Hammond Flora M, Malec James F, Zafonte Ross D, Sherer Mark, Bogner Jennifer, Dikmen Sureyya, Whitney Marybeth P, Bell Kathleen R, Perkins Susan M, Moser Elizabeth A
Indiana University School of Medicine, Indianapolis, Indiana (Drs Hammond, Malec, and Perkins and Ms Moser); Rehabilitation Hospital of Indiana, Indianapolis, Indiana (Drs Hammond and Malec); Spaulding Rehabilitation Hospital, Harvard Medical School, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts (Dr Zafonte); TIRR Memorial Hermann, Houston, Texas (Dr Sherer); Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio (Dr Bogner); University of Washington, Seattle, Washington (Drs Dikmen and Bell); Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Carolinas HealthCare System, Charlotte, North Carolina (Ms Whitney); and University of Texas Southwestern Medical School, Dallas, Texas (Dr Bell).
J Head Trauma Rehabil. 2017 Sep/Oct;32(5):308-318. doi: 10.1097/HTR.0000000000000342.
To assess the effects of amantadine on anger and aggression among individuals with a chronic traumatic brain injury (TBI).
A cohort of 118 persons with chronic TBI (>6 months postinjury) and moderate-severe aggression selected from a larger cohort of 168 participants enrolled in a parallel-group, randomized, double-blind, placebo-controlled trial of amantadine 100 mg twice daily (n = 82) versus placebo (n = 86) for treatment of irritability were studied. Anger and aggression were measured at treatment days 0, 28, and 60 using observer-rated and participant-rated State-Trait Anger Expression Inventory-2 (STAXI-2) and Neuropsychiatric Inventory-Agitation/Aggression domain (NPI-A) Most Problematic and Distress scores.
Participant-rated day 60 NPI-A Most Problematic (adjusted P = .0118) and NPI-A Distress (adjusted P = .0118) were statistically significant between the 2 groups, but STAXI-2 differences were not significant after adjustment for multiple comparisons. Substantial improvements were noted in both amantadine and placebo groups (70% vs 56% improving at least 3 points on day 60 Observer NPI-A; P = .11).
Amantadine 100 mg twice daily in this population with chronic TBI appears to be beneficial in decreasing aggression from the perspective of the individual with TBI. No beneficial impact on anger was found.
clinicaltrials.gov Identifier: NCT00779324; http://www.clinicaltrials.gov/ct2/show/NCT00779324?term=irritability&rank=6.
评估金刚烷胺对慢性创伤性脑损伤（TBI）患者愤怒和攻击行为的影响。
从168名参与者组成的更大队列中选取118名慢性TBI患者（受伤后>6个月）且有中度至重度攻击行为，这些患者参与了一项平行组、随机、双盲、安慰剂对照试验，试验中患者被分为两组，一组每日两次服用100毫克金刚烷胺（n = 82），另一组服用安慰剂（n = 86）以治疗易怒症状。在治疗第0天、28天和60天，使用观察者评定和参与者评定的状态-特质愤怒表达量表-2（STAXI-2）以及神经精神科问卷-激越/攻击领域（NPI-A）中最成问题和痛苦程度得分来测量愤怒和攻击行为。
两组之间在参与者评定的第60天NPI-A最成问题得分（校正P = 0.0118）和NPI-A痛苦程度得分（校正P = 0.0118）上具有统计学意义，但在进行多重比较校正后，STAXI-2差异不显著。金刚烷胺组和安慰剂组均有显著改善（第60天观察者NPI-A至少提高3分的比例分别为70%和56%；P = 0.11）。
对于这群慢性TBI患者，每日两次服用100毫克金刚烷胺似乎有利于从TBI患者自身角度减少攻击行为。未发现对愤怒有有益影响。试验注册：clinicaltrials.gov标识符：NCT00779324；http://www.clinicaltrials.gov/ct2/show/NCT00779324?term=irritability&rank = 6 。
