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Dekundy A, Pichler G, El Badry R, Scheschonka A, Danysz W. Amantadine for Traumatic Brain Injury-Supporting Evidence and Mode of Action. Biomedicines 2024; 12:1558. [PMID: 39062131 PMCID: PMC11274811 DOI: 10.3390/biomedicines12071558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Traumatic brain injury (TBI) is an important global clinical issue, requiring not only prevention but also effective treatment. Following TBI, diverse parallel and intertwined pathological mechanisms affecting biochemical, neurochemical, and inflammatory pathways can have a severe impact on the patient's quality of life. The current review summarizes the evidence for the utility of amantadine in TBI in connection to its mechanism of action. Amantadine, the drug combining multiple mechanisms of action, may offer both neuroprotective and neuroactivating effects in TBI patients. Indeed, the use of amantadine in TBI has been encouraged by several clinical practice guidelines/recommendations. Amantadine is also available as an infusion, which may be of particular benefit in unconscious patients with TBI due to immediate delivery to the central nervous system and the possibility of precise dosing. In other situations, orally administered amantadine may be used. There are several questions that remain to be addressed: can amantadine be effective in disorders of consciousness requiring long-term treatment and in combination with drugs approved for the treatment of TBI? Do the observed beneficial effects of amantadine extend to disorders of consciousness due to factors other than TBI? Well-controlled clinical studies are warranted to ultimately confirm its utility in the TBI and provide answers to these questions.
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Affiliation(s)
- Andrzej Dekundy
- Merz Therapeutics GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt am Main, Germany; (A.D.); (A.S.)
| | - Gerald Pichler
- Department of Neurology, Albert-Schweitzer-Hospital Graz, Albert-Schweitzer-Gasse 36, 8020 Graz, Austria;
| | - Reda El Badry
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, Assiut University, Assiut 71526, Egypt;
| | - Astrid Scheschonka
- Merz Therapeutics GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt am Main, Germany; (A.D.); (A.S.)
| | - Wojciech Danysz
- Danysz Pharmacology Consulting, Vor den Gärten 16, 61130 Nidderau, Germany
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Gatto LAM, Demartini Z, Telles JPM, Figueiredo EG. Does amantadine improve cognitive recovery in severe disorders of consciousness after aneurysmal subarachnoid hemorrhage? A double-blind placebo-controlled study. Clin Neurol Neurosurg 2024; 237:108135. [PMID: 38330801 DOI: 10.1016/j.clineuro.2024.108135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Severe disorders of consciousness (sDoC) are a common sequela of aneurysmal subarachnoid hemorrhages (aSAH), and amantadine has been used to improve cognitive recovery after traumatic brain injury. OBJECTIVE This study evaluated the effect of amantadine treatment on consciousness in patients with sDoC secondary to aSAH. METHODS This double-center, randomized, prospective, cohort study included patients ≥ 18 years old with sDoC after aSAH from February 2020 to September 2023. Individual patient data of patients were pooled to determine the effect of amantadine, in comparison to placebo. The primary outcomes at 3 and 6 months after the ictus were evaluated using the modified Rankin scale (mRS) and Glasgow outcome scale (GOS). In addition to all-cause mortality, secondary endpoints were assessed weekly during intervention by scores on Rappaport's Disability Rating Scale (RDRS) and Coma Recovery Scale-Revised (CRSR). RESULTS Overall, 37 patients with sDoC and initial Glasgow Coma Scale (GCS) varying between 3 and 11 were recruited and randomized to amantadine (test group, n = 20) or placebo (control group, n = 17). The average age was 59.5 years (28 to 81 year-old), 24 (65%) were women, and the mean GCS at the beginning of intervention was 7.1. Most patients evolved to vasospasm (81%), with ischemia in 73% of them. The intervention was started between 30 to 180 days after the ictus, and administered for 6 weeks, with progressively higher doses. Neither epidemiological characteristics nor considerations regarding the treatment of the aneurysm and its complications differed between both arms. Overall mortality was 10.8% (4 deaths). During the study, four patients had potential adverse drug effects: two presented seizures, one had paralytic ileus, and another evolved with tachycardia; the medication was not suspended, only the dose was not increased. At data opening, 2 were taking amantadine and 2 placebo. CONCLUSION Despite some good results associated with amantadine in the literature, this study did not find statistically significant positive effects in cognitive recovery in patients with delayed post-aSAH sDoC. Further large randomized clinical trials in patients' subgroups are needed to better define its effectiveness and clarify any therapeutic window where it can be advantageous.
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Affiliation(s)
| | - Zeferino Demartini
- Department of Neurosurgery, Hospital de Clinicas - Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - João Paulo Mota Telles
- Department of Neurology, Hospital das Clinicas, Universidade de São Paulo, São Paulo, SP, Brazil
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Molteni E, Canas LDS, Briand MM, Estraneo A, Font CC, Formisano R, Fufaeva E, Gosseries O, Howarth RA, Lanteri P, Licandro GI, Magee WL, Veeramuthu V, Wilson P, Yamaki T, Slomine BS. Scoping Review on the Diagnosis, Prognosis, and Treatment of Pediatric Disorders of Consciousness. Neurology 2023; 101:e581-e593. [PMID: 37308301 PMCID: PMC10424839 DOI: 10.1212/wnl.0000000000207473] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/17/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Comprehensive guidelines for the diagnosis, prognosis, and treatment of disorders of consciousness (DoC) in pediatric patients have not yet been released. We aimed to summarize available evidence for DoC with >14 days duration to support the future development of guidelines for children, adolescents and young adults aged 6 months-18 years. METHODS This scoping review was reported based on Preferred Reporting Items for Systematic reviews and Meta-Analyses-extension for Scoping Reviews guidelines. A systematic search identified records from 4 databases: PubMed, Embase, Cochrane Library, and Web of Science. Abstracts received 3 blind reviews. Corresponding full-text articles rated as "in-scope" and reporting data not published in any other retained article (i.e., no double reporting) were identified and assigned to 5 thematic evaluating teams. Full-text articles were reviewed using a double-blind standardized form. Level of evidence was graded, and summative statements were generated. RESULTS On November 9, 2022, 2,167 documents had been identified; 132 articles were retained, of which 33 (25%) were published over the past 5 years. Overall, 2,161 individuals met the inclusion criteria; female patients were 527 of 1,554 (33.9%) cases included, whose sex was identifiable. Of 132 articles, 57 (43.2%) were single case reports and only 5 (3.8%) clinical trials; the level of evidence was prevalently low (80/132; 60.6%). Most studies included neurobehavioral measures (84/127; 66.1%) and neuroimaging (81/127; 63.8%); 59 (46.5%) were mainly related to diagnosis, 56 (44.1%) to prognosis, and 44 (34.6%) to treatment. Most frequently used neurobehavioral tools included the Coma Recovery Scale-Revised, Coma/Near-Coma Scale, Level of Cognitive Functioning Assessment Scale, and Post-Acute Level of Consciousness scale. EEG, event-related potentials, structural CT, and MRI were the most frequently used instrumental techniques. In 29/53 (54.7%) cases, DoC improvement was observed, which was associated with treatment with amantadine. DISCUSSION The literature on pediatric DoCs is mainly observational, and clinical details are either inconsistently presented or absent. Conclusions drawn from many studies convey insubstantial evidence and have limited validity and low potential for translation in clinical practice. Despite these limitations, our work summarizes the extant literature and constitutes a base for future guidelines related to the diagnosis, prognosis, and treatment of pediatric DoC.
