Amantadine for the agitated head-injury patient

Abstract

Traumatic brain injury may be associated with agitated aggressive behaviour and the potential for injury to the patient and staff. We report two cases of recovering brain injury patients with difficult-to-treat destructive behaviour, whose agitation and aggression responded to amantadine. Direct-acting dopamine agonists such as amantadine may be the preferred treatment for patients with behaviour problems in the acute stages of recovery from coma.

Improved neurological function after Amantadine treatment in two patients with brain injury

“…Amantadine has been reported to improve fatigue, rigidity, orientation, initiation, attention, concentration, sequencing skills, processing time, and motor coordination in patients after traumatic brain injury (15,16). In a small double-blind placebo-controlled crossover design study conducted in 2002, data suggested that Amantadine treatment in patients suffering from diffuse axonal injury (DAI) after traumatic brain injury resulted in rapid functional improvement (17).…”

“…To date, only a few studies have specifically addressed the dopaminergic effects of Amantadine in patients after brain injury (6,15,16). Of the research available, data are limited to the effects of Amantadine treatment after traumatic brain injury alone.…”

Pharmacological management of neurobehavioral disorders following traumatic brain injuryA state-of the-art review

“…In one retrospective analysis of 12 subjects treated with amantadine for cognitive deficits [137], 2 subjects in whom amantadine was initiated for the treatment of agitation showed reduction in agitation and improvement in attention, concentration, and participation at therapy. Other case reports of difficult-to-treat destructive behavior following TBI that responded to amantadine therapy exist [138].…”

Amantadine in Pediatric Patients with Traumatic Brain Injury

“…11 There have been several case reports and a few retrospective studies that have found amantadine to be useful in the treatment of agitation and underarousal in adult patients with TBI. [12][13][14][15][16][17][18][19][20] There has also been one retrospective study of ten pediatric patients who were in persistent low-response states and were treated with dopamine agonists, including amantadine in some cases. The children did significantly better on the Western NeuroSensory Stimulation Profile after the dopamine agonist was administered.…”