Thalamic Dementia in Acute Inpatient Rehabilitation—Role for Amantadine?

Abstract

Thalamic dementia is an uncommon type of stroke that presents with disorientation, behavioral changes, and impairment of executive functions, with relative preservation of motor functions. It is typically caused by paramedian territory infarctions of the thalamus, most often due to ischemic insult at the tip of the basilar artery. In this report, we present a case of bilateral thalamic infarcts resulting in thalamic dementia with severe behavioral manifestations in a 64-yr-old man with no preexisting neuropsychiatric comorbidities. A trial of amantadine, a dopamine-promoting agent, in the acute rehabilitation unit in an attempt to manage his agitation led to multiple weeks of dramatic behavioral improvement and increased participation in therapies. Dopamine receptors are believed to be present at increased densities in thalamic nuclei with mesolimbic projections, suggesting that they are able to modulate limbic functions such as arousal, emotion, and memory. This case report, aimed both to increase the awareness of this uncommon stroke syndrome and describe the observed effect of amantadine, will ultimately help clinicians properly recognize thalamic dementia, minimize unnecessary investigations, and develop effective neurorehabilitation strategies in these patients.

Comments on “Thalamic Dementia in Acute Inpatient Rehabilitation—Role for Amantadine? A Case Report”

“…To the Editor: W e read with great interest the recently published article by Song et al 1 The systematic review provides an in-depth discussion with regard to the methodology for botulinum toxin injections in recalcitrant lateral epicondylitis. The authors have summarized different (as well as inconsistent) toxin injection sites either to kill pain or to decrease muscle tonus.…”

“…The limitations of the study may be mitigated by including patients in a chronic stage to eliminate symptom improvement by natural recovery as a confounding factor. In the case report by Kim et al, 1 the authors did not specify the time from onset; the authors must specify this because the time from stroke onset is a crucial factor in determining the therapeutic effects on stroke rehabilitation. Considering the context of the study by Kim et al, 1 it is likely that the patient was in a subacute stage.…”

“…In the case report by Kim et al, 1 the authors did not specify the time from onset; the authors must specify this because the time from stroke onset is a crucial factor in determining the therapeutic effects on stroke rehabilitation. Considering the context of the study by Kim et al, 1 it is likely that the patient was in a subacute stage. In this stage, despite symptom improvement at 24 hrs after administration, the therapeutic effect of amantadine was not unequivocal.…”

“…To the Editor: W e read the recently published article "Thalamic dementia in acute inpatient rehabilitation -role for amantadine? A case report" by Kim et al 1 The authors showed a potential role for amantadine for controlling symptoms (disorientation, disinhibition, hypersexuality, agitation, hostility, amnesia, confabulation, delusion, hypersomnolence, and paranoia) of thalamic dementia. It was an interesting case report.…”

Serotonin Syndrome Precipitated by Amantadine in a Patient With Persistent Post Concussive Symptoms – A Case Report

“… 7 , 11 In addition to its use for individuals with TBI, amantadine is also increasingly being trialed within the rehabilitation setting as a treatment option for individuals with other acquired brain injuries, though evidence remains limited. 12 …”