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Affiliation(s)
- Erika Molteni
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD.
| | - Liane Dos Santos Canas
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Marie-Michèle Briand
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Anna Estraneo
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Carolina Colomer Font
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Rita Formisano
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Ekaterina Fufaeva
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Olivia Gosseries
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Robyn A Howarth
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Paola Lanteri
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Gimena Inès Licandro
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Wendy L Magee
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Vigneswaran Veeramuthu
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Pamela Wilson
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Tomohiro Yamaki
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Beth S Slomine
- From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
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4
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Khormali M, Heidari S, Ahmadi S, Arab Bafrani M, Baigi V, Sharif-Alhoseini M. N-methyl-D-aspartate receptor antagonists in improving cognitive deficits following traumatic brain injury: a systematic review. Brain Inj 2022; 36:1071-1088. [PMID: 35997315 DOI: 10.1080/02699052.2022.2109749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To review the role of N-methyl-D-aspartate receptor (NMDAR) antagonists in managing post-TBI cognitive deficits. METHODS A search of PubMed, Embase, and Cochrane was conducted on Jan 12, 2021 without publication date or language restriction. RESULTS Forty-seven studies were included, involving 20 (42.6%) randomized controlled trials. Four (8.5%) studies had a low risk of bias (RoB), while 34 (72.3%) had unclear and nine (19.2%) had high RoB. Six NMDAR antagonists had been investigated: amantadine (n = 32), memantine (n = 4), magnesium (n = 4), traxoprodil (n = 3), selfotel (n = 2), and dextromethorphan (n = 2). CONCLUSION Although some benefits were observed, there are still some concerns regarding the efficacy and safety of NMDAR antagonists in improving post-TBI cognitive deficits. Further research is required to examine whether (i) these agents, notably amantadine, could accelerate cognitive improvement and shorten the hospital stay, (ii) these agents affect different cognitive domains/subdomains in the same direction, (iii) an optimal therapeutic time window exists, (iv) a member of this drug class can be proved to be effective without interfering in non-excitotoxic actions of glutamate, (v) they can be more effective as part of combination therapies or in particular subgroups of patients with TBI.
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Affiliation(s)
- Moein Khormali
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sama Heidari
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sana Ahmadi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Arab Bafrani
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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5
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McLaughlin MJ, Caliendo E, Lowder R, Watson WD, Kurowski B, Baum KT, Blackwell LS, Koterba CH, Hoskinson KR, Tlustos SJ, Zimmerman KO, Shah SA, Suskauer SJ. Prescribing Patterns of Amantadine During Pediatric Inpatient Rehabilitation After Traumatic Brain Injury: A Multicentered Retrospective Review From the Pediatric Brain Injury Consortium. J Head Trauma Rehabil 2022; 37:240-248. [PMID: 34320554 PMCID: PMC8789935 DOI: 10.1097/htr.0000000000000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To describe dosing practices for amantadine hydrochloride and related adverse effects among children and young adults with traumatic brain injury (TBI) admitted to pediatric inpatient rehabilitation units. SETTING Eight pediatric acute inpatient rehabilitation units located throughout the United States comprising the Pediatric Brain Injury Consortium. PARTICIPANTS Two-hundred thirty-four children and young adults aged 2 months to 21 years with TBI. DESIGN Retrospective data revie. MAIN OUTCOME MEASURES Demographic variables associated with the use of amantadine, amantadine dose, and reported adverse effects. RESULTS Forty-nine patients (21%) aged 0.9 to 20 years received amantadine during inpatient rehabilitation. Forty-five percent of patients admitted to inpatient rehabilitation with a disorder of consciousness (DoC) were treated with amantadine, while 14% of children admitted with higher levels of functioning received amantadine. Children with DoC who were not treated with amantadine were younger than those with DoC who received amantadine (median 3.0 vs 11.6 years, P = .008). Recorded doses of amantadine ranged from 0.7 to 13.5 mg/kg/d; the highest total daily dose was 400 mg/d. Adverse effects were reported in 8 patients (16%); nausea/abdominal discomfort and agitation were most common, each reported in 3 patients. The highest reported dose without an adverse effect was 10.1 mg/kg/d. CONCLUSION During pediatric inpatient rehabilitation, amantadine was prescribed to children across a range of ages and injury severity and was most commonly prescribed to older children with DoC. Dosing varied widely, with weight-based dosing for younger/smaller children at both lower and higher doses than what had been previously reported. Prospective studies are needed to characterize the safety and tolerability of higher amantadine doses and optimize amantadine dosing parameters for children with TBI.
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Affiliation(s)
- Matthew J. McLaughlin
- Division of Pediatric Rehabilitation Medicine, Children’s Mercy - Kansas City, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Eric Caliendo
- Weill Cornell School of Medicine, New York, New York
| | - Ryan Lowder
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - William D. Watson
- Blythedale Children’s Hospital, Valhalla, New York
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Brad Kurowski
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Laura S. Blackwell
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Christine H. Koterba
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, OH
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Kristen R. Hoskinson
- The Ohio State University College of Medicine, Columbus, Ohio
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Sarah J. Tlustos
- Department of Rehabilitation, Children’s Hospital Colorado and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kanecia O. Zimmerman
- Division of Critical Care Medicine, Department of Pediatrics, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | - Sudhin A. Shah
- Blythedale Children’s Hospital, Valhalla, New York
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
| | - Stacy J. Suskauer
- Kennedy Krieger Institute, Baltimore, Maryland
- Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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6
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Mohamed MS, El Sayed I, Zaki A, Abdelmonem S. Assessment of the effect of amantadine in patients with traumatic brain injury: A meta-analysis. J Trauma Acute Care Surg 2022; 92:605-614. [PMID: 34284464 DOI: 10.1097/ta.0000000000003363] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic brain injury is a global burden. We aimed to perform a meta-analysis to determine the efficacy of amantadine for cognitive performance after traumatic brain injury. METHODS The systematic review was prospectively registered on the International Prospective Register of Systematic Reviews website under the registration number CRD42017080044. We used Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to report the steps of meta-analysis. The search included electronic databases (PubMed, PsycINFO, Embase, Cochrane Library databases, CENTRAL, ProQuest and ClinicalTrials.gov trial registry). Critical care medicine journals and clinical neurology specialty were searched using www.scimagojr.com. There was no publication date restriction. Two authors assessed studies' relevance and extracted data. Studies were assessed for quality using the Cochrane risk of bias tool. Data were analyzed using Comprehensive Meta-analysis Program versions 2.0 and 3.0. RESULTS Twenty-six studies out of 3,440 records were included in the systematic review, of which only 14 clinical trials and 6 observational studies were included in the meta-analysis. Amantadine significantly enhanced the cognitive function relative to control group (mean difference [MD], 0.50; 95% confidence interval [CI], 0.33-0.66; p < 0.001, 16 studies, 1,127 participants, low certainty evidence). Consistent significant difference in favor of amantadine relative to control group was found (MD of 0.79 [95% CI, 0.34-1.24], very low certainty evidence, for cohort studies vs. MD of 0.40 [95% CI, 0.25-0.56], moderate certainty evidence, for RCTS). Starting amantadine in the first week after TBI had a significant effect on improving cognitive function (MD, 0.97; 95% CI, 0.45-1.49; 16 studies, 1,127 participants, low certainty). Amantadine showed a better effect when administered for less than 1 month (MD, 0.83; 95% CI, 0.56-1.11; low certainty) and to patients below 18 years of age (MD, 0.66; 95% CI, 0.32-0.99; low certainty) or to patients with less severe traumatic brain injury (MD, 0.40; 95% CI, 0.18-0.62; low certainty). No statistically significant difference existed between amantadine and the control concerning the adverse events (OR, 1.74; 95% CI, 0.88-3.44; p = 0.11, moderate certainty). Metaregression of the different clinical parameters, which are onset of treatment, age, and severity of traumatic brain injury, showed a statistically significant relation between onset of treatment and the effect size of amantadine. The relation between the other two parameters and the effect size of amantadine showed a marginal statistical significance. CONCLUSION Amantadine may improve the cognitive function when used after TBI. Further research with high validity is needed to reach a solid conclusion about the use of amantadine in traumatic brain injury. LEVEL OF EVIDENCE Systematic review/meta-analysis, level III.
