Abstract
Higher brain functions are common sequelae of cerebrovasucular disease and other central nervous system disorders. Pharmacotherapy for higher brain dysfunction is a new still experimental and somewhat controversial topic. Attentional theories of the underlying neurological deficits in hemispatial neglect have led to different pharmacological rationales for therapy. TRH (thyrotropin releasing hormone) enhances cholinergic functions. And more important, TRH has been shown to improve mild consciousness disturbances in patients with cerebrovascular disease. We recruited four patients who showed left hemispatial neglect. The subjects received intravenous TRH for 10 days. Standard tests for hemispatial neglect including the copying and line bisections were performed three times, before and final days of the treatment, 10 days after the ceased of the treatment. Hemispatial neglect significantly improved during the treatment. Lesions of ascending dopaminergic pathways induce neglect in animals. Apomorphine, a dopaminergic receptor agonist, decreases the magnitude of neglect in rats. Fleet et al. treated two neglect patients with 15 mg of bromocriptine daily for 3 to 4 weeks. Tests for neglect that significantly improved on therapy and worsened after its withdrawal. Noradrenaline is one of the most important transmitters for the regulation of arousal systems. The clonidine, an adrenoceptor agonist, in low doses acts presynaptically to decrease noradrenaline release. Smith et al. reported the lapses of attention would increase following clonidine challenge. As for aphasia, Albert and colleagues reported a case in which speech fluency in an aphasic patient was partially restored by administration of a dopamine agonist, bromocriptine. Tanaka hypothesized that the damages to the left temporal lobe, causing fluent aphasia with anomia, produces a relative deficit in cholinergic activity, therefore that treatment with cholinergic agents will improve naming ability. This review concludes that when used as an adjunct to behavioral therapy, pharmacotherapy appears to have benefit.
