抗惊厥药物金刚烷胺在小儿颅脑损伤住院康复期间的应用模式：小儿颅脑损伤联盟多中心回顾性研究。
Prescribing Patterns of Amantadine During Pediatric Inpatient Rehabilitation After Traumatic Brain Injury: A Multicentered Retrospective Review From the Pediatric Brain Injury Consortium.
机构信息
Division of Pediatric Rehabilitation Medicine, Children's Mercy Kansas City, Kansas City, Missouri (Dr McLaughlin); University of Missouri-Kansas City School of Medicine (Dr McLaughlin); Weill Cornell School of Medicine, New York City, New York (Mr Caliendo); David Geffen School of Medicine at UCLA, Los Angeles, California (Mr Lowder); Blythedale Children's Hospital, Valhalla, New York (Drs Watson and Shah); Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York (Dr Watson); Departments of Pediatrics and Neurology and Rehabilitation Medicine, Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, and Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Kurowski); Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Baum); Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia (Dr Blackwell); Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio (Dr Koterba); The Ohio State University College of Medicine, Columbus (Drs Koterba and Hoskinson); Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Dr Hoskinson); Department of Rehabilitation, Children's Hospital Colorado and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Dr Tlustos); Department of Pediatrics, Division of Critical Care Medicine, Department of Pediatrics, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina (Dr Zimmerman); Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York (Dr Shah); Kennedy Krieger Institute, Baltimore, Maryland (Dr Suskauer); and Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Suskauer).
出版信息
J Head Trauma Rehabil. 2022;37(4):240-248. doi: 10.1097/HTR.0000000000000709. Epub 2021 Jul 26.
OBJECTIVES
To describe dosing practices for amantadine hydrochloride and related adverse effects among children and young adults with traumatic brain injury (TBI) admitted to pediatric inpatient rehabilitation units.
SETTING
Eight pediatric acute inpatient rehabilitation units located throughout the United States comprising the Pediatric Brain Injury Consortium.
PARTICIPANTS
Two-hundred thirty-four children and young adults aged 2 months to 21 years with TBI.
DESIGN
Retrospective data revie.
MAIN OUTCOME MEASURES
Demographic variables associated with the use of amantadine, amantadine dose, and reported adverse effects.
RESULTS
Forty-nine patients (21%) aged 0.9 to 20 years received amantadine during inpatient rehabilitation. Forty-five percent of patients admitted to inpatient rehabilitation with a disorder of consciousness (DoC) were treated with amantadine, while 14% of children admitted with higher levels of functioning received amantadine. Children with DoC who were not treated with amantadine were younger than those with DoC who received amantadine (median 3.0 vs 11.6 years, P = .008). Recorded doses of amantadine ranged from 0.7 to 13.5 mg/kg/d; the highest total daily dose was 400 mg/d. Adverse effects were reported in 8 patients (16%); nausea/abdominal discomfort and agitation were most common, each reported in 3 patients. The highest reported dose without an adverse effect was 10.1 mg/kg/d.
CONCLUSION
During pediatric inpatient rehabilitation, amantadine was prescribed to children across a range of ages and injury severity and was most commonly prescribed to older children with DoC. Dosing varied widely, with weight-based dosing for younger/smaller children at both lower and higher doses than what had been previously reported. Prospective studies are needed to characterize the safety and tolerability of higher amantadine doses and optimize amantadine dosing parameters for children with TBI.
目的
描述盐酸金刚烷胺在创伤性脑损伤（TBI）患儿和年轻患者中使用剂量的情况，以及相关不良反应。
背景
美国 8 个儿科急性住院康复单位组成了儿科脑损伤联合会，本文的数据来自该联合会的 234 名患儿和年轻患者。
参与者
2 个月至 21 岁 TBI 患儿和年轻患者共 234 名。
设计
回顾性数据分析。
主要观察指标
与使用金刚烷胺、金刚烷胺剂量和报告的不良反应相关的人口统计学变量。
结果
49 名年龄 0.9 至 20 岁的患者在住院康复期间接受了金刚烷胺治疗。45%的患者在入院时存在意识障碍（DOC），其中 14%的患儿存在较高水平的功能障碍。未接受金刚烷胺治疗的 DOC 患儿比接受治疗的患儿年龄小（中位数 3.0 岁 vs 11.6 岁，P=0.008）。记录的金刚烷胺剂量范围为 0.7 至 13.5mg/kg/d；最高日总剂量为 400mg/d。8 名患者（16%）报告出现不良反应；最常见的不良反应为恶心/腹部不适和激越，各有 3 名患者报告。未出现不良反应的最高报告剂量为 10.1mg/kg/d。
结论
在儿科住院康复期间，金刚烷胺被用于治疗不同年龄段和损伤严重程度的儿童，最常用于治疗意识障碍的较大儿童。剂量差异很大，对于较小或年龄较小的儿童，体重剂量低于或高于以前报道的剂量。需要进行前瞻性研究，以评估更高剂量金刚烷胺的安全性和耐受性，并优化 TBI 患儿的金刚烷胺剂量参数。
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