Amantadine may hasten functional recovery in patients with. The study did not find a beneficial effect on anger, another common behavioral. He is on quetiapine 50 mg 2xday, levetiracetam 750 mg 2xday and amantadine 200 mg 2xday. Pubmed and cinahl were used to search the literature for articles using amantadine to treat tbi from 1994 to 2004. An evaluation of five clinical trials, two case reports, and one case series is conducted focusing on the use of amantadine following tbi. Efficacy of amantadine in improving cognitive dysfunction in adults. A single patient noticed relief in her parkinson disease pd symptoms after taking amantadine for a flu infection, and this observation sparked an interest, and several important studies that eventually led to a new drug indication. A retrospective pilot study from 2004 that included patients with severe tbi aged 25 to 62 years n 74 examined the impact of intravenous amantadine treatment 100 mg bid for 3 days n 41 versus standard treatment without amantadine n 33. Treatment options for tbi are currently limited promising data to support amantadine in tbi improved drs improved behavioral symptoms no current standard of care limited adverse events further studies dose initiation duration drs disability rating scale tbi traumatic brain injury. The mechanism of action of amantadine in the treatment of parkinsons disease and druginduced extrapyramidal reactions is not known. He is restless and paces up and down the halls, but is not aggressive. Amantadine treatment following traumatic brain injury in children.
They were composed of prospective, retrospective and case study designs. Many survivors live with significant disabilities, resulting in major socioeconomic burden as well. Amantadine, as a dopamine receptor agonist, may stimulate and help the recovery of the nervous system after traumatic brain injury tbi. Subtype of delirium unique to tbi which occurs during period of posttraumatic amnesia pta period of impaired consciousness after head injury. The researchers hypothesis for this trial, then, was that 4 weeks of treatment with amantadine, given 4 to 16 weeks after injury in patients in vegetative and minimally conscious states after tbi. Amantadine effect on perceptions of irritability after. Capitals indicate lifethreatening, underlines indicate most frequent. Dopaminergic neurostimulator similar to amantadine d. Pharmacological interventions for traumatic brain injury. Randomization was stratified on diagnosis vegetativeminimally conscious and on interval from injury to enrollment 28 to 70 days vs. Oct 24, 2008 amantadine for the treatment of traumatic brain injury irritability and aggression. Management of post traumatic brain injury tbi agitation i. Effectiveness of amantadine hydrochloride for treatment of severe traumatic brain injury tbi the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Dsm diagnostic and statistical manual of mental disorders. Amantadine is primarily used for treatment and prophylaxis of influenza a. The nmdadopamine agonist agents amantadine and memantine have been used for the treatment of hypoactivelike symptoms associated with coma, traumatic brain injury, and stroke 421 422 423. Amantadine hydrochloride is one treatment considered to have potential therapeutic value in this patient population. Furthermore, in patients with tbi, it is recommended to abide by prescription guidelines common to the. Cognitive function was measured at treatment days 0, 28, and 60.
It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. Its ability to improve mentation and motor function in patients with head injury remains questionable. Amantadine for the treatment of traumatic brain injury. This study examines the effect of amantadine on irritability in persons in the postacute period after traumatic brain injury tbi. Management of post traumatic brain injury agitation final 4. Sep 17, 2018 detailed amantadine dosage information for adults, the elderly and children. Clinical trials have taken place to chart the link of. Enrolled 416 weeks posttbi amantadine n87 vs placebo n97 dosing drs disability rating scale tbi traumatic brain injury giacino jt, et al.
Amantadine for irritability after traumatic brain injury. Though there is little evidence to support amantadines effectiveness to improve cognitive function after traumatic brain injury tbi, clinicians still commonly use it for this purpose. Secondary aims are to determine the efficacy of amantadine for decreasing caregiver distress as a consequence of decreased irritability for the person with tbi, to determine the durability of the effect of amantadine by assessing at a longer period postinitiation of treatment, and to determine the effectiveness of amantadine in improving. There have been no randomized, placebocontrolled studies published that speci. Amantadine to treat cognitive dysfunction in moderate to severe. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6.