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Affiliation(s)
- Mona Salah Mohamed
- From the Department of Clinical Pharmacy and Pharmacy Practice (M.S.M.), Faculty of Pharmacy, Pharos University in Alexandria; and Department of Biomedical Informatics and Medical Statistics (I.E.S., A.Z.), Medical Research Institute, and Department of Critical Care Medicine (S.A.), Faculty of Medicine, Alexandria University, Alexandria, Egypt
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7
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Irzan H, Pozzi M, Chikhladze N, Cebanu S, Tadevosyan A, Calcii C, Tsiskaridze A, Melbourne A, Strazzer S, Modat M, Molteni E. Emerging Treatments for Disorders of Consciousness in Paediatric Age. Brain Sci 2022; 12:198. [PMID: 35203961 PMCID: PMC8870410 DOI: 10.3390/brainsci12020198] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
The number of paediatric patients living with a prolonged Disorder of Consciousness (DoC) is growing in high-income countries, thanks to substantial improvement in intensive care. Life expectancy is extending due to the clinical and nursing management achievements of chronic phase needs, including infections. However, long-known pharmacological therapies such as amantadine and zolpidem, as well as novel instrumental approaches using direct current stimulation and, more recently, stem cell transplantation, are applied in the absence of large paediatric clinical trials and rigorous age-balanced and dose-escalated validations. With evidence building up mainly through case reports and observational studies, there is a need for well-designed paediatric clinical trials and specific research on 0-4-year-old children. At such an early age, assessing residual and recovered abilities is most challenging due to the early developmental stage, incompletely learnt motor and cognitive skills, and unreliable communication; treatment options are also less explored in early age. In middle-income countries, the lack of rehabilitation services and professionals focusing on paediatric age hampers the overall good assistance provision. Young and fast-evolving health insurance systems prevent universal access to chronic care in some countries. In low-income countries, rescue networks are often inadequate, and there is a lack of specialised and intensive care, difficulty in providing specific pharmaceuticals, and lower compliance to intensive care hygiene standards. Despite this, paediatric cases with DoC are reported, albeit in fewer numbers than in countries with better-resourced healthcare systems. For patients with a poor prospect of recovery, withdrawal of care is inhomogeneous across countries and still heavily conditioned by treatment costs as well as ethical and cultural factors, rather than reliant on protocols for assessment and standardised treatments. In summary, there is a strong call for multicentric, international, and global health initiatives on DoC to devote resources to the paediatric age, as there is now scope for funders to invest in themes specific to DoC affecting the early years of the life course.
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Affiliation(s)
- Hassna Irzan
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 7JE, UK
| | - Marco Pozzi
- Scientific Institute IRCCS E. Medea, Acquired Brain Injury Unit, 22040 Bosisio Parini, Italy; (M.P.); (S.S.)
| | - Nino Chikhladze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia; (N.C.); (A.T.)
| | - Serghei Cebanu
- Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD-2004 Chišināu, Moldova; (S.C.); (C.C.)
| | - Artashes Tadevosyan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan 0025, Armenia;
| | - Cornelia Calcii
- Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD-2004 Chišināu, Moldova; (S.C.); (C.C.)
| | - Alexander Tsiskaridze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia; (N.C.); (A.T.)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 7JE, UK
| | - Sandra Strazzer
- Scientific Institute IRCCS E. Medea, Acquired Brain Injury Unit, 22040 Bosisio Parini, Italy; (M.P.); (S.S.)
- Rehabilitation Service, “Usratuna” Health and Rehabilitation Centre, Juba, South Sudan
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
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Fridman EA, Schiff ND. Organizing a Rational Approach to Treatments of Disorders of Consciousness Using the Anterior Forebrain Mesocircuit Model. J Clin Neurophysiol 2022; 39:40-48. [PMID: 34474427 PMCID: PMC8900660 DOI: 10.1097/wnp.0000000000000729] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY Organizing a rational treatment strategy for patients with multifocal structural brain injuries and disorders of consciousness (DOC) is an important and challenging clinical goal. Among potential clinical end points, restoring elements of communication to DOC patients can support improved patient care, caregiver satisfaction, and patients' quality of life. Over the past decade, several studies have considered the use of the anterior forebrain mesocircuit model to approach this problem because this model proposes a supervening circuit-level impairment arising across DOC of varying etiologies. We review both the conceptual foundation of the mesocircuit model and studies of mechanisms underlying DOC that test predictions of this model. We consider how this model can guide therapeutic interventions and discuss a proposed treatment algorithm based on these ideas. Although the approach reviewed originates in the evaluation of patients with chronic DOC, we consider some emerging implications for patients in acute and subacute settings.
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Affiliation(s)
- Esteban A Fridman
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, U.S.A
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9
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Danysz W, Dekundy A, Scheschonka A, Riederer P. Amantadine: reappraisal of the timeless diamond-target updates and novel therapeutic potentials. J Neural Transm (Vienna) 2021; 128:127-169. [PMID: 33624170 PMCID: PMC7901515 DOI: 10.1007/s00702-021-02306-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/13/2021] [Indexed: 12/30/2022]
Abstract
The aim of the current review was to provide a new, in-depth insight into possible pharmacological targets of amantadine to pave the way to extending its therapeutic use to further indications beyond Parkinson's disease symptoms and viral infections. Considering amantadine's affinities in vitro and the expected concentration at targets at therapeutic doses in humans, the following primary targets seem to be most plausible: aromatic amino acids decarboxylase, glial-cell derived neurotrophic factor, sigma-1 receptors, phosphodiesterases, and nicotinic receptors. Further three targets could play a role to a lesser extent: NMDA receptors, 5-HT3 receptors, and potassium channels. Based on published clinical studies, traumatic brain injury, fatigue [e.g., in multiple sclerosis (MS)], and chorea in Huntington's disease should be regarded potential, encouraging indications. Preclinical investigations suggest amantadine's therapeutic potential in several further indications such as: depression, recovery after spinal cord injury, neuroprotection in MS, and cutaneous pain. Query in the database http://www.clinicaltrials.gov reveals research interest in several further indications: cancer, autism, cocaine abuse, MS, diabetes, attention deficit-hyperactivity disorder, obesity, and schizophrenia.
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Affiliation(s)
- Wojciech Danysz
- Merz Pharmaceuticals GmbH., Eckenheimer Landstraße 100, 60318, Frankfurt am Main, Germany
| | - Andrzej Dekundy
- Merz Pharmaceuticals GmbH., Eckenheimer Landstraße 100, 60318, Frankfurt am Main, Germany
| | - Astrid Scheschonka
- Merz Pharmaceuticals GmbH., Eckenheimer Landstraße 100, 60318, Frankfurt am Main, Germany
| | - Peter Riederer
- Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, University of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany.
- Department Psychiatry, University of Southern Denmark Odense, Vinslows Vey 18, 5000, Odense, Denmark.
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10
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Dale ML, Brumbach BH, Boxer AL, Hiller AL. Associations Between Amantadine Usage, Gait, and Cognition in PSP: A post-hoc Analysis of the Davunetide Trial. Front Neurol 2021; 11:606925. [PMID: 33408688 PMCID: PMC7779593 DOI: 10.3389/fneur.2020.606925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: Amantadine anecdotally improves gait in progressive supranuclear palsy (PSP) but definitive data is lacking. We investigated associations between amantadine usage, gait, cognition, and activities of daily living in 310 subjects with PSP using data from the davunetide trial. Method: We compared baseline demographics, PSP Rating Scale (PSPRS), Repeat Battery for the Assessment of Neuropsychological Status (RBANS), and Schwab and England Activities of Daily Living (SEADL) scores between subjects taking vs. not taking amantadine using chi-square tests for categorical variables and independent sample t-tests for continuous variables. Using the general linear model (GLM), we tested whether group status predicted total PSPRS, PSPRS-gait and midline, total RBANS, RBANS-attention, and SEADL before and after the 52-weeks follow-up. Results: Subjects taking vs. not taking amantadine were similar at baseline, except subjects taking amantadine had a higher Clinical Global Impression (CGI) Score (p = 0.01). However, the CGI change score did not differ between groups at week 52 (p = 0.10). Using GLM models (controlling for covariates), we found that subjects taking vs. not taking amantadine did not significantly predict total PSPRS, PSPRS-gait and midline, total RBANS, RBANS-attention, or SEADL at baseline, week 52, or the change score between baseline and week 52. Discussion: This post-hoc analysis of the davunetide trial did not find an association between amantadine and gait or cognitive measures in PSP, but was not powered to find such a difference. Future studies should still examine amantadine for symptomatic benefit in multiple PSP subtypes.
