Gabapentin given on the day of TBI is linked to lower risks of lasting cognitive impairment and death, a retrospective study of nearly 50,000 patients suggests.
Over two years, gabapentin was associated with a 22 per cent lower adjusted risk of cognitive impairment in mild TBI and a 46 per cent lower adjusted risk of mortality in severe TBI.
Adverse outcomes linked to gabapentin over five years included psychiatric, sleep and cardiovascular disorders.
“TBI is a major cause of long-term disability and “one of the most important and intractable challenges, with meaningful improvements in long-term outcomes remaining limited,” according to co-author Fawaz Al-Mufti, of New York Medical College.
“Despite decades of work and a very large number of studies, we have made relatively limited progress in reducing the long-term impact of TBI, particularly with respect to post-traumatic epilepsy, cognitive decline, neurobehavioral symptoms, and functional disability.
“That is what makes this line of inquiry important.
“Even an association, if biologically plausible and reproducible, may help us think differently about therapies that could modify downstream injury rather than treat symptoms after the fact.”
The analysis was prompted by an earlier study of levetiracetam, researchers said.
That study found the drug was linked only to a lower risk of early seizures in the week after severe TBI, with no associations seen for late seizures or mild injuries.
Researchers said this led them to look further at whether anti-seizure medicines might modify other risks after TBI and whether they may have a neuroprotective effect when used in the right role.
They added that gabapentin was originally developed as an anti-seizure medicine, but has become a widely used and generally well-tolerated drug that is commonly used after TBI for pain and agitation.
The team analysed health records from 49,925 adult patients who had a first TBI and a same-day Glasgow Coma Scale score recorded in the multinational TriNetX Research Network
. The Glasgow Coma Scale measures consciousness after brain injury, from deep coma to fully alert. People with a history of cognitive impairment or prior exposure to gabapentin were excluded.
The main outcomes were durable cognitive impairment and all-cause mortality within two years. Durable cognitive impairment was defined using diagnostic codes for vascular dementia, Alzheimer’s disease or mild cognitive impairment.
The average age of the cohort was 47.5 and 32.4 per cent were women. Overall, 34,376 people had mild TBI and 12,845 had severe injury.
A total of 1,757 people, or 3.5 per cent, received gabapentin.
Within two years, durable cognitive impairment developed in 6.6 per cent of people with mild TBI and 7.1 per cent of those with severe TBI.
The researchers said causal relationships cannot be inferred from the analysis and residual confounding is likely.
They added: “These findings should be viewed as hypothesis-generating and as a rationale for further prospective study.”
