there was clause or article generalizing TBI (Traumatic Brain Injury), or on ours of a brain concussion. Also application of Diazepamum within 10 days or weeks was recommended. Authentically lowers at this contingent episodes a post- of the cramps connected with TBI during this period. If cramps was not within 10 days after CHMT treatment is not recommended.

[aura-chel]

Dear colleagues,



1) Dr. Giljarov has fairly noted senselessness of purposes or appointments (well it would be possible to explain one more Fenobarbitalum *quot; Soviet ?aa?*quot; doctors, but with Sibazonum is already debauch....)



2) I do not absolutely agree with Dr. L-with in occasion of its or his comment. First allow nesoglasitsja under the form:

- The matter is that in the English-speaking literature it is usual under term TBI it is meant serious CHMT, but nikaki not sotrjas (anyway, I nirazu did not meet clauses or articles about sotrjas where he would be called TBI). Sotrjas on aglitski name minor head injury more often



Now under the maintenance or contents:



- You wrote I do not know what for Sibazonum. But barbiturates, (Diazepamum), those that apply Sibazonum and Diazepamum it to tell the truth one and too, besides all of them taki benzodiazepines, instead of barbiturates (though it does not change a short of a problem, sm.nizhe more shortly:))



- At sotrjase DO NOT APPOINT or NOMINATE ANTICONVULSANT PREPARATIONS (it senselessly since risk/benefit ratio aspires to infinity, that nagljado has shown an example of our patient)

- Even at TBI their purpose or appointment remains on *quot; sense of justice nOOa*quot;, because is not present niodnogo the research which have shown on influence of these purposes or appointments on clinical *quot; oUOn*quot;. To not be proofless, I below result or bring two citations (one of Cohrane on this subject (2002), other of TBI guidelines (2000))



Cochrane:

Main results: We identified 10 eligible randomised controlled trials, including 2036 participants, but data was unavailable for four unpublished trials,

representing 631 participants and they were excluded. For the remaining six trials, the pooled relative risk (RR) for early seizure prevention was 0.34 (95 %

confidence interval 0.21 to 0.54); based on this estimate, for every 100 patients treated, 10 would be kept seizure free in the first week. Seizure control in

the acute phase was not accompanied by a reduction in mortality (RR=1.15; 95 % confidence interval 0.89 to 1.51), a reduction in death and neurological

disability (RR = 1.49; 95 % confidence interval 1.06 to 2.08 for carbamazepine and RR = 0.96; 95 % confidence interval 0.72 to 1.26 for phenytoin) or a

reduction in late seizures (pooled RR =1.28; 95 % confidence interval 0.90 to 1.81). The pooled relative risk for skin rashes was 1.57 (95 % confidence

interval 0.57 to 39.88).

Reviewers' conclusions: Prophylactic anti-epileptics are effective in reducing early seizures, but there is no evidence that treatment with prophylactic

anti-epileptics reduces the occurrence of late seizures, or has any effect on death and neurological disability. Insufficient evidence is available to establish

the net benefit of prophylactic treatment at any time after injury.





TBI guidelines:



The Role of Antiseizure Prophylaxis Following Head Injury

I. RECOMMENDATIONS

A. Standards

Prophylactic use of phenytoin, carbamazepine. phenobarbital or valproate, is not recommended for preventing late posttraumatic seizures (PTS).

B. Guidelines

None C. Options

1. It is recommended as a treatment option that anticonvulsants may be used to prevent early posttraumatic seizures in patients at high risk for seizures following head injury. Phenytoin and carbama-zepine have been demonstrated to be effective in preventing early posttraumatic seizures. However, the available evidence does not indicate that prevention of early posttraumatic seizures improves outcome following head injury.



PS - once again I pay attention, that all this concerns to serious CHMT, about *quot; ?N?N??N*quot; sotrjasov also it anywhere is not spoken consists in exclusively symptomatic therapy.





For the PATIENT - I would go to dokotogru which has appointed or nominated all this and have asked *quot; oNO?OOy*quot; all as was. Most likely at you elements of a phenomenon of a cancelling which should be passed or taken place softly, i.e. are better for not increasing or enlarging a dose, and to try to reduce smoothly. But all this is better for discussing with the doctor who treats you.



Yours faithfully,

[Arzt]

Uv. Dr. Kushel, thanks for benzodiazepines and barbiturates:)



In occasion of TBI, that is the concept and mild TBI, and is enough often applied at doctors of Rehabilitational medicine and Rehab. To the literature. There are disagreements in this occasion, you are right. In my opinion the similar diagnosis is lawful at disturbance kognitivnyh functions and various signs TSNS, such as perception, reasoning, etc. I think, that if at this patient zdelat the ?NO-psychological test we shall find out deviations or rejections. The reason of purpose or appointment of this test or dough, complaints of the patient can logically serve. *quot; mood in down, insomnia, trouble, etc.



As to prophylaxis of cramps I can result or bring to you, clause or article and stady standing up *quot; cC*quot; prophylaxis of cramps. Besides, business all in design of research what they the instrument applied to studying and so forth I personally SAW patients after mild TBI acting on fast with cramps, therefore usually I appoint or nominate prophylaxis will not be certain yet more precise criteria, both most TBI, and a contingent not getting under prophylaxis.

[Galina]

Uv. Dr. Kushel. Here the case unusual has turned up, one of these days I shall present.

[Log]

Yours faithfully,