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Affiliation(s)
- Marian L Dale
- Department of Neurology, Oregon Health & Science University, The VA Portland Health Care System, Portland, OR, United States
| | - Barbara H Brumbach
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, United States
| | - Adam L Boxer
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Amie L Hiller
- Department of Neurology, Oregon Health & Science University, The VA Portland Health Care System, Portland, OR, United States
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Molteni E, Colombo K, Pastore V, Galbiati S, Recla M, Locatelli F, Galbiati S, Fedeli C, Strazzer S. Joint Neuropsychological Assessment through Coma/Near Coma and Level of Cognitive Functioning Assessment Scales Reduces Negative Findings in Pediatric Disorders of Consciousness. Brain Sci 2020; 10:E162. [PMID: 32178348 PMCID: PMC7140001 DOI: 10.3390/brainsci10030162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/28/2020] [Accepted: 03/10/2020] [Indexed: 01/26/2023] Open
Abstract
The present study aimed to: (a) characterize the emergence to a conscious state (CS) in a sample of children and adolescents with severe brain injury during the post-acute rehabilitation and through two different neuropsychological assessment tools: the Rappaport Coma/Near Coma Scale (CNCS) and Level of Cognitive Functioning Assessment Scale (LOCFAS); (b) compare the evolution in patients with brain lesions due to traumatic and non-traumatic etiologies; and (c) describe the relationship between the emergence to a CS and some relevant clinical variables. In this observational prospective longitudinal study, 92 consecutive patients were recruited. Inclusion criteria were severe disorders of consciousness (DOC), Glasgow Coma Scale (GCS) score ≤8 at insult, age 0 to 18 years, and direct admission to inpatient rehabilitation from acute care. The main outcome measures were CNCS and LOCFAS, both administered three and six months after injury. The cohort globally shifted towards milder DOC over time, moving from overall 'moderate/near coma' at three months to 'near/no coma' at six months post-injury. The shift was captured by both CNCS and LOCFAS. CNCS differentiated levels of coma at best, while LOCFAS was superior in characterizing the emergence from coma. Agreement between scales was fair, and reduced negative findings at less than 10%. Patients with traumatic brain injury (TBI) vs. non-traumatic brain injury (NTBI) were older and had neurosurgical intervention more frequently. No relation between age and the level of consciousness was found overall. Concurrent administration of CNCS and LOCFAS reduced the rate of false negatives and better detected signs of arousal and awareness. This provides indication to administer both tools to increase measurement precision.
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Affiliation(s)
- Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, and Centre for Medical Engineering, King’s College, London SE1 7EU, UK
| | - Katia Colombo
- Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.P.); (S.G.); (M.R.); (C.F.)
| | - Valentina Pastore
- Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.P.); (S.G.); (M.R.); (C.F.)
| | - Susanna Galbiati
- Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.P.); (S.G.); (M.R.); (C.F.)
| | - Monica Recla
- Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.P.); (S.G.); (M.R.); (C.F.)
| | - Federica Locatelli
- Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (F.L.); (S.G.); (S.S.)
| | - Sara Galbiati
- Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (F.L.); (S.G.); (S.S.)
| | - Claudia Fedeli
- Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (V.P.); (S.G.); (M.R.); (C.F.)
| | - Sandra Strazzer
- Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy; (F.L.); (S.G.); (S.S.)
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Morrison A, Houtrow A, Zullo J, Kochanek P, Vetterly C, Fink E. Neurostimulant Prescribing Patterns in Children Admitted to the Intensive Care Unit after Traumatic Brain Injury. J Neurotrauma 2018; 36:293-299. [PMID: 29756534 DOI: 10.1089/neu.2017.5575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Neurostimulant medications are commonly prescribed following traumatic brain injury (TBI) in adults; little is known about their use in children with TBI. Our objective was to analyze neurostimulant prescribing practices from 2005 to 2015 in children admitted to the intensive care unit (ICU) with TBI. We hypothesized that neurostimulant prescriptions have increased over time and are associated with older age and injury severity. A retrospective cohort study of patients age 1 month to 18 years with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) discharge diagnosis code for TBI admitted to the ICU between 2005 and 2015 in 37 pediatric hospitals included in the Pediatric Health Information System was conducted. Variables examined include patient and injury characteristics and neurostimulant medication use. Descriptive statistics and multi-variable logistic regression testing were used to determine variables associated with neurostimulant prescription. Of 30,881 patients with TBI, most were male (64%) and age 0-4 years (43%). In patients with mechanism of injury reported (n = 21,998), TBI was most frequently due to falls (36%) and motor vehicle collisions (36%). One thousand sixty-four neurostimulants were prescribed to 878 (3%) patients with 41% of prescriptions for amantadine and 38% for methylphenidate. Neurostimulants were prescribed a median (interquartile range) of 17 (8-35) days post-injury and increased over the study decade (R2 = 0.806). In a multi-variable analysis, variables most strongly associated with receipt of a neurostimulant were age 14-18 years (odds ratio 5.8, 95% confidence interval [4.3,7.8]), motor vehicle collision (3.1, [2.4,4.2]), intracranial pressure (ICP) monitor (3.8, [3.1,4.5]), and mechanical ventilation (3.4, [2.7,4.3]). Use of neurostimulants following pediatric TBI is uncommon, has increased over time, and is associated with indicators of higher severity of illness. Knowledge of prescribing practices may assist in optimizing the design of efficacy and outcome studies that will inform clinical guidelines.
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Affiliation(s)
- Amanda Morrison
- 1 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Amy Houtrow
- 2 Department of Physical Medicine and Rehabilitation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Jim Zullo
- 3 CHP-Data Warehouse, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Patrick Kochanek
- 4 Department of Critical Care Medicine, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Carol Vetterly
- 5 Pharmacy Services, Pediatric Critical Care, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Ericka Fink
- 6 Division of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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13
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Plummer NR, Tam AWF, Mulvaney CA, Preston NJ, Laha SK. Dopamine agonists for traumatic brain injury. Hippokratia 2018. [DOI: 10.1002/14651858.cd013062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicholas R Plummer
- Lancashire Teaching Hospitals NHS Foundation Trust; Critical Care Unit, Royal Preston Hospital; Sharoe Green Lane Preston Lancashire UK PR1 9TS
- Health Education East Midlands; Westbridge Place 1 Westbridge Close Leicester Leicestershirew UK LE3 5DR
| | - Alex WF Tam
- University of Liverpool; School of Health Sciences; Liverpool UK
| | | | - Nancy J Preston
- Lancaster University; International Observatory on End of Life Care; Furness College Lancaster UK LA1 4YG
| | - Shondipon K Laha
- Lancashire Teaching Hospitals NHS Foundation Trust; Critical Care Unit, Royal Preston Hospital; Sharoe Green Lane Preston Lancashire UK PR1 9TS
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Ghalaenovi H, Fattahi A, Koohpayehzadeh J, Khodadost M, Fatahi N, Taheri M, Azimi A, Rohani S, Rahatlou H. The effects of amantadine on traumatic brain injury outcome: a double-blind, randomized, controlled, clinical trial. Brain Inj 2018; 32:1050-1055. [PMID: 29790790 DOI: 10.1080/02699052.2018.1476733] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Amantadine, as a dopamine receptor agonist, may stimulate and help the recovery of the nervous system after traumatic brain injury (TBI). METHODS We performed this study as a double-blind, randomized, controlled clinical trial with target population including all patients with TBI who scored nine or lower on the Glasgow Coma Scale (GCS), admitted to our hospital between January 2013 and April 2014. The protocol included administration of the drug (placebo or amantadine) for 6 weeks and patient evaluation using the GCS and FOUR score on the first, third and seventh days after the drug was started. After 6 months from starting study drug, the patients were evaluated on the Mini-Mental State Examination, Glasgow Outcome Study, Disability Rating Scale and Karnofsky Performance Scale. RESULTS We included 40 patients in the study. The mean age of the patients was 36.77 ± 18.21. As an only important finding, the amantadine group registered an important rise between the first and the seventh day of study drug (∆GCS7-GCS1) with p-value = 0.044. CONCLUSION Based on our findings during the first week and the 6 months (since starting drug) follow-ups, prescribing amantadine did not lead to reportable effects on the patients' level of consciousness, memory, disability, cognition, mortality and performance.
