Hammond Flora M, Bickett Allison K, Norton James H, Pershad Rashmi
Indiana University School of Medicine, and Rehabilitation Hospital of Indiana, Indianapolis, Indiana.
J Head Trauma Rehabil. 2014 Sep-Oct;29(5):391-9. doi: 10.1097/01.HTR.0000438116.56228.de.
Following traumatic brain injury (TBI), individuals may experience chronic problems with irritability or aggression, which may need treatment to minimize the negative impact on their relationships, home life, social interactions, community participation, and employment
: To test the a priori hypothesis that amantadine reduces irritability (primary hypothesis) and aggression (secondary hypothesis) among individuals greater than 6 months post-TBI METHODS:: A total of 76 individuals greater than 6 months post-TBI referred for irritability management were enrolled in a parallel-group, randomized, double-blind, placebo-controlled trial of amantadine (n = 38) versus placebo (n = 38). Study participants were randomly assigned to receive amantadine hydrochloride 100 mg twice daily versus equivalent placebo for 28 days. Symptoms of irritability and aggression were measured before and after treatment using the Neuropsychiatric Inventory Irritability (NPI-I) and Aggression (NPI-A) domains, as well as the NPI-Distress for these domains
: In the amantadine group, 80.56% improved at least 3 points on the NPI-I, compared with 44.44% in the group that received placebo (P = .0016). Mean change in NPI-I was -4.3 in the amantadine group and -2.6 in the placebo group (P = .0085). When excluding individuals with minimal to no baseline aggression, mean change in NPI-A was -4.56 in the amantadine group and -2.46 in the placebo group (P = .046). Mean changes in NPI-I and NPI-A Distress were not statistically significant between the amantadine and placebo groups. Adverse event occurrence did not differ between the 2 groups
: Amantadine 100 mg every morning and at noon appears an effective and safe means of reducing frequency and severity of irritability and aggression among individuals with TBI and sufficient creatinine clearance.
创伤性脑损伤（TBI）后，个体可能会出现易怒或攻击性行为等慢性问题，可能需要进行治疗以尽量减少对其人际关系、家庭生活、社交互动、社区参与和就业的负面影响。
检验预先设定的假设，即金刚烷胺可减轻TBI后6个月以上个体的易怒情绪（主要假设）和攻击性行为（次要假设）。
共有76名TBI后6个月以上因易怒情绪管理前来就诊的个体被纳入一项平行组、随机、双盲、安慰剂对照试验，比较金刚烷胺（n = 38）与安慰剂（n = 38）的效果。研究参与者被随机分配接受每日两次100毫克盐酸金刚烷胺或等效安慰剂，为期28天。使用神经精神科问卷易怒（NPI-I）和攻击（NPI-A）领域以及这些领域内NPI-痛苦量表，在治疗前后测量易怒和攻击症状。
在金刚烷胺组中，80.56%的个体NPI-I至少改善了3分，而接受安慰剂组这一比例为44.44%（P = 0.0016）。金刚烷胺组NPI-I的平均变化为-4.3，安慰剂组为-2.6（P = 0.0085）。排除基线攻击行为极少或无攻击行为的个体后，金刚烷胺组NPI-A的平均变化为-4.56，安慰剂组为-2.46（P = 0.046）。金刚烷胺组和安慰剂组之间，NPI-I和NPI-A痛苦量表的平均变化无统计学意义。两组不良事件发生率无差异。
每天早晚各服用100毫克金刚烷胺，似乎是一种有效且安全的方法，可降低TBI且肌酐清除率足够的个体易怒和攻击行为的频率及严重程度。