Amantadine, cognitive dysfunction, severe traumatic brain injury. Traumatic brain injury pharmacological treatment scielo. Management of post traumatic brain injury agitation. This study aimed to examine the effects of amantadine on memory tasks, attention and general thinking among individuals with tbi. Amantadine did not positively impact cognition in chronic. A multisite study the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Amantadine use for postconcussion syndrome mayo clinic. Amantadine treatment of a patient with anoxic brain injury. Amantadine has a growing body of evidence for the treatment of aggressive behavior in patients with traumatic brain injury, autism spectrum disorder, and developmental disability.
Listing a study does not mean it has been evaluated by the u. Modafinil ameliorates excessive daytime sleepiness after traumatic brain injury. Call your doctor for medical advice about side effects. Treatment interventions medications 1 anticonvulsants limbic instability 2 amantadine hcl or alphaadrenergic agonists frontal lobe dysfunction 3 stimulants attentional deficits psychosocial and psychoeducational 1 psychotherapy family and individual 2 specialized academic interventions 3 skillbased therapies. He is up much of the night and sleeps on and off during the day. The electronic medical record was used to retrieve clinical data including patient demographics, mechanism of tbi, drug dosage, treatment duration, glasgow coma scale gcs score, length of time to. Amantadine found to improve prolonged disorders of. Nov 17, 2017 the antiviral drug amantadine may reduce aggression in people with chronic traumatic brain injury tbidefined as symptoms lasting for more than six months postinjury, according to a study published in the septemberoctober issue of the journal of head trauma rehabilitation. Amantadine treatment following traumatic brain injury in. Outcomes were summarized and the evidence was appraised. Recommendations on the pharmacological management of tbi related impairments health canada indications of use authors year referenced clinical practice guidelines neurobehavioral guidelines working group ngwg deborah l. Currently, amantadine is used to treat brain severe traumatic brain injury cases, most notably when the patient is near an unresponsive state.
Drugs for behavior disorders after traumatic brain injury em consulte. Key words amantadine, pharmacologic treatment, tbi, traumatic brain injury. Amantadine hydrochloride is one treatment considered to have potential therapeutic value in this patient population objective. Jul 29, 2015 this study examines the effect of amantadine on irritability in persons in the postacute period after traumatic brain injury tbi. Includes dosages for parkinsons disease, extrapyramidal reaction, influenza prophylaxis and more. Therefore, guidelines for management of the person who has had a tbi are of paramount. Amantadine to treat cognitive dysfunction in moderate to. Fewer patients receiving amantadine remained in a vegetative state compared with patients receiving placebo. Benzodiazepines almost always, hinder cognition recover. The antiviral drug amantadine may reduce aggression in people with chronic traumatic brain injury tbidefined as symptoms lasting for more than six months postinjury, according to a study published in the septemberoctober issue of the journal of head trauma rehabilitation. As the treatment for cognitive dysfunction in severe tbi is relatively limited. Effectiveness of amantadine hydrochloride for treatment of. Evidencebased practice traumatic brain injury panel members.
Amantadine for the treatment of traumatic brain injury irritability and aggression. You may report side effects to the fda at 1800fda1088. Other side effects not listed may also occur in some patients. A randomized trial of modafinil for the treatment of fatigue and excessive daytime sleepiness in individuals with chronic traumatic brain injury. Diagnostic testing and therapeutics for patients with severe tbi are 2 areas on which there is increasing focus. Placebocontrolled trial of amantadine for severe traumatic brain. It can be started days to months postinjury and still produces benefits. Ancc amantadine to treat cognitive dysfunction in moderate to. Sep 24, 2018 a smaller study n 35 of individuals with acute tbi found greater improvements in minimental status, disability rating scale, gcs, and functional independence measure who received amantadine 200 mg as compared to placebo for 6 weeks from time of injury to up to 12 weeks postinjury in a crossover design.
Amantadine was originally introduced and utilized as an antiviral medication. To explore how amantadine transitioned from an antiflu drug to antiparkinsonian agent. A medline search was conducted and yielded five papers. We performed this study as a doubleblind, randomized, controlled clinical trial with target population including all patients with tbi who scored nine or lower on the glasgow coma. Division of child and adolescent psychiatry, department of psychiatry. This study aims to begin to address the gap in the current knowledge base by conducting a singlecenter, prospective, doubleblind, randomized, placebocontrolled trial to determine the safety. Disruptive mood dysregulation disorder dmdd developing. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only.