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Affiliation(s)
- Hossein Ghalaenovi
- a Medical Doctor, Assistant Professor of Neurosurgery,Department of Neurosurgery , Iran University of Medical Sciences , Tehran , Iran
| | - Arash Fattahi
- a Medical Doctor, Assistant Professor of Neurosurgery,Department of Neurosurgery , Iran University of Medical Sciences , Tehran , Iran
| | | | - Mahmoud Khodadost
- c Epidemiology, Department of Epidemiology, School of Public Health , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Neda Fatahi
- d Master of genetics, Ronash , Medical Genetic Center , Tehran , Iran
| | - Morteza Taheri
- e Medical doctor, Resident of neurosurgery, Department of Neurosurgery , Iran University of Medical Sciences , Tehran , Iran
| | - Alireza Azimi
- e Medical doctor, Resident of neurosurgery, Department of Neurosurgery , Iran University of Medical Sciences , Tehran , Iran
| | - Sadra Rohani
- e Medical doctor, Resident of neurosurgery, Department of Neurosurgery , Iran University of Medical Sciences , Tehran , Iran
| | - Hessam Rahatlou
- e Medical doctor, Resident of neurosurgery, Department of Neurosurgery , Iran University of Medical Sciences , Tehran , Iran
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Letzkus L, Keim-Malpass J, Anderson J, Conaway M, Patrick P, Kennedy C. A retrospective analysis of paroxysmal sympathetic hyperactivity following severe pediatric brain injury. J Pediatr Rehabil Med 2018; 11:153-160. [PMID: 30198878 DOI: 10.3233/prm-160428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There are several gaps in the literature related to the prognosis and care of children who have experienced a brain injury then develop paroxysmal sympathetic hyperactivity (PSH). OBJECTIVE The objective of the present study was to explore the characteristics and prognosis of children who have experienced severe brain injury and developed PSH. METHODOLOGY A secondary analysis was conducted using an established clinical dataset of children who had experienced severe brain injury and were admitted to an academic children's rehabilitation center (n= 83). RESULTS Those children with PSH had a significantly longer acute care length of stay (p= 0.024) and total length of stay (p= 0.034) compared with those without PSH. There was no significant difference in cognitive and motor function or transition to rehabilitation between those with and those without PSH after controlling for age and etiology of injury. IMPLICATIONS The findings from the present study reveal factors regarding the elusive phenomenon of PSH among children.
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Affiliation(s)
- Lisa Letzkus
- School of Nursing, University of Virginia, Charlottesville, VA, USA.,Children's Hospital, University of Virginia, Charlottesville, VA, USA
| | | | - Joel Anderson
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Mark Conaway
- Public Health Sciences, University of Virginia, VA, USA
| | - Peter Patrick
- Curry School of Education, University of Virginia, VA, USA
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16
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Steinberg A, Rittenberger JC, Baldwin M, Faro J, Urban A, Zaher N, Callaway CW, Elmer J. Neurostimulant use is associated with improved survival in comatose patients after cardiac arrest regardless of electroencephalographic substrate. Resuscitation 2017; 123:38-42. [PMID: 29221942 DOI: 10.1016/j.resuscitation.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/25/2017] [Accepted: 12/03/2017] [Indexed: 01/13/2023]
Abstract
AIM Identify EEG patterns that predict or preclude favorable response in comatose post-arrest patients receiving neurostimulants. METHODS We examined a retrospective cohort of consecutive electroencephalography (EEG)-monitored comatose post-arrest patients. We classified the last day of EEG recording before neurostimulant administration based on continuity (continuous/discontinuous), reactivity (yes/no) and malignant patterns (periodic discharges, suppression burst, myoclonic status epilepticus or seizures; yes/no). In subjects who did not receive neurostimulants, we examined the last 24h of available recording. For our primary analysis, we used logistic regression to identify EEG predictors of favorable response to treatment (awakening). RESULTS In 585 subjects, mean (SD) age was 57 (17) years and 227 (39%) were female. Forty-seven patients (8%) received a neurostimulant. Neurostimulant administration independently predicted improved survival to hospital discharge in the overall cohort (adjusted odds ratio (aOR) 4.00, 95% CI 1.68-9.52) although functionally favorable survival did not differ. No EEG characteristic predicted favorable response to neurostimulants. In each subgroup of unfavorable EEG characteristics, neurostimulants were associated with increased survival to hospital discharge (discontinuous background: 44% vs 7%, P=0.004; non-reactive background: 56% vs 6%, P<0.001; malignant patterns: 63% vs 5%, P<0.001). CONCLUSION EEG patterns described as ominous after cardiac arrest did not preclude survival or awakening after neurostimulant administration. These data are limited by their observational nature and potential for selection bias, but suggest that EEG patterns alone should not affect consideration of neurostimulant use.
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Affiliation(s)
- Alexis Steinberg
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jon C Rittenberger
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Maria Baldwin
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States; Department of Neurology, Pittsburgh VA Medical Center, Pittsburgh PA, United States
| | - John Faro
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alexandra Urban
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Naoir Zaher
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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17
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Singh R, Turner RC, Nguyen L, Motwani K, Swatek M, Lucke-Wold BP. Pediatric Traumatic Brain Injury and Autism: Elucidating Shared Mechanisms. Behav Neurol 2016; 2016:8781725. [PMID: 28074078 PMCID: PMC5198096 DOI: 10.1155/2016/8781725] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 11/23/2016] [Indexed: 02/08/2023] Open
Abstract
Pediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditions that affect youth. Recent data, both preclinical and clinical, show that pediatric TBI and ASD share not only similar symptoms but also some of the same biologic mechanisms that cause these symptoms. Prominent symptoms for both disorders include gastrointestinal problems, learning difficulties, seizures, and sensory processing disruption. In this review, we highlight some of these shared mechanisms in order to discuss potential treatment options that might be applied for each condition. We discuss potential therapeutic and pharmacologic options as well as potential novel drug targets. Furthermore, we highlight advances in understanding of brain circuitry that is being propelled by improved imaging modalities. Going forward, advanced imaging will help in diagnosis and treatment planning strategies for pediatric patients. Lessons from each field can be applied to design better and more rigorous trials that can be used to improve guidelines for pediatric patients suffering from TBI or ASD.
