Amantadine for the agitated head-injury patient

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Abstract
Traumatic brain injury may be associated with agitated aggressive behaviour and the potential for injury to the patient and staff. We report two cases of recovering brain injury patients with difficult-to-treat destructive behaviour, whose agitation and aggression responded to amantadine. Direct-acting dopamine agonists such as amantadine may be the preferred treatment for patients with behaviour problems in the acute stages of recovery from coma. There are not many treatment alternatives for the agitated, assaultive, disorganized head-injury patient who is recovering from coma. More precisely, there are a number of medications to choose among–carbamazepine, lithium, benzodiazepines, antihistaminics, beta-blockers–but therapeutic effect is not always predictable. All too often, physicians are compelled to prescribe neuroleptics [1]. Neuroleptics are reliable tranquillizers in such circumstances, at least over the short term; but they may result in serious side-effects (extrapyramidal reactions, cognitive blunting, temperature disregulation); and there is preclinical evidence to suggest that dopamine antagonists may retard the course of cortical recovery [2]. We have observed that the direct-acting dopamine agonist, amantadine, may sometimes be useful for the acute management of such patients. The fact that dopamine agonists may actually enhance the course of cortical recovery [2] suggests that amantadine may be a rational treatment for the recovering brain-injured patient [1].