Amantadine minimally improves arousal in patients with severe. Recommendations on the pharmacological management of tbirelated impairments health canada indications of use authors year referenced clinical practice guidelines neurobehavioral guidelines working group ngwg deborah l. Useful in both acute and chronic tbi agitation 28, 30, 31 ii. Placebocontrolled trial of amantadine for severe traumatic. Amantadine comes as a capsule, extendedrelease capsule gocovri, tablet, and liquid to take by mouth. Amantadine and cognition in chronic traumatic brain injury. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. In previous studies amantadine has been used to treat various symptoms in the setting of traumatic brain injury, ranging from certain aspects of frontal lobe. Dec 23, 20 amantadine, a readily available, inexpensive, easytoadminister medication, was effective for irritability in outpatients with chronic, moderate traumatic brain injury. Original article from the new england journal of medicine placebocontrolled trial of amantadine for severe traumatic brain injury. After 4 weeks of treatment, a lower percentage of patients in the amantadine group remained in a vegetative state or an extreme vegetative state, compared with their counterparts in the.
Traumatic brain injury tbi is a leading cause of death and disability. Pdf amantadine treatment of a patient with anoxic brain injury. Ancc amantadine to treat cognitive dysfunction in moderate. Aggression in the whole group might not have significantly improved because of a ceiling effect. Efficacy of modafinil, methylphenidate, amantadine, and. Grimsmo j, andersson s, finset a 1992 amantadine treatment of severe attentional disorder in traumatic brain injury patients. Amantadine is a dopaminergic and serotonergic agonist. The effects of amantadine on traumatic brain injury outcome. Book of abstracts, xith world congress of the international federation of physical medicine and rehabilitation, 1620 sept 1992, dresden. Pdf an 18yearold boy with anoxic brain injury, suffering from severe psychomotor inhibition, tetrarigidity and dystonia, was treated with. Traumatic brain injury tbi is commonly defined as an insult to the brain from an external force that causes temporary or permanent impairment in functional, psychosocial, or physical abilities. Although earlier studies from 1994 to 2003 were lowerlevel studies and recommended further research on treatment of cognitive dysfunction in tbi, the literature from 2004 to present generally concluded that amantadine. Improves cognition similarly to amantadine above iii.
First evaluate side effects of current medications anticholinergic, antihistaminic, sedative. Amantadine for traumatic brain injury wiley online library. A single patient noticed relief in her parkinson disease pd. Treatment with amantadine also was more effective in improving recovery regardless of whether it was administered within 410 weeks or 1016 weeks postinjury. Request pdf placebocontrolled trial of amantadine for severe. Medication management for tbi jun zhang, md, faapmr. By listing the following individuals or organizations, it does not infer that these individuals or organizations support or endorse the traumatic brain injury guideline developed by acoem. The effects of amantadine on traumatic brain injury. Take amantadine at around the same time s every day. If you notice any other effects, check with your healthcare professional.
It is the most common cause of death and disability in adults between the ages of 15 and 30 years. Research into traumatic brain injury tbi has increased significantly. The capsules, tablets, and liquid medications are usually taken once or twice a day. The extendedrelease capsules are taken once a day at bedtime. Utilization of amantadine in traumatic brain injury. Dosage use and side effect profiles were consistent with.
Amantadine, a readily available, inexpensive, easytoadminister medication, was effective for irritability in outpatients with chronic, moderate traumatic brain injury. Trial of amantadine hydrochloride in the treatment of. In six healthy volunteers, the ratio of amantadine renal clearance to apparent oral plasma clearance was 0. Patients with posttraumatic disorders of consciousness who received amantadine hydrochloride experienced a more rapid rate of functional recovery than those treated with a placebo, according to an article published in the march 1 new england journal of. Crosssectional and longitudinal abnormalities in brain structure in children with severe mood dysregulation or bipolar disorder, j child psychology, psychiatry, and allied disciplines, 53, 11, 11491156. This singlecenter study the second largest outpatient study including multicenter studies ever published on any tbi treatment examines.