Poster 38 Feasibility of a TBI Emergence Protocol Utilizing Amantadine Hydrochloride in the Acute Polytrauma Setting

Abstract

To demonstrate feasibility and safety of a TBI emergence protocol utilizing amantadine (AMH) in an acute polytrauma environment. Secondarily, to demonstrate this can be integrated successfully with the interdisciplinary trauma team treatment plan. Case series. Military acute polytrauma. Six active duty servicemen (average age 26.8 yrs) with acute polytrauma including severe TBI secondary to blast (four) or motor vehicle accidents (two), all in low level states of consciousness. AMH titrated up to 200 mg or 300 mg per day. Speech Pathology also performed evaluation and intervention. Serial focused neurological exams, Coma Scale and Rancho scores. Data demonstrate the feasibility/safety of this intervention in this complex polytrauma setting, with no observed adverse events. Upon discharge to TBI rehabilitation, three of the blast patients and one of the MVA patients emerged to Rancho levels V-VI. One blast and one MVA patient progressed to Rancho level II -III. We also present and discuss results of neuroimaging. AMH has shown benefit in both in the subacute and chronic phases of TBI (Giacino et al 2012, Kraus et al 2005). Use more acutely could maximize potential benefit. The mission of our Inpatient TBI consult team is to provide a bridge from the acute setting to inpatient TBI rehabilitation by providing such interventions. Additional advantages in this setting are reviewed, such as AMH's role in acute pain management. AMH has several mechanisms which may contribute to improvement in arousal and function, and these will be discussed.