Gabapentin After Brain Injury May Reduce Long Term Cognitive Risk
A large retrospective study suggests same-day gabapentin use after traumatic brain injury was linked to lower cognitive impairment risk in mild TBI and lower mortality risk in severe TBI.
A multinational health-record study of nearly 50,000 adults with traumatic brain injury found that people who received gabapentin on the same day as their injury had better long-term outcomes in some groups.
Same-day gabapentin was associated with a 22% lower adjusted risk of durable cognitive impairment after mild TBI and a 46% lower adjusted risk of death after severe TBI over 2 years. The study is important, but it does not prove gabapentin caused these benefits. The authors emphasized that the findings are hypothesis-generating and need prospective study.
Study Details
Traumatic brain injury, or TBI, can lead to long-term problems with memory, thinking, mood, behavior, seizures, pain, and daily function. Even after the initial injury stabilizes, many patients continue to live with downstream effects that can last months or years.
Gabapentin is widely known as a medication used for nerve pain, seizures, and sometimes agitation or pain after brain injury. Researchers wanted to know whether early gabapentin use might be linked to better long-term brain outcomes after TBI.
This study was presented at the 2026 American Academy of Neurology annual meeting and used data from the multinational TriNetX Research Network.
Methodology
Researchers reviewed health records from 49,925 adults who had a first traumatic brain injury and had a same-day Glasgow Coma Scale score recorded. The Glasgow Coma Scale is a clinical tool used to estimate how severe a brain injury is, based on alertness and response.
The study excluded people who already had cognitive impairment or previous gabapentin exposure.
The researchers compared patients who received gabapentin on the same day as their TBI with those who did not. They then looked at two major outcomes over 2 years:
durable cognitive impairment, defined using diagnosis codes for vascular dementia, Alzheimer’s disease, or mild cognitive impairment, and all-cause mortality.
Because this was an observational study, the researchers used adjusted statistical models to account for differences between patients. Still, this type of study can show association, not proof of cause and effect.
Key Findings
The study included 49,925 adult patients with first-time traumatic brain injury.
1,757 patients, or 3.5%, received gabapentin on the same day as their injury.
Among people with mild TBI, same-day gabapentin was associated with a 22% lower adjusted risk of durable cognitive impairment over 2 years.
Among people with severe TBI, same-day gabapentin was associated with a 46% lower adjusted risk of death over 2 years.
Durable cognitive impairment developed in 6.6% of people with mild TBI and 7.1% of people with severe TBI within 2 years.
The researchers also reported potential adverse outcomes over 5 years, including psychiatric, sleep, and cardiovascular disorders.
The authors clearly stated that the study does not prove causation and that residual confounding is likely.
Implications for Practice
For patients and families, the main takeaway is cautious optimism. This study suggests that gabapentin, when given early after traumatic brain injury, may be linked to better long-term outcomes in some patients. That does not mean gabapentin should be started automatically after every concussion or brain injury. TBI severity, symptoms, other medications, kidney function, fall risk, sedation risk, and mental health history all matter.
For healthcare providers, the study raises an important clinical question: could some medications already used for post-TBI pain or agitation also influence downstream injury pathways? The finding is especially relevant because gabapentin is already familiar to clinicians and commonly used in real-world care.
However, this should not change practice on its own. The study was retrospective, based on health records, and vulnerable to confounding. Patients who received gabapentin may have differed from those who did not in ways that were not fully captured. The next step would be prospective studies or randomized trials to test whether early gabapentin truly modifies long-term cognitive or survival outcomes after TBI.
For now, this research should be viewed as a signal worth studying, not a new standard of care.