A review of pharmacological and non-pharmacological interventions identifies promising approaches and gaps in current research

Agitation is a common complication of traumatic brain injury, yet there are no standardized approaches to managing it. In a recent scoping review, a research team in the UK examined 13 studies on agitation management published over the past decade, identifying promising pharmacological and non-pharmacological strategies. Their findings highlight the need for more precise measures and larger clinical trials to guide safer, evidence-based care.

Traumatic brain injury (TBI) occurs when an external force damages the brain, such as during a fall or a traffic accident. It is a major cause of death and disability worldwide, with over 214,000 TBI-related hospitalizations reported in 2020 in the United States alone. For many people with moderate to severe TBI, recovery can be complicated by agitation. This condition includes restlessness, impulsive behavior, irritability, and aggression, and affects up to 41% of patients in acute care and as many as 70% in rehabilitation units. Agitated patients are at greater risk of falls or injury, and their behavior often slows recovery and places a greater burden on healthcare staff.

Despite the high prevalence of agitation after TBI, there is still no standardized approach to its management. Clinicians tend to use a mix of non-pharmacological approaches, including improving the patient’s environment, supporting sleep, and involving family members in care. Some medications have also shown potential for reducing agitation in patients with TBI. While several studies on this topic are available, they often involve small numbers of patients, define agitation in different ways, and provide limited evidence about which treatments work best for different individuals. This leaves clinicians with few clear guidelines to inform their decisions.

Against this backdrop, a research team led by Dr. Irrum Aneela from the Rehabilitation Medicine, Astley Ainslie Hospital in the UK, conducted a scoping review of approaches to managing agitation after TBI. Published online in Volume 12 of the Chinese Neurosurgical Journal on August 11, 2026, the study assessed research on both medication-based and non-medication approaches published over the past decade.

In scoping reviews, researchers survey the existing literature on a topic to assess the available evidence and identify important research gaps. In this case, the team led by Dr. Aneela searched the PubMed, Embase, and Cochrane databases, identifying 65 records published between January 2015 and March 2026. After screening the results for relevance, they selected 13 papers for a more detailed analysis.

According to the results of an online survey, clinicians reported that reducing noise and placing patients in single rooms were among the most frequently used non-pharmacological approaches. Other studies highlighted the value of helping patients understand their surroundings, maintaining consistent behavioral support, and minimizing environmental triggers. Relatives reported that comforting measures, such as holding a patient’s hand and creating a familiar environment, also helped.

Notably, the relationship between patients’ families and healthcare staff was also deemed important. “Families felt that being informed about the short-term and long-term recovery of patient was essential,” says Dr. Aneela, “In addition, keeping families informed about the patient’s current care plan and needs may empower them to support their loved one’s recovery and remain engaged in the process, which has been found to be beneficial.”

While the review identified several medications that may help manage agitation, the evidence remains limited. A randomized controlled trial suggested potential benefits of the antipsychotic drug olanzapine during post-traumatic amnesia, but this study included only 11 participants. Valproic acid was also associated with improvements in a small case series involving three male patients, and another report described the benefits of dextromethorphan combined with quinidine. Although the overall findings are promising, further research will be needed to thoroughly understand the effectiveness and safety of these medications.

The researchers emphasized that, ideally, treatment decisions should be tailored to each individual rather than applied uniformly. “Clinicians and health professionals reported that treating the patient holistically, taking into account their medical, social, and psychiatric history, was of benefit,” remarks Dr. Aneela. Such an approach may help clinicians consider underlying health conditions, previous psychiatric diagnoses, and other factors that could influence agitation or treatment responses.

A major limitation of the review was the lack of strong clinical evidence, as most of the included literature comprised observational studies, surveys, and previous reviews. The team notes that, going forward, establishing consistent measures of agitation and using them in large clinical trials should be a priority in the field. Such efforts could help turn current practice into evidence-based care that supports patients, families, and healthcare staff alike.