EFFECTIVINESS OF AMANTADINE FOR SEVERE TRAVMATIC BRAIN INJURY: CASE SERIES AND LITERATURE REVIEW

Abstract

Traumatic brain injury (TBI) is the most common cause of death among young population. Approximately 10-15% of these patients, are associated with many severe comorbid conditions, are discharged in vegetative state. Amantadine acts as both a NMDA receptor antagonist and an indirect dopamine agonist. But its exact mechanism of action is still unknown. It is frequently use to increase alertness in patients with TBI. In this presentation, we aimed to present the eight cases with TBI which were treated with Amantadine in İntensive Care Unit (ICU). The characteristics of the cases are given in Table 1. All of patients with traumatic brain injury were intubated and unconscious upon arrival. We used Thiopental sodium for sedation to all patients. Amantadine sulfate treatment was started in the first hour as 200 mg / day and treatment was continued for at least 10 days. Traumatic brain injury (TBI) are serious health problems with social and economic consequences. Although there are many methods for to increase neurological recovery, there is still no specific treatment. Amantadine is a reliable and frequently used drug for to improve the neurological recovery of the patients with TBI. In the literature, the studies on the use of amantadine in patients with TBI was compared with the control group and various parameters. These studies were shown that neurological recovery was better in the amantadine group. We used some variables such as Glasgow Coma Scale (GKS), Full Outline of Unresponsiveness (FOUR) scale and duration of stay at ıcu and hospital. FOUR scale are better reflects the neurological status in intubated patients. Although there are a limited number of articles indicating efficacy, new studies on amantadine use, dose, and duration are needed in patients with TBI.

Keywords

• Amantadine
• Neurological Recovery
• Severe Travmatic Brain Injury

CİDDİ TRAVMATİK BEYİN HASARINDA AMANTADİN ETKİNLİĞİNİN DEĞERLENDİRİLMESİ: OLGU SERİSİ VE LİTERATÜR DERLEMESİ

Abstract

Travmatik beyin hasarı (TBH) genç nüfus arasında sık görülen bir ölüm sebebidir. Bu hastaların yaklaşık % 10-15'nde ciddi komorbiditeler görülmektedir ve vejetatif bir hayat ile taburcu edilmektedirler. Amantadin, NMDA (N-metil-D-aspartat) reseptör antagonisti ve indirekt dopamin agonisti gibi davranmaktadır. Fakat etki mekanizması net değildir. TBH olan hastalarda uyanıklığı artırmak için hala kullanılmaktadır. Bu olgu serisinde, TBH ile yoğun bakımda takip edilen ve tedavilerinde amantadin kullanılan 8 hasta sunulmuştur. Olguların özellikleri Tablo 1'de verilmiştir. Travmatik beyin hasarı olan tüm hastalar geldiklerinde bilinçsizdi ve entübe edildiler. Tüm hastalara sedasyon için tiyopental sodyum 3 mg/kg yükleme sonrası 3-5 mg/ kg / saat infüzyon dozlarında kullanıldı. Amantadin sülfat tedavisine ilk saatte 200 mg / gün olarak başlandı ve tedaviye en az 10 gün devam edildi. Travmatik beyin hasarı (TBI), sosyal ve ekonomik sonuçları olan ciddi bir sağlık problemidir. Nörolojik iyileşmeyi artırmak için pek çok yöntem bulunmasına rağmen hala spesifik bir tedavisi yoktur. Amantadin, TBH'li hastaların nörolojik iyileşmesi için güvenilir ve sıklıkla kullanılan bir ilaçtır. Literatürde TBH'li hastalarda amantadin kullanımına ilişkin çalışmalar kontrol grubu ve çeşitli parametreler ile karşılaştırılmıştır. Bu çalışmalar, amantadin grubunda nörolojik iyileşmenin daha iyi olduğunu göstermiştir. Glasgow Koma Ölçeği (GKS), Full Outline of Unresponsiveness (FOUR) skalası ve yoğun bakım ve hastanede kalış süresi gibi bazı değişkenler kullandık. FOUR skalası entübe hastalarda nörolojik durumu daha iyi yansıtır. Etkinliği gösteren sınırlı sayıda makale olmasına rağmen TBH'li hastalarda amantadin kullanımı, dozu, süresi ile ilgili yeni çalışmalara ihtiyaç vardır.

Keywords

• Amantadin
• Nörolojik İyileşme
• Şiddetli Travmatik Beyin Hasarı

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