Disclosures: Reza R. Roohanirad, MD MBA: Nothing to disclose

Case Description: A 25-year-old male was involved in MVC and sustained a severe traumatic brain injury (TBI). Course complicated by 2 cardiac arrests with return of spontaneous circulation. He was in a vegetative state for over 1 month. Amantadine was started on day 22. He began emerging to a minimally conscious state 10 days after and continued to make significant improvements in function. Amantadine was weaned in favor of an alternative neurostimulant on day 65. Two days subsequent, he exhibited significant decline in function due to waxing and waning levels of consciousness, ranging from somnolence to stupor. The decline lasted for nearly a week with significant improvement in awareness noted 6 days following re-initiation. Functional status continued to improve following dose dependent increase.

Setting: Tertiary care adult hospital.

Patient: 25-year-old male involved in MVC with severe TBI with presumed anoxic injury.

Assessment/Results: Initiation of amantadine coincided with improvements in consciousness and function in a patient with severe TBI. When amantadine was weaned in favor of an alternative, he demonstrated unexpected, significant decline in consciousness.

Discussion: Amantadine has been used to treat patients with all severities of TBI to improve arousal, memory, and aggression. Studies have shown its effectiveness in accelerating the pace of recovery, but not many demonstrate long term utility. Length of treatment and consequences resulting from discontinuation remains unclear. This case demonstrates a significant, reversible, decline in consciousness coinciding with the discontinuation of amantadine in a patient with severe TBI and presumed anoxic injury.

Conclusion: This case illustrates the potential role amantadine plays in maintaining arousal and consciousness, and the potential, extreme consequences of its discontinuation, in patients with severe TBI. Also, simultaneous anoxic brain injury could heighten the utility of dopaminergic agents. Future studies are needed to identify which patients are likely to respond to amantadine, the effective dose, and the optimal duration of treatment.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/significant-but-reversible-decline-in-level-of-consciousness-following-amantadine-cessation-in-a-patient-with-severe-traumatic-brain-injury-and-presumed-anoxic-brain-injury-a-case-report/