Siy Hantz Filbert C, Gimenez Michael Louis A
University of Santo Tomas Hospital, España Blvd., Sampaloc, Manila, Philippines.
Brain Spine. 2024 Feb 23;4:102773. doi: 10.1016/j.bas.2024.102773. eCollection 2024.
TBIs contribute in over one-third of injury-related deaths with mortality rates as high as 50% in trauma centers serving the most severe TBI. The effect of TBI on mortality is about 10% across all ages. Amantadine hydrochloride is one of the most commonly prescribed medications for patients undergoing inpatient neurorehabilitation who have disorders of consciousness. It is a dopamine (DA) receptor agonist and a N-Methyl-D-aspartate (NMDA) receptor antagonist via dopamine release and dopamine reuptake inhibition. The current study will synthesize the current available evidence and show the effect of Amantadine in functional improvement after TBI.
Does Amantadine have an effect on functional improvement of TBI patients?
This systematic review included all randomized placebo-controlled trials that compare the use of Amantadine versus placebo for functional improvement of patients after TBI. Outcome measures included DRS, GCS and/or GOS scores.
Three studies with a total of 281 patients were included in the quantitative analyses. GRADE assessments show that there was a high certainty of evidence for functional improvement in terms of DRS scores.
Evidence of this review show that the use of Amantadine may have a beneficial effect on functional outcome in moderate to severe traumatic brain injuries among adult patients. Given the still-limited body of knowledge, more relevant studies must be made exploring the impact of Amantadine therapies on promoting functional recovery within the brain injury rehabilitation care continuum, with the goals of achieving larger sample sizes and establishing the early- or later-treatment beneficial effects.
创伤性脑损伤（TBI）导致超过三分之一的损伤相关死亡，在救治最严重TBI患者的创伤中心，死亡率高达50%。TBI对各年龄段人群死亡率的影响约为10%。盐酸金刚烷胺是意识障碍住院神经康复患者最常用的处方药之一。它是一种多巴胺（DA）受体激动剂，通过释放多巴胺和抑制多巴胺再摄取成为N-甲基-D-天冬氨酸（NMDA）受体拮抗剂。本研究将综合现有证据，展示金刚烷胺对TBI后功能改善的作用。
金刚烷胺对TBI患者的功能改善有影响吗？
本系统评价纳入了所有比较金刚烷胺与安慰剂用于TBI患者功能改善的随机安慰剂对照试验。结局指标包括残疾评定量表（DRS）、格拉斯哥昏迷量表（GCS）和/或格拉斯哥预后量表（GOS）评分。
三项研究共281例患者纳入定量分析。GRADE评估显示，就DRS评分而言，功能改善证据具有高确定性。
本评价证据表明，使用金刚烷胺可能对成年中重度创伤性脑损伤患者的功能结局有有益影响。鉴于目前知识仍有限，必须开展更多相关研究，探讨金刚烷胺疗法在脑损伤康复护理连续过程中对促进功能恢复的影响，目标是获得更大样本量并确定早期或晚期治疗的有益效果。
