Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

Amantadine Use in Severe Traumatic Brain Injury Shea E. Fincher, B.S., Madison B. Battersby, B.S., Matthew C. Fitzpatrick, B.S., Zachary T. Fitzgerald, B.S., Isabella Lombardozzi, B.A., John Peterson, DO, Amy Hamrick, ARNP, Miles Lane, B.S., Kristine Lombardozzi, MD Spartanburg Regional Hospital System, Acute Care and Trauma Surgery, Spartanburg, SC Edward Via College of Osteopathic Medicine, Spartanburg, SC

Discussion/Conclusions

Introduction

Results

● Amantadine (Am) is a weak NMDA receptor antagonist classically used as an adjunct medication with levodopa in Parkinson’s Disease. ● In 1989, studies first documented use of Am in traumatic brain injury (TBI) patients. ● In 2018, the American Academy of Neurology guidelines recommended Am use as level B evidence for expedition of cognitive recovery and neuroprotection in disorders of consciousness. ● Despite Am’s known efficacy in restoring cognitive function and safety, current literature does not describe using Am in TBI treatment algorithms. ● Here, we further define the effects and response of Am use in patients with severe traumatic brain injuries (STBIs).

● Am is being utilized in only 26% of out STBI population and only after the patients have survived their initial hospitalization, with initiation of Am on a median of HD 13. This selection bias may inform both the age differences between the groups as well as the improved mortality in AmU. ● There is no statistically significant difference in GCSD between AmU and NAmU cohorts in STBI patients despite the higher ISS, increased incidence of DAI and IPH, use of PEG and trach and increased HLOS, ICU LOS, and VD in the AmU group. This suggests that Am may have a positive role in the outcomes of these more severely injured patients. ● While this study suggests benefits of Am therapy in improving functional recovery of STBIs in younger patients with more severe injuries, further studies are needed to better define ideal patient selection, optimal timing of Am initiation and extent of Am’s role in improving cognitive function and recovery in STBI patients.

Figure 1. Percentage of death, diffuse axonal injury (DAI), intraparenchymal hemorrhage (IPH), percutaneous gastrostomy (PEG), and tracheostomy (Trach) between participants not receiving amantadine (NAmU) and receiving amantadine (AmU) while in the hospital.

Methods

Subject Selection

● Adult trauma patients at Spartanburg Regional Medical Center ● STBI ● Jan. 1, 2019 to Dec. 31, 2022 ● Survive > 24 hours

Figure 2. Hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), and ventilator days (VD) in NAmU compared with AmU participants.

Data Analysis

Normally distributed continuous

2 Sample T Test

● Pregnant women ● Prisoners ● Non-acute trauma ICU admissions

Wilcoxon Rank Sum Test

Non-parametric continuous

Excluded

Discrete/ordinal with normal distribution

Pearson Correlation Coefficient

Table 2. (Right) Injury Severity Score (ISS) on admission in NAmU and AmU groups. Table 1. (Left) Comparison of age of participants in the NAmU and AmU group on admission.

● Admission GCS or ICU admission GCS > 8 ● Survived < 24 hours ● Diagnoses other than blunt STBI including penetrating, blast, and non-traumatic brain injuries

References

Non-parametric discrete/ordinal

Spearman Correlation

References can be found by following the QR code.

Chi Square or Fisher’s Exact Test

Categorical

Excluded

164 patients included in study

IRB approval obtained through the Spartanburg Regional Healthcare System IRB on July 1, 2023. Approval to waive informed consent was given due to the research involving no more than minimal risk to the participants with no adverse effect to the welfare of participants. Acknowledgements

GCSD (p 0.2) NAmU (n = 137) 14 AmU (n = 27) 14

Table 3. Glasgow Coma Scale on discharge (GCSD) of patients in NAmU and AmU groups.

Primary outcome: discharge GCS (GCSD)

2025 Research Recognition Day

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