1506 - A rare case of amantadine use on a disorders of consciousness patient without evidence of brain injury

Disorder of Consciousness

Case Description:

A 68-year-old female with no significant past medical history was hospitalized after an influenza infection complicated by transverse myelitis, hemophagocytic lymphohistiocytosis, distributive shock, and multi-organ failure. The PM&R consult service was involved for progressive encephalopathy of unclear etiology. Initial Coma Recovery Scale-Revised (CRS-R) score was 5, with minimal eye movement and no verbal response. Over the following week, her score improved to 10 with medical management, and Seroquel 12.5mg was recommended PRN for agitation. Her CRS-R score later rose to 21, however she then experienced a PEA arrest and was transferred to the ICU. Brain MRI showed no acute findings, but her CRS-R dropped to 1, fluctuating between 0 and 5 over the next week. Amantadine 100 mg was initiated for neurostimulation. Two days later, her CRS-R score improved to 16. She stabilized, was downgraded, and her CRS-R reached 19. She became alert, oriented, and resumed therapy.

Discussions:

Amantadine is most commonly used as a stimulating medication for patients with brain injuries. This case utilized the medication in a patient whose disorder of consciousness was not based on any acute brain injury pathology present on neuro-imaging. The addition of the medication saw the patient emerge from DOC and begin communicating within a few days without significant changes in other medical management. 

Conclusions:

This case highlights the potential for amantadine to be considered as a therapeutic option for patients with altered or minimal mental status, extending its use beyond those with anoxic or traumatic brain injury to a broader range of etiologies.