Clinical Effect Of Amantadine Combined With Comprehensive Rehabilitation On Vegetative State With Post-traumatic Brain Injury Patients

Objective:To observe the awakening effect of amantadine combined with comprehensive rehabilitation in vegetative state with post-traumatic brain injury patients,and to provide theoretical basis for its clinical application.Methods:We enrolled 29 patients who were in a vegetative state 4 to 16 weeks after traumatic brain injury and who hospitalized at the Department of Rehabilitation Medicine of First Hospital of Jilin University from September 2015 to January 2018.The average age was 48.35±11.90 years old,including 20 males and 9 females.All the patients were randomly divided into control group(n=14)and treatment group(n=15).All the patients were received inpatient comprehensive rehabilitation for2 weeks,including positioning,passive range of motion,passive limb stretching,wake-up therapy(stimulation of smell,taste,vision,touch,etc.),physiatrics,and traditional acupuncture therapy,60 minutes each time,once a day.After 2 weeks treatment,the treatment group continued to receive amantadine combined with comprehensive rehabilitation for 8 weeks,while the control group only received comprehensive rehabilitation for 8 weeks.The medication regimen was: the patients received amantadine at a dose of 100 mg twice daily from 3 to 4 weeks after hospitalization.The dose was increased to 150 mg twice daily at the fifth week and to200 mg twice daily that from 6 to 10 weeks.All the patients received the disability rating scale(DRS),the coma recovery scale-revised(CRS-R)and the Rancho Los Amigos Levels of Cognitive Functioning Scale(RLA)on the first day,the second weekends,the sixth weekends,and the tenth weekends of hospitalization to assess the level of arousal,consciousness,and cognitive function.Results:There was no significant difference in DRS scores,CRS-R scores,and RLA grades between the two groups on the first day and the second weekends after hospitalization(P>0.05).Comparison in the treatment group: There was no significant difference in DRS scores,CRS-R scores,and RLA grades between the two groups on the first day and the second weekends(P>0.05).Compared with the second weekends,the DRS scores,CRS-R scores