Article

Amantadine hydrochloride is one of the most commonly used drugs in the
pharmacotherapeutic treatment of disorders of consciousness (DOCs) following
traumatic brain injury (TBI). Indeed, its actions as a pro-dopaminergic drug and
as an N-methyl-D-aspartate antagonist makes amantadine an interesting candidate
to improve consciousness and responsiveness in individuals with DOC, including
vegetative state and minimally conscious state. Giacino et al (N Engl J Med.
2012;366(9):819-826) recently reported that amantadine was able to accelerate the
functional recovery course of subjects after TBI with DOC, during a 4-week
treatment period. Some patients with DOC following severe TBI have been reported
to have parkinsonian symptoms. Severe TBI and posttraumatic parkinsonism may
share a common midbrain network dysfunction. In fact, both vegetative state and
minimally conscious state following severe TBI can include features of akinetic
mutism and parkinsonism. Responsiveness to pro-dopaminergic agents in some
patients and to deep brain stimulation in others, might depend, respectively, on
the integrity, or lack thereof, of the dopaminergic postsynaptic receptors. We
are of the strong opinion that more attention should be given to parkinsonian
findings in persons with DOC after severe TBI and would advocate for multicenter,
randomized, controlled trials to assess risk factors for parkinsonism following
severe TBI.

Langue : ANGLAIS