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Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury
OBJECTIVE: This study determined the effect of amantadine treatment on consciousness in patients with non-traumatic brain injury. METHODS: We pooled individual patient data of five single-centre observational studies to determine the effect of amantadine treatment among patients with ischaemic strok...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9148986/ https://www.ncbi.nlm.nih.gov/pubmed/35086939 http://dx.doi.org/10.1136/jnnp-2021-327408 |
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author | Rühl, Lena Kuramatsu, Joji B Sembill, Jochen A Kallmünzer, Bernd Madzar, Dominik Gerner, Stefan T Giede-Jeppe, Antje Balk, Stefanie Mueller, Tamara Jäger, Jakob Schwab, Stefan Huttner, Hagen B Sprügel, Maximilian I |
author_facet | Rühl, Lena Kuramatsu, Joji B Sembill, Jochen A Kallmünzer, Bernd Madzar, Dominik Gerner, Stefan T Giede-Jeppe, Antje Balk, Stefanie Mueller, Tamara Jäger, Jakob Schwab, Stefan Huttner, Hagen B Sprügel, Maximilian I |
author_sort | Rühl, Lena |
collection | PubMed |
description | OBJECTIVE: This study determined the effect of amantadine treatment on consciousness in patients with non-traumatic brain injury. METHODS: We pooled individual patient data of five single-centre observational studies to determine the effect of amantadine treatment among patients with ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, community-acquired bacterial meningitis and status epilepticus, admitted between January 2012 and December 2015 and ventilated ≥7 days. Patient selection and multivariable regression modelling were used to adjust for differences in intergroup comparison and for parameters associated with consciousness. Improvement of consciousness 5 days after treatment initiation was defined as primary outcome. Secondary outcomes included Glasgow Coma Scale (GCS) at day 5 and GCS at day 10, rate of ICU delirium, epileptic seizures and all-cause mortality at 90 days. RESULTS: Overall, 84 of 294 (28.6%) eligible patients received amantadine. Amantadine treatment was associated with improvement of consciousness at day 5 (amantadine: 86.9% vs control: 54.0%; absolute difference: 32.9 (20.0–44.2); adjusted OR (aOR): 5.71 (2.50–13.05), p<0.001). Secondary outcomes showed differences in GCS 5 days (9 (8–11) vs 6 (3–9), p<0.001) and GCS 10 days (10(8–11) vs 9(6–11), p=0.003) after treatment initiation. There were no significant differences regarding all-cause mortality (aOR: 0.89 (0.44–1.82), p=0.758) and ICU delirium (aOR: 1.39 (0.58–3.31), p=0.462). Rate of epileptic seizures after initiation of amantadine treatment was numerically higher in the amantadine group (amantadine: 10.7% vs control: 3.0%; absolute difference: 7.7 (0.3–16.4); aOR: 3.68 (0.86–15.71), p=0.079). CONCLUSIONS: Amantadine treatment is associated with improved consciousness among patients with different types of non-traumatic brain injury in this observational cohort analysis. Epileptic seizures should be considered as potential side effects and randomised controlled trials are needed to confirm these findings. |
format | Online Article Text |
id | pubmed-9148986 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-91489862022-06-16 Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury Rühl, Lena Kuramatsu, Joji B Sembill, Jochen A Kallmünzer, Bernd Madzar, Dominik Gerner, Stefan T Giede-Jeppe, Antje Balk, Stefanie Mueller, Tamara Jäger, Jakob Schwab, Stefan Huttner, Hagen B Sprügel, Maximilian I J Neurol Neurosurg Psychiatry Cerebrovascular Disease OBJECTIVE: This study determined the effect of amantadine treatment on consciousness in patients with non-traumatic brain injury. METHODS: We pooled individual patient data of five single-centre observational studies to determine the effect of amantadine treatment among patients with ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, community-acquired bacterial meningitis and status epilepticus, admitted between January 2012 and December 2015 and ventilated ≥7 days. Patient selection and multivariable regression modelling were used to adjust for differences in intergroup comparison and for parameters associated with consciousness. Improvement of consciousness 5 days after treatment initiation was defined as primary outcome. Secondary outcomes included Glasgow Coma Scale (GCS) at day 5 and GCS at day 10, rate of ICU delirium, epileptic seizures and all-cause mortality at 90 days. RESULTS: Overall, 84 of 294 (28.6%) eligible patients received amantadine. Amantadine treatment was associated with improvement of consciousness at day 5 (amantadine: 86.9% vs control: 54.0%; absolute difference: 32.9 (20.0–44.2); adjusted OR (aOR): 5.71 (2.50–13.05), p<0.001). Secondary outcomes showed differences in GCS 5 days (9 (8–11) vs 6 (3–9), p<0.001) and GCS 10 days (10(8–11) vs 9(6–11), p=0.003) after treatment initiation. There were no significant differences regarding all-cause mortality (aOR: 0.89 (0.44–1.82), p=0.758) and ICU delirium (aOR: 1.39 (0.58–3.31), p=0.462). Rate of epileptic seizures after initiation of amantadine treatment was numerically higher in the amantadine group (amantadine: 10.7% vs control: 3.0%; absolute difference: 7.7 (0.3–16.4); aOR: 3.68 (0.86–15.71), p=0.079). CONCLUSIONS: Amantadine treatment is associated with improved consciousness among patients with different types of non-traumatic brain injury in this observational cohort analysis. Epileptic seizures should be considered as potential side effects and randomised controlled trials are needed to confirm these findings. BMJ Publishing Group 2022-06 2022-01-27 /pmc/articles/PMC9148986/ /pubmed/35086939 http://dx.doi.org/10.1136/jnnp-2021-327408 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Cerebrovascular Disease Rühl, Lena Kuramatsu, Joji B Sembill, Jochen A Kallmünzer, Bernd Madzar, Dominik Gerner, Stefan T Giede-Jeppe, Antje Balk, Stefanie Mueller, Tamara Jäger, Jakob Schwab, Stefan Huttner, Hagen B Sprügel, Maximilian I Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury |
title | Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury |
title_full | Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury |
title_fullStr | Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury |
title_full_unstemmed | Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury |
title_short | Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury |
title_sort | amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury |
topic | Cerebrovascular Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9148986/ https://www.ncbi.nlm.nih.gov/pubmed/35086939 http://dx.doi.org/10.1136/jnnp-2021-327408 |
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