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Affiliation(s)
- Rahul Singh
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Ryan C. Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Linda Nguyen
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Kartik Motwani
- Department of Medical Sciences, University of Florida School of Medicine, Gainesville, FL 32611, USA
| | - Michelle Swatek
- Department of Psychology, North Carolina State University, Raleigh, NC 27695, USA
| | - Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
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18
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A Narrative Review of Pharmacologic and Non-pharmacologic Interventions for Disorders of Consciousness Following Brain Injury in the Pediatric Population. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016; 4:56-70. [PMID: 27280064 DOI: 10.1007/s40141-016-0108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Traumatic brain injury (TBI) is the most common cause of long-term disability in the United States. A significant proportion of children who experience a TBI will have moderate or severe injuries, which includes a period of decreased responsiveness. Both pharmacological and non-pharmacological modalities are used for treating disorders of consciousness after TBI in children. However, the evidence supporting the use of potential therapies is relatively scant, even in adults, and overall, there is a paucity of study in pediatrics. The goal of this review is to describe the state of the science for use of pharmacologic and non-pharmacologic interventions for disorders of consciousness in the pediatric population.
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Bhatnagar S, Iaccarino MA, Zafonte R. Pharmacotherapy in rehabilitation of post-acute traumatic brain injury. Brain Res 2016; 1640:164-179. [DOI: 10.1016/j.brainres.2016.01.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 11/30/2022]
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20
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Margulies SS, Kilbaugh T, Sullivan S, Smith C, Propert K, Byro M, Saliga K, Costine BA, Duhaime AC. Establishing a Clinically Relevant Large Animal Model Platform for TBI Therapy Development: Using Cyclosporin A as a Case Study. Brain Pathol 2016; 25:289-303. [PMID: 25904045 DOI: 10.1111/bpa.12247] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/05/2015] [Indexed: 11/26/2022] Open
Abstract
We have developed the first immature large animal translational treatment trial of a pharmacologic intervention for traumatic brain injury (TBI) in children. The preclinical trial design includes multiple doses of the intervention in two different injury types (focal and diffuse) to bracket the range seen in clinical injury and uses two post-TBI delays to drug administration. Cyclosporin A (CsA) was used as a case study in our first implementation of the platform because of its success in multiple preclinical adult rodent TBI models and its current use in children for other indications. Tier 1 of the therapy development platform assessed the short-term treatment efficacy after 24 h of agent administration. Positive responses to treatment were compared with injured controls using an objective effect threshold established prior to the study. Effective CsA doses were identified to study in Tier 2. In the Tier 2 paradigm, agent is administered in a porcine intensive care unit utilizing neurological monitoring and clinically relevant management strategies, and intervention efficacy is defined as improvement in longer term behavioral endpoints above untreated injured animals. In summary, this innovative large animal preclinical study design can be applied to future evaluations of other agents that promote recovery or repair after TBI.
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21
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Osier ND, Dixon CE. Catecholaminergic based therapies for functional recovery after TBI. Brain Res 2015; 1640:15-35. [PMID: 26711850 DOI: 10.1016/j.brainres.2015.12.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022]
Abstract
Among the many pathophysiologic consequences of traumatic brain injury are changes in catecholamines, including dopamine, epinephrine, and norepinephrine. In the context of TBI, dopamine is the one most extensively studied, though some research exploring epinephrine and norepinephrine have also been published. The purpose of this review is to summarize the evidence surrounding use of drugs that target the catecholaminergic system on pathophysiological and functional outcomes of TBI using published evidence from pre-clinical and clinical brain injury studies. Evidence of the effects of specific drugs that target catecholamines as agonists or antagonists will be discussed. Taken together, available evidence suggests that therapies targeting the catecholaminergic system may attenuate functional deficits after TBI. Notably, it is fairly common for TBI patients to be treated with catecholamine agonists for either physiological symptoms of TBI (e.g. altered cerebral perfusion pressures) or a co-occuring condition (e.g. shock), or cognitive symptoms (e.g. attentional and arousal deficits). Previous clinical trials are limited by methodological limitations, failure to replicate findings, challenges translating therapies to clinical practice, the complexity or lack of specificity of catecholamine receptors, as well as potentially counfounding effects of personal and genetic factors. Overall, there is a need for additional research evidence, along with a need for systematic dissemination of important study details and results as outlined in the common data elements published by the National Institute of Neurological Diseases and Stroke. Ultimately, a better understanding of catecholamines in the context of TBI may lead to therapeutic advancements. This article is part of a Special Issue entitled SI:Brain injury and recovery.
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Affiliation(s)
- Nicole D Osier
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, USA; School of Nursing, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - C Edward Dixon
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA; V.A. Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.
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Neuromodulation of the conscious state following severe brain injuries. Curr Opin Neurobiol 2014; 29:172-7. [PMID: 25285395 DOI: 10.1016/j.conb.2014.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/16/2014] [Accepted: 09/22/2014] [Indexed: 11/22/2022]
Abstract
Disorders of consciousness (DOC) following severe structural brain injuries globally affect the conscious state and the expression of goal-directed behaviors. In some subjects, neuromodulation with medications or electrical stimulation can markedly improve the impaired conscious state present in DOC. We briefly review recent studies and provide an organizing framework for considering the apparently widely disparate collection of medications and approaches that may modulate the conscious state in subjects with DOC. We focus on neuromodulation of the anterior forebrain mesocircuit in DOC and briefly compare mechanisms supporting recovery from structural brain injuries to those underlying facilitated emergence from unconsciousness produced by anesthesia. We derive some general principles for approaching the problem of restoration of consciousness after severe structural brain injuries, and suggest directions for future research.
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Emergence to the Conscious State During Inpatient Rehabilitation After Traumatic Brain Injury in Children and Young Adults. J Head Trauma Rehabil 2014; 29:E44-8. [DOI: 10.1097/htr.0000000000000022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cossu G. Therapeutic options to enhance coma arousal after traumatic brain injury: state of the art of current treatments to improve coma recovery. Br J Neurosurg 2013; 28:187-98. [PMID: 24090192 DOI: 10.3109/02688697.2013.841845] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Traumatic brain injury is a leading cause of death and disability. Optimizing the recovery from coma is a priority in seeking to improve patients' functional outcomes. Standards of care have not been established: pharmacological interventions, right median nerve and sensory stimulation, dorsal column stimulation (DCS), deep brain stimulation, transcranial magnetic stimulation, hyperbaric oxygen therapy and cell transplantation have all been utilized with contrasting results. The aim of this review is to clarify the indications for the various techniques and to guide the clinical practice towards an earlier coma arousal. A systematic bibliographic search was undertaken using the principal search engines (Pubmed, Embase, Ovid and Cochrane databases) to locate the most pertinent studies. Traumatic injury is a highly individualized process, and subsequent impairments are dependent on multiple factors: this heterogeneity influences and determines therapeutic responses to the various interventions.
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Affiliation(s)
- Giulia Cossu
- Azienda Ospedaliera Universitaria San Luigi Gonzaga , Orbassano, Turin , Italy
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25
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Millichap JG. Dopamine-Serotonin Transporter Disease. Pediatr Neurol Briefs 2013. [DOI: 10.15844/pedneurbriefs-27-4-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Suskauer SJ, Trovato MK. Update on pharmaceutical intervention for disorders of consciousness and agitation after traumatic brain injury in children. PM R 2013; 5:142-7. [PMID: 23415249 DOI: 10.1016/j.pmrj.2012.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/05/2012] [Indexed: 11/15/2022]
Abstract
Responsiveness and agitation are common targets for pharmaceutical intervention after traumatic brain injury (TBI) in children. This focused review presents a critical discussion of the limited literature available on the use of medications for disorders of consciousness and agitation in children with TBI. For disorders of consciousness, evidence from several small studies supports a potential benefit of dopaminergic agents for improving responsiveness in some children with lower levels of function after TBI. Larger studies, likely requiring multicenter collaborations, are needed to more definitively address questions regarding the use of medications for responsiveness in children with TBI. The literature regarding use of pharmaceutical agents for agitation in children with TBI is even more limited. The dearth of literature regarding the effects of medications used for agitation in children with TBI highlights the need for additional basic and clinical science contributions in this area.
