TBI
Madeleine N. Mitcham, MA
Medical Student
University of the Incarnate Word School of Osteopathic Medicine
San Antonio, Texas, United States
Aaron M. Bernal, n/a
Medical Student
University of The Incarnate Word School of Osteopathic Medicine
Boerne, Texas, United States
Austin Smith, MS
Medical Student
University of the Incarnate Word School of Osteopathic Medicine
San Antonio, Texas, United States
Jacob Nieves, BS
Medical Student
The University of Texas Medical Branch John Sealy School of Medicine
Pearland, Texas, United States
Roshan Santhosh, DO
Resident Physician
Larkin Health System
Miami, Florida, United States
Madeleine N. Mitcham, MA
University of the Incarnate Word School of Osteopathic Medicine
San Antonio, Texas, United States
Amantadine and Methylphenidate are commonly used off-label for neurostimulation after traumatic brain injury (TBI). Amantadine has been associated with accelerated functional recovery and improved early arousal, while Methylphenidate has been linked to enhanced attention and processing speed. This retrospective cohort study compares their adverse effects to better inform therapeutic decision-making in TBI management. In this retrospective cohort study, Amantadine use after TBI was associated with higher rates of mortality, hypotension, autonomic dysregulation, mood disorders, and sleep disturbances compared to Methylphenidate. While both agents are used for neurostimulation, these findings suggest that methylphenidate may have a more favorable short-term safety profile. Prospective studies are warranted to validate these results and further inform individualized treatment strategies in TBI recovery.
Design:
Design: Case-control retrospective cohort analysis using the TriNetX Database, which contains de-identified electronic health record data to select patients with a diagnosis of TBI. This study is exempt from IRB review, determined by the University of Texas Medical Branch IRB.
Participants: Cohort one (Methylphenidate + TBI), 819 patients; mean age of 46.6 +/- 23.7 and cohort two (Amantadine + TBI), 819 patients; mean age of 46.5 +/- 21.2 after propensity score matching. Both cohorts were diagnosed with TBI and received Inpatient care.
Outcomes: New diagnoses of mood disorders, sleep disorders, autonomic dysregulation, hypotension, and mortality in patients receiving Methylphenidate or Amantadine for neurostimulation after TBI. Cohorts were matched for SSRI or bromocriptine use, neurosurgical intervention, and need for mechanical ventilation.
Results: The Amantadine cohort had higher rates of autonomic dysregulation (49.1% vs. 37.1%, p=0.000), hypotension (13.9% vs. 8.4%, p=0.000), and mortality (7.1% vs. 4.2%, p=0.010) compared with Methylphenidate. Kaplan-Meier survival was higher with Methylphenidate (95.65% vs. 92.56%, p=0.009). Although not statistically significant, Amantadine was associated with slightly higher rates of mood disorders (32.7% vs. 31%, p=0.458) and sleep disorders (11% vs. 10%, p=0.379).
Conclusions:
