Passman Justin N, Cleri Nathaniel A, Saadon Jordan R, Naddaf Nicki, Gilotra Kevin, Swarna Sujith, Vagal Vaibhav, Zheng Xuwen, Zhang Jason, Wong Jeffrey, Asencio Anthony, Wang Cassie, Khalili Andrew, Hou Wei, Mofakham Sima, Mikell Charles B
Department of Neurosurgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA.
Department of Family, Population & Preventive Medicine, Stony Brook University, Stony Brook, New York, USA.
World Neurosurg. 2023 Sep;177:e277-e287. doi: 10.1016/j.wneu.2023.06.034. Epub 2023 Jun 17.
Disruption of dopamine neurotransmission is associated with functional impairment after severe traumatic brain injury (sTBI). This has prompted the study of dopamine agonists, such as amantadine, to assist recovery of consciousness. Randomized trials have mostly addressed the posthospital setting, with inconsistent findings. Therefore, we evaluated the efficacy of early amantadine administration on recovery of consciousness after sTBI.
We searched the medical records of all patients with sTBI admitted to our hospital between 2010 and 2021 who survived 10 days postinjury. We identified all patients receiving amantadine and compared them with all patients not receiving amantadine and a propensity score-matched nonamantadine group. Primary outcome measures included discharge Glasgow Coma Scale, Glasgow Outcome Scale-Extended score, length of stay, mortality, recovery of command-following (CF), and days to CF.
In our study population, 60 patients received amantadine and 344 did not. Compared with the propensity score-matched nonamantadine group, the amantadine group had no difference in mortality (86.67% vs. 88.33%, P = 0.783), rates of CF (73.33% vs. 76.67%, P = 0.673), or percentage of patients with severe (3-8) discharge Glasgow Coma Scale scores (11.11% vs. 12.28%, P = 0.434). In addition, the amantadine group was less likely to have a favorable recovery (discharge Glasgow Outcome Scale-Extended score 5-8) (14.53% vs. 16.67%, P < 0.001), had a longer length of stay (40.5 vs. 21.0 days, P < 0.001), and had a longer time to CF (11.5 vs. 6.0 days, P = 0.011). No difference in adverse events existed between groups.
Our findings do not support the early administration of amantadine for sTBI. Larger inpatient randomized trials are necessary to further investigate amantadine treatment for sTBI.
严重创伤性脑损伤（sTBI）后多巴胺神经传递中断与功能障碍有关。这促使人们研究多巴胺激动剂，如金刚烷胺，以帮助意识恢复。随机试验大多针对出院后情况，结果不一致。因此，我们评估了早期给予金刚烷胺对sTBI后意识恢复的疗效。
我们检索了2010年至2021年间我院收治的所有sTBI患者的病历，这些患者在受伤后存活了10天。我们确定了所有接受金刚烷胺治疗的患者，并将他们与所有未接受金刚烷胺治疗的患者以及倾向评分匹配的非金刚烷胺组进行比较。主要结局指标包括出院时格拉斯哥昏迷量表评分、格拉斯哥预后量表扩展评分、住院时间、死亡率、指令遵循恢复情况（CF）以及达到CF的天数。
在我们的研究人群中，60例患者接受了金刚烷胺治疗，344例未接受。与倾向评分匹配的非金刚烷胺组相比，金刚烷胺组在死亡率（86.67%对88.33%，P = 0.783）、CF发生率（73.33%对76.67%，P = 0.673）或出院时格拉斯哥昏迷量表评分为重度（3 - 8分）的患者百分比（11.11%对12.28%，P = 0.434）方面没有差异。此外，金刚烷胺组获得良好恢复（出院时格拉斯哥预后量表扩展评分为5 - 8分）的可能性较小（14.53%对16.67%，P < 0.001），住院时间更长（40.5天对21.0天，P < 0.001），达到CF的时间更长（11.5天对6.0天，P = 0.011）。两组之间不良事件无差异。
我们的研究结果不支持早期给予金刚烷胺治疗sTBI。需要更大规模的住院患者随机试验来进一步研究金刚烷胺治疗sTBI的效果。
