(Kiosk 4) Use of Amantadine in Traumatic Brain Injury with Underlying Parkinsonism: A Case Report

Case Diagnosis: An elderly male patient with features of Parkinsonism sustained a traumatic brain injury (TBI) and demonstrated significant, multifaceted improvement after initiation of amantadine.

Case Description or Program Description: A 75-year-old male, with a history notable for GI stromal tumor on chemotherapy and coronary artery disease on dual antiplatelet therapy, was found to have a mild complicated TBI with left-sided subdural hematoma with minimal midline shift following a ground-level fall. He was admitted to IPR after stabilization at the acute care hospital. At that time, he was noted to have masked facies, postural freezing, festinating gait, and mild tremor; further investigation with family revealed that these symptoms had been ongoing for several months prior to admission. He had features of Parkinsonism, the etiology likely a combination of chronic vascular insults and pharmacologic effects. While working with therapies, he was also noted to have neurocognitive deficits related to his brain injury. He was started on amantadine 100 milligrams twice daily for Parkinsonism and neurocognitive co-management.

Setting: Inpatient rehabilitation (IPR) facility

Assessment/Results: Per therapists, family, and the patient himself, improvement was seen in initiation of response, ambulatory distance, anomic speech, and attention deficit. He had improved participation with therapy during the remainder of his IPR admission. As an outpatient, he remains on this dose with continued progress noted by therapy and neurology.

Discussion (relevance): This case is noteworthy due to the treatment intersection of Parkinsonism and neurocognitive deficit related to TBI. Non-idiopathic Parkinsonism syndromes may have poorer response to carbidopa/levodopa therapy, and other dopaminergic agents have been shown to have better effect. One of these agents, amantadine, is a mainstay of neurocognitive treatment in the TBI population, and is often used to improve attention, arousal, and cognitive participation with therapy.

Conclusions: In patients who have TBI and Parkinsonism symptoms, early initiation of Amantadine can have profound impacts on cognitive, physical, and functional recovery.