医学
蛛网膜下腔出血
金刚烷胺
安慰剂
意识障碍
麻醉
双盲
认知
持续植物状态
意识
精神科
最小意识状态
药理学
神经科学
替代医学
病理
生物
作者
Luana Antunes Maranha Gatto,Zeferino Demartini,João Paulo Mota Telles,Eberval Gadelha Figueiredo
标识
DOI:10.1016/j.clineuro.2024.108135
摘要
Severe disorders of consciousness (sDoC) are a common sequela of aneurysmal subarachnoid hemorrhages (aSAH), and amantadine has been used to improve cognitive recovery after traumatic brain injury. This study evaluated the effect of amantadine treatment on consciousness in patients with sDoC secondary to aSAH. This double-center, randomized, prospective, cohort study included patients ≥18 years old with sDoC after aSAH from February 2020 to September 2023. Individual patient data of patients were pooled to determine the effect of amantadine, in comparison to placebo. The primary outcomes at 3 and 6 months after the ictus were evaluated using the modified Rankin scale (mRS) and Glasgow outcome scale (GOS). In addition to all-cause mortality, secondary endpoints were assessed weekly during intervention by scores on Rappaport's Disability Rating Scale (RDRS) and Coma Recovery Scale-Revised (CRSR). Overall, 37 patients with sDoC and initial Glasgow Coma Scale (GCS) varying between 3 and 11 were recruited and randomized to amantadine (test group, n=20) or placebo (control group, n=17). The average age was 59.5 years (28 to 81 year-old), 24 (65%) were women, and the mean GCS at the beginning of intervention was 7.1. Most patients evolved to vasospasm (81%), with ischemia in 73% of them. The intervention was started between 30 to 180 days after the ictus, and administered for 6 weeks, with progressively higher doses. Neither epidemiological characteristics nor considerations regarding the treatment of the aneurysm and its complications differed between both arms. Overall mortality was 10.8% (4 deaths). During the study, four patients had potential adverse drug effects: two presented seizures, one had paralytic ileus, and another evolved with tachycardia; the medication was not suspended, only the dose was not increased. At data opening, 2 were taking amantadine and 2 placebo. Despite some good results associated with amantadine in the literature, this study did not find statistically significant positive effects in cognitive recovery in patients with delayed post-aSAH sDoC. Further large randomized clinical trials in patients’ subgroups are needed to better define its effectiveness and clarify any therapeutic window where it can be advantageous.
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