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Affiliation(s)
- Stacy J Suskauer
- Kennedy Krieger Institute, Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
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Nissenkorn A, Hassin-Baer S, Lerman SF, Levi YB, Tzadok M, Ben-Zeev B. Movement disorder in ataxia-telangiectasia: treatment with amantadine sulfate. J Child Neurol 2013; 28:155-60. [PMID: 22550086 DOI: 10.1177/0883073812441999] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ataxia-telangiectasia is a cerebellar neurodegenerative disorder presenting with ataxia, chorea, myoclonus, and bradykinesia. Literature on treatment of movement disorders is scarce. We treated 17 children (aged 11.2 ± 3.9 years) for 8 weeks with the dopaminergic and anti-N-methyl-d-aspartate (NMDA) agent amantadine sulfate 6.3 ± 0.87 mg/kg/d. Ataxia was assessed by using the International Cooperative Ataxia Scale, parkinsonism by the Unified Parkinson Disease Rating Scale, and chorea/myoclonus by the Abnormal Involuntary Movement Scale. Responders were considered those patients who had at least 20% improvement in the summation of the 3 scales. Overall, 76.5% of patients were responders, with a mean 29.3% improvement. Ataxia, involuntary movements, and parkinsonism improved significantly (25.3%, 32.5%, and 29.5%, respectively); (P < .001, t test). Side effects were mild and transient, and they did not lead to drug discontinuation. Amantadine is a well-tolerated and effective treatment for motor symptoms in ataxia telangiectasia. Assessment of long-term effects and a double-blind study should follow.
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Affiliation(s)
- Andreea Nissenkorn
- The National A-T Clinic, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.
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Reynolds JC, Rittenberger JC, Callaway CW. Methylphenidate and amantadine to stimulate reawakening in comatose patients resuscitated from cardiac arrest. Resuscitation 2012. [PMID: 23178867 DOI: 10.1016/j.resuscitation.2012.11.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite critical-care packages including therapeutic hypothermia (TH), neurologic injury is common after cardiac arrest (CA) resuscitation. Methylphenidate and amantadine have treated coma in traumatically-brain-injured patients with mixed success, but have not been explored in post-arrest patients. OBJECTIVE Compare the outcome of comatose post-arrest patients treated with neurostimulants to a matched cohort. METHODS Retrospective cohort study from 6/2008 to 12/2011 in a tertiary university hospital. We included adult patients treated with methylphenidate or amantadine after resuscitation from in-hospital or out-of-hospital CA (OHCA) of any rhythm, excluding patients with traumatic/surgical etiology of arrest, terminal re-arrest within 6h, or withdrawal of care by family within 6h. Primary outcome was following commands; secondary outcomes included survival to hospital discharge, cerebral performance category (CPC), and modified Rankin scale (mRS). We compared characteristics and outcomes to a control cohort matched on TH and 72 h FOUR score ± 1. RESULTS Of 588 patients, 8 received methylphenidate, 6 received amantadine, and 2 both. Most were female suffering OHCA with median age 61 years. All received TH and a multi-modal neurological evaluation. Initial exam revealed median GCS 6 and FOUR 7, which was unchanged at 72 h. Six patients (38%) followed commands prior to discharge at median 2.5 days (range: 1-18 days) after treatment. Patients receiving neurostimulants trended toward improved rate of following commands, survival to hospital discharge, and distribution of CPC and mRS scores. CONCLUSIONS Neurostimulants may be considered to stimulate wakefulness in selected post-cardiac arrest patients, but a prospective trial is needed to evaluate this therapy.
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Affiliation(s)
- Joshua C Reynolds
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Kilbaugh TJ, Bhandare S, Lorom DH, Saraswati M, Robertson CL, Margulies SS. Cyclosporin A preserves mitochondrial function after traumatic brain injury in the immature rat and piglet. J Neurotrauma 2011; 28:763-74. [PMID: 21250918 DOI: 10.1089/neu.2010.1635] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cyclosporin A (CsA) has been shown to be neuroprotective in mature animal models of traumatic brain injury (TBI), but its effects on immature animal models of TBI are unknown. In mature animal models, CsA inhibits the opening of the mitochondrial permeability transition pore (MPTP), thereby maintaining mitochondrial homeostasis following injury by inhibiting calcium influx and preserving mitochondrial membrane potential. The aim of the present study was to evaluate CsA's ability to preserve mitochondrial bioenergetic function following TBI (as measured by mitochondrial respiration and cerebral microdialysis), in two immature models (focal and diffuse), and in two different species (rat and piglet). Three groups were studied: injured+CsA, injured+saline vehicle, and uninjured shams. In addition, we evaluated CsA's effects on cerebral hemodynamics as measured by a novel thermal diffusion probe. The results demonstrate that post-injury administration of CsA ameliorates mitochondrial dysfunction, preserves cerebral blood flow (CBF), and limits neuropathology in immature animals 24 h post-TBI. Mitochondria were isolated 24 h after controlled cortical impact (CCI) in rats and rapid non-impact rotational injury (RNR) in piglets, and CsA ameliorated cerebral bioenergetic crisis with preservation of the respiratory control ratio (RCR) to sham levels. Results were more dramatic in RNR piglets than in CCI rats. In piglets, CsA also preserved lactate pyruvate ratios (LPR), as measured by cerebral microdialysis and CBF at sham levels 24 h after injury, in contrast to the significant alterations seen in injured piglets compared to shams (p<0.01). The administration of CsA to piglets following RNR promoted a 42% decrease in injured brain volume (p<0.01). We conclude that CsA exhibits significant neuroprotective activity in immature models of focal and diffuse TBI, and has exciting translational potential as a therapeutic agent for neuroprotection in children.
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Affiliation(s)
- Todd J Kilbaugh
- University of Pennsylvania School of Medicine, Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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30
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Pangilinan PH, Giacoletti-Argento A, Shellhaas R, Hurvitz EA, Hornyak JE. Neuropharmacology in Pediatric Brain Injury: A Review. PM R 2010; 2:1127-40. [DOI: 10.1016/j.pmrj.2010.07.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 06/16/2010] [Accepted: 07/05/2010] [Indexed: 11/28/2022]
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31
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Meyer MJ, Megyesi J, Meythaler J, Murie-Fernandez M, Aubut JA, Foley N, Salter K, Bayley M, Marshall S, Teasell R. Acute management of acquired brain injury Part III: An evidence-based review of interventions used to promote arousal from coma. Brain Inj 2010; 24:722-9. [DOI: 10.3109/02699051003692134] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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32
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Pharmacokinetics of Amantadine in Children With Impaired Consciousness due to Acquired Brain Injury: Preliminary Findings Using a Sparse-sampling Technique. PM R 2010; 2:37-42. [DOI: 10.1016/j.pmrj.2009.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 10/16/2009] [Accepted: 10/26/2009] [Indexed: 11/20/2022]
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Al-Adawi S, Hoaglin H, Vesali F, Dorvlo ASS, Burke DT. Effect of amantadine on the sleep–wake cycle of an inpatient with brain injury. Brain Inj 2009; 23:559-65. [DOI: 10.1080/02699050902970745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
PRIMARY OBJECTIVE The focus of this paper is to review the current literature on the use of amantadine in children who have sustained a head injury. MAIN OUTCOMES AND RESULTS A MEDLINE search was conducted and yielded five papers. They were composed of prospective, retrospective and case study designs. Dosage use and side effect profiles were consistent with expected norms. Efficacy was measures primarily by alertness and arousal and positive results were found for all studies on these dimensions. Behavioural and cognitive measures of outcome yielded mixed results. CONCLUSIONS The studies reviewed for this paper suggest that amantadine is clinically beneficial for children who have sustained head injuries. Double blind placebo controlled trials with larger sample sizes are needed to further substantiate these findings.
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Affiliation(s)
- Sharon E Williams
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Stanford University School of Medicine, Stanford, CA 94305-5719, USA.
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Effects of Amantadine in Children with Impaired Consciousness Caused by Acquired Brain Injury. Am J Phys Med Rehabil 2009; 88:525-32. [DOI: 10.1097/phm.0b013e3181a5ade3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patrick PD, Wamstad JB, Mabry JL, Smith-Janik S, Gurka MJ, Buck ML, Blackman JA. Assessing the relationship between the WNSSP and therapeutic participation in adolescents in low response states following severe traumatic brain injury. Brain Inj 2009; 23:528-34. [PMID: 19484626 DOI: 10.1080/02699050902926325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE This study examines the relationship between scores on the Western Neuro Sensory Stimulation Profile (WNSSP) and therapeutic participation as it relates to rehabilitation readiness (RR) in adolescents with low response following severe traumatic brain injury (TBI). RESEARCH DESIGN This is a serial observational design using multiple measures of clinical status and participation. METHODS AND PROCEDURES Ten children, mean age 16.7 years, who remained in a low response state (30 days or more) were assessed with the WNSSP and videotaped during physical and occupational therapy sessions. Associations were evaluated between WNSSP scores and participation scores related to arousal, awareness and communication. MAIN OUTCOMES AND RESULTS The WNSSP was only associated with the communication score (p < 0.0001). The arousal and awareness scores had no significant impact on the WNSSP score. CONCLUSIONS These results suggest that scores on the WNSSP may be related to the return of communication skills in adolescents in low response states as one part of assessing their therapeutic participation and ultimate rehabilitation readiness. This ability may assist in making decisions regarding care planning.
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Affiliation(s)
- Peter D Patrick
- University of Virginia, Charlottesville, Pediatric, 2270 Ivy Road, Charlottesville, Virginia 22901, USA.
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Demertzi A, Vanhaudenhuyse A, Bruno MA, Schnakers C, Boly M, Boveroux P, Maquet P, Moonen G, Laureys S. Is there anybody in there? Detecting awareness in disorders of consciousness. Expert Rev Neurother 2009; 8:1719-30. [PMID: 18986242 DOI: 10.1586/14737175.8.11.1719] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The bedside detection of awareness in disorders of consciousness (DOC) caused by acquired brain injury is not an easy task. For this reason, differential diagnosis using neuroimaging and electrophysiological tools in search for objective markers of consciousness is being employed. However, such tools cannot be considered as diagnostic per se, but as assistants to the clinical evaluation, which, at present, remains the gold standard. Regarding therapeutic management in DOC, no evidence-based recommendations can be made in favor of a specific treatment. The present review summarizes clinical and paraclinical studies that have been conducted with neuroimaging and electrophysiological techniques in search of residual awareness in DOC. We discuss the medical, scientific and ethical implications that derive from these studies and we argue that, in the future, the role of neuroimaging and electrophysiology will be important not only for the diagnosis and prognosis of DOC but also in establishing communication with these challenging patients.
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Affiliation(s)
- Athena Demertzi
- Coma Science Group, Neurology Department, Cyclotron Research Centre, University of Liège, Liège, Belgium
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Claudet I, Maréchal C. Status epilepticus in a pediatric patient with amantadine overdose. Pediatr Neurol 2009; 40:120-2. [PMID: 19135627 DOI: 10.1016/j.pediatrneurol.2008.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 10/13/2008] [Accepted: 10/20/2008] [Indexed: 10/21/2022]
Abstract
A 2-year-old boy who ingested 0.8-1.5 g of amantadine developed status epilepticus. One hour later, the child presented with agitation, diaphoresis, and vomiting. He was admitted to the pediatric emergency department 2 hours later. Generalized seizures evolved to status epilepticus, with alternating generalized tonic-clonic and partial seizures, over a period of 7 hours. Other initial clinical signs were sinusal tachycardia and reactive bilateral mydriasis. All symptoms resolved within 20 hours, with a good recovery; the child was released from the hospital on day 3.
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Affiliation(s)
- Isabelle Claudet
- Pediatric Emergency Department, Children's Hospital, Toulouse, France.
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Pharmacotherapy to enhance arousal: what is known and what is not. PROGRESS IN BRAIN RESEARCH 2009; 177:293-316. [PMID: 19818909 DOI: 10.1016/s0079-6123(09)17720-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Severe brain injury results in a disturbance among a wide range of critical neurotransmitter systems. Each neurotransmitter system places its own functional role while being interconnected to a multitude of other systems and functions. This chapter seeks to review the major neurotransmitter systems involved after severe acquired brain injury. While limited in their construct, animal models of brain injury have demonstrated agents that may assist in the recovery process and those that may further slow recovery. We review further the issue of laboratory evidence and what is transferable to the clinic. Lastly, this chapter reviews published clinical pharmacotherapy studies or trials in the arena of arousal for those with clinical severe brain injury. We discuss limitations as well as findings and present the available evidence in a table-based format. While no clear evidence exists to suggest a defined and rigid pharmacotherapeutic approach, interesting data does suggest that several medications have been associated with enhanced arousal. Several studies are underway or about to begin that will shed more light on the utility of such agents in improving function after severe brain injury. For now, clinicians must employ their own judgment and what has been learned from the limited literature to the care of a challenging group of persons.
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Patrick PD, Mabry JL, Gurka MJ, Buck ML, Boatwright E, Blackman JA. MRI patterns in prolonged low response states following traumatic brain injury in children and adolescents. Brain Inj 2007; 21:63-8. [PMID: 17364521 DOI: 10.1080/02699050601111401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore the relationship between location and pattern of brain injury identified on MRI and prolonged low response state in children post-traumatic brain injury (TBI). METHODS This observational study compared 15 children who spontaneously recovered within 30 days post-TBI to 17 who remained in a prolonged low response state. RESULTS 92.9% of children with brain stem injury were in the low response group. The predicted probability was 0.81 for brain stem injury alone, increasing to 0.95 with a regional pattern of injury to the brain stem, basal ganglia, and thalamus. CONCLUSIONS Low response state in children post-TBI is strongly correlated with two distinctive regions of injury: the brain stem alone, and an injury pattern to the brain stem, basal ganglia, and thalamus. This study demonstrates the need for large-scale clinical studies using MRI as a tool for outcome assessment in children and adolescents following severe TBI.
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Affiliation(s)
- Peter D Patrick
- Department of Pediatrics, Kluge Children's Rehabilitation Center and Research Institute, University of Virginia, Charlottesville, VA 22901, USA.
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Donfrancesco R, Calderoni D, Vitiello B. Open-label amantadine in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2007; 17:657-64. [PMID: 17979585 DOI: 10.1089/cap.2006.0128] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of this study was to explore the possible efficacy and tolerability of amantadine in the treatment of attention-deficit/hyperactivity disorder (ADHD) in stimulant-naïve children. METHODS Twenty four children (5-13 years old) with Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) ADHD (4 inattentive, 2 hyperactive, and 18 combined type) entered a 6-week open-label treatment with amantadine (50-150 mg) given as a single morning dose. Parent and teacher ADHD rating scales and the parent Child Behavior Checklist (CBCL) were administered at baseline and at week 6. RESULTS Twenty three subjects completed the 6-week treatment. One child dropped out at week 2 because of persistent headache, and another 12 children reported adverse effects, most commonly transient appetite decrease. The parent ADHD score decreased from mean 41.04 +/- D 6.9 at baseline to 28.9 +/- 8.7 at week 6 (p < 0.001, effect size d = 1.5), and the teacher ADHD score from 35.8 +/- 9.6 to 26.2 +/- 9.5 (p < 0.001, effect size d = 1.0). Response rate (a 25% or greater decline in ADHD score) was 58% based on parents and 46% based on teachers. CONCLUSIONS These data suggest that amantadine has acceptable acute tolerability at single doses up to 150 mg/day and is possibly efficacious in decreasing ADHD symptoms, although its activity appears to be more modest than that of stimulant medications.
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