Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA.
Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Brain Inj. 2020 Feb 23;34(3):299-315. doi: 10.1080/02699052.2020.1723697. Epub 2020 Feb 20.
This comprehensive review discusses clinical studies of patients following brain injuries (traumatic, acquired, or stroke), who have been treated with amantadine or memantine. Both amantadine and memantine are commonly used in the acute rehabilitation setting following brain injuries, despite their lack of FDA-approval for neuro-recovery. Given the broad utilization of such agents, there is a need to review the evidence supporting this common off-label prescribing. The purpose of this review is to describe the mechanisms of action for memantine and amantadine, as well as to complete a comprehensive review of the clinical uses of these agents. We included 119 original, clinical research articles from NCBI Medline, published before 2019. We focused on the domains of neuroplasticity, functional recovery, motor recovery, arousal, fatigue, insomnia, behavior, agitation, and cognition. Most of the existing research supporting the use of amantadine and memantine in recovery from brain injuries was done in very small populations, limiting the significance of conclusions. While most studies are positive; small effect sizes are usually reported, or populations are subject to bias. Furthermore, evidence is so limited that this review includes research regarding both acute and chronic acquired brain injury populations. Fortunately, reported short-term side effects generally are modest, and stop soon after amantadine/memantine is discontinued. However, responses are inconsistent, and the phenotype of responders remains elusive.
这篇全面的综述讨论了接受金刚烷胺或美金刚治疗的脑损伤（外伤性、获得性或中风）患者的临床研究。尽管金刚烷胺和美金刚未获得 FDA 批准用于神经恢复，但它们在脑损伤后的急性康复治疗中被广泛应用。鉴于这些药物的广泛应用，有必要对支持这种常见的超适应证处方的证据进行审查。本综述的目的是描述美金刚和金刚烷胺的作用机制，并全面回顾这些药物的临床应用。我们纳入了来自 NCBI Medline 的 119 篇原始临床研究文章，这些文章发表于 2019 年之前。我们关注的领域包括神经可塑性、功能恢复、运动恢复、觉醒、疲劳、失眠、行为、激越和认知。支持金刚烷胺和美金刚在脑损伤恢复中应用的大部分现有研究都是在很小的人群中进行的，这限制了结论的意义。虽然大多数研究结果是积极的，但通常报告的效果较小，或者人群存在偏倚。此外，证据非常有限，因此本综述包括了关于急性和慢性获得性脑损伤人群的研究。幸运的是，报告的短期副作用通常较为轻微，且在停止使用金刚烷胺/美金刚后很快停止。然而，反应并不一致，且应答者的表型仍难以捉摸。
