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Acute-Phase Amantadine Treatment in Children with Severe Traumatic Brain Injury: A Dual-Center Cohort Study
Hüseyin Bahadır Şenol1, Kaan Furkan Bıyık2, Çağatay Günay3
1Department of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye.
Insights
Amantadine did not significantly improve functional outcomes in children with severe traumatic brain injury (TBI). However, it was well-tolerated and associated with fewer craniectomies, with inotrope use predicting poor neurological outcomes.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Traumatology
Background:
- Severe traumatic brain injury (TBI) in children presents complex neurological and systemic challenges.
- Evaluating novel therapeutic interventions in the acute phase is crucial for improving patient outcomes.
- Amantadine is a potential agent for neuroprotection and functional recovery.
Purpose of the Study:
- To assess the neurological and systemic effects of amantadine in pediatric severe TBI.
- To identify factors influencing functional recovery post-TBI.
- To evaluate the safety and efficacy of amantadine in this population.
Main Methods:
- Retrospective cohort study of pediatric patients with severe TBI.
- Amantadine administered from the third day of hospitalization (6 mg/kg/day or 100 mg BID).
- Functional Status Scale (FSS) assessed at ICU discharge and 6-month follow-up.
Main Results:
- No significant difference in functional recovery between amantadine and non-amantadine groups at 6 months.
- Significant improvement in FSS scores from ICU discharge to 6-month follow-up (P < .001).
- Inotrope requirement identified as an independent risk factor for poor neurological outcome.
Conclusions:
- Amantadine did not confer significant functional benefits in pediatric severe TBI.
- Craniectomy rates were lower in the amantadine group.
- Amantadine demonstrated a favorable safety profile and was well-tolerated.
Objective:
This study aimed to evaluate the neurological and systemic outcomes of amantadine treatment in the acute phase of severe traumatic brain injury (TBI) in children. In addition, the potential factors associated with functional outcomes were analyzed.
Methods:
This retrospective cohort study analyzed data of pediatric patients with severe TBI. Amantadine treatment was administered to all patients who presented after 2022. The treatment protocol was initiated on the third day of hospitalization, at a daily dose of 6 mg/kg, and at 100 mg twice daily for older children. The Functional Status Scale (FSS) was used to assess mental status, vision, hearing, communication, motor abilities, respiration, and feeding both at discharge from intensive care unit (ICU) and again 6 months after the incident of TBI.
Results:
In this study, 60 patients had a median age of 14.5 years (IQR 8; range 2-17 years), while 32 patients received amantadine treatment. The length of median ICU stay and hospital stay were 11 and 20 days, respectively. At the 6-month follow-up, there was a significant improvement in FSS scores compared to those estimated at ICU discharge (P < .001), but no significant difference was observed between the amantadine and non-amantadine groups in terms of functional recovery, and inotrope requirement was identified as an independent risk factor for poor neurological outcome.
Conclusion:
Administration of amantadine did not provide a significant functional benefit. However, craniectomy was performed less frequently for patients who received amantadine. Amantadine treatment was well tolerated with a favorable safety profile.
