Clinical and electroencephalographic on–off effect of amantadine in chronic non-traumatic minimally conscious state

Therapeutic interventions in patients with prolonged disorders of consciousness

“…20 In non-TBI, one uncontrolled case-report has described the positive behavioural effects of amantadine in a MCS patient (16 months post-injury). 21 An older controlled case-report showed an increased metabolism in the fronto-parietal cortex during amantadine in an anoxic MCS responder (figure 2A). 12 These two case-reports should encourage the development of RCT evaluating the effect of amantadine in other etiologies than TBI.…”

Selegiline in Patients With Disorder of Consciousness: An Open Pilot Study

“…However, our observation would support the effectiveness of dopaminergic drugs (such as selegiline) even in patients with DoC of non-traumatic etiology, who usually have poorer prognosis than post-traumatic patients, in keeping with two previous case reports showing positive effects (emergence from MCS) of dopaminergic drug (amantadine) in patients with anoxic or vascular etiology. 2 Here, selegiline seemed to exert positive effects even in patients with chronic stabilized DoC (case 1), in whom late recovery is infrequent. 12 It is worth mentioning that prudentially we ended treatment in three patients for possible side effects (protracted diarrhea and persistent supraventricular tachycardia); although these clinical conditions are not frequently associated with selegiline, 10 they are quite frequent in patients with DoC, and occurred several weeks after starting selegiline.…”

“…Clinical recovery in severely brain-injured patients with disorder of consciousness (DoC) could be enhanced by amantadine, a dopaminergic agent. [1][2][3] Unfortunately, severe side effects such as seizures or QT-interval enlargement on electrocardiogram (ECG) could limit the use of amantadine. 2 Selegiline, a dopaminergic drug that acts as an irreversible selective monoamine oxidase type B (MAOB) inhibitor, is used in early Parkinson's disease and is usually well tolerated at a low dosage (10 mg daily).…”

“…[1][2][3] Unfortunately, severe side effects such as seizures or QT-interval enlargement on electrocardiogram (ECG) could limit the use of amantadine. 2 Selegiline, a dopaminergic drug that acts as an irreversible selective monoamine oxidase type B (MAOB) inhibitor, is used in early Parkinson's disease and is usually well tolerated at a low dosage (10 mg daily). 4 More recently, selegiline has been shown also to exert clinical positive effects on apathy in patients with severe traumatic brain injury 5 and on cognitive performance in stroke patients.…”

Pharmacological Treatments

“…A first study used electroencephalogram (EEG) to show an increase of alpha activity and a decrease of theta activity in one UWS patient who clinically responded to amantadine [26]. A second case report of a non-traumatic MCS patient showed that during amantadine treatment when the patient was able to communicate and use objects (i.e., emergence of MCS), the EEG data also showed an increase in predominant background alpha activity (10)(11), while during baseline and washout periods, the EEG showed moderately abnormal EEG background (7-8 Hz) [27]. Note that this case also presented a dose-dependent effect, but epileptic facial myoclonus was observed during treatment, which led to the discontinuation of amantadine.…”