From the Guidelines
Amantadine can be used alongside neurostimulation therapies to promote consciousness recovery in patients with severe acute brain injuries, including aneurysmal subarachnoid hemorrhage (aSAH), as evidenced by recent guidelines 1. When considering the use of amantadine and neurostimulation, it is essential to weigh the potential benefits and risks. The 2023 guideline for the management of patients with aSAH suggests that neurostimulants, including amantadine, may be used to promote consciousness recovery in the acute setting 1. Although the evidence is primarily based on retrospective studies and extrapolated from literature on traumatic brain injury, it is reasonable to consider amantadine as a potential treatment option.
Key points to consider when using amantadine and neurostimulation include:
- The median time from aSAH to initiation of neurostimulants was approximately 19 days 1
- Amantadine may be initiated safely in patients with stroke in the subacute period, but the optimal dose and combination with other neurostimulants are unclear 1
- Patients should be monitored for potential side effects of amantadine, including hallucinations, confusion, ankle edema, and livedo reticularis (a skin discoloration)
- The combination of amantadine and neurostimulation may provide enhanced symptom control and potentially offer better outcomes than either treatment alone, particularly in patients with cognitive motor dissociation 1
It is crucial to note that the evidence for using amantadine and neurostimulation in patients with aSAH is not as robust as in other neurological conditions, such as Parkinson's disease. However, based on the available evidence, amantadine can be considered a viable treatment option for promoting consciousness recovery in patients with severe acute brain injuries, including aSAH, when used in conjunction with neurostimulation therapies 1. Medication adjustments should be made gradually and in consultation with a neurologist who specializes in neurocritical care.
From the Research
Amantadine and Neurostimulation
- Amantadine has been studied as a potential neurostimulant in various clinical settings, including Parkinson's disease and post-stroke care 2, 3, 4, 5, 6.
- In Parkinson's disease, amantadine has been shown to improve motor function and reduce levodopa-induced dyskinesia 2, 3.
- In post-stroke care, amantadine has been investigated as a potential treatment for improving cognitive and functional recovery, with some studies suggesting positive effects on wakefulness and responsiveness 4, 5, 6.
Mechanisms of Action
- Amantadine's mechanisms of action are thought to involve blockade of NMDA receptors, modulation of cortico-striatal glutamatergic-dopaminergic interactions, and potential effects on nicotinic receptors and dopamine receptors 3, 6.
Clinical Studies
- A 2007 study found that amantadine infusions during a "drug holiday" from levodopa improved motor function and reduced complications in patients with advanced Parkinson's disease 2.
- A 2018 study demonstrated the efficacy and safety of amantadine for the treatment of L-DOPA-induced dyskinesia in patients with Parkinson's disease 3.
- A 2020 systematic review found that amantadine and modafinil may improve cognitive and functional recovery post-stroke, but higher-quality data are needed to confirm this conclusion 4.
- A 2021 retrospective study found that amantadine and modafinil administration during acute stroke care may improve wakefulness, with 53% of patients considered responders 5.
- An ongoing 2023 pilot study is investigating the effects of amantadine on neuroenhancement in non-traumatic neurointensive patients with persisting coma 6.