223 - Amantadine-Augmented Intensive Rehabilitation Promotes Language and Functional Recovery in Osmotic Demyelination Syndrome: A Case Report

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CN

Cindy Nguyen, MD

Resident Physician
Schwab Rehabilitation Hospital
Chicago, Illinois, United States
CR

Christiana Reeve, DO

Resident Physician
Schwab Rehailitation Hospital
Chicago, Illinois, United States
SN

Son Nguyen, BA

Medical Student
University of Missouri - Kansas City School of Medicine
Kansas City, Missouri, United States

Co-Author(s)

GA

Ghada Ahmed, MD

Attending Physician
Schwab Rehab Hospital
chicago, Illinois, United States
MW

Michael Whittendale, DO

Physician
Naval Airspace Pensacola
Chicago, Illinois, United States

Submitter(s)

CN

Cindy Nguyen

Case Diagnosis: Osmotic demyelination syndrome secondary to rapid correction of severe hyponatremia

Case Description: A 46-year-old woman with alcohol use disorder was hospitalized for alcohol withdrawal complicated by status epilepticus and hyponatremia. Serum sodium was rapidly corrected from 106 to 122 mEq/L within 24 hours, resulting in acute encephalopathy, oropharyngeal dysphagia, expressive aphasia, impaired gait, and hemiparesis. Neuroimaging was significant for pontine and extrapontine osmotic demyelination. Through a comprehensive interdisciplinary rehabilitation program and use of amantadine to support neurorecovery, the patient achieved substantial gains in communication, mobility, swallowing, and activities of daily living.

Discussions: This case highlights the role of Amantadine in neurorecovery in conjunction with intensive therapy. Its dopaminergic properties act on the prefrontal cortex and basal ganglia, improving verbal fluency, initiation, and cognitive flexibility. NMDA receptor antagonism promotes reorganization of language networks, while increased arousal and attention enhanced engagement in therapy. Integrated with speech therapy, amantadine accelerated recovery from severe expressive aphasia to full communicative ability. Physical and occupational therapy maximized neuroplasticity and restored functions in mobility and ADLs. By discharge, the patient transitioned to an oral diet, achieved modified independence with transfers and ambulation, and required only minimal assistance for dressing and hygiene.

Conclusions: Recovery from pontine osmotic demyelination syndrome is often difficult due to severe neurological deficits; however, this case illustrates that a multimodal rehabilitation approach can yield meaningful gains. While previous reports have described the use of carbidopa/levodopa for truncal instability and ataxic gait, this patient also presented with expressive aphasia related to extrapontine involvement. The integration of amantadine with speech therapy supported language recovery, while concurrent physical and occupational therapy supported improvements in mobility, coordination, and activities of daily living. These findings underscore the potential of combining neuropharmacologic interventions and high-intensity rehabilitation to maximize independence, cognitive engagement, and overall quality of life in patients with complex neurological impairments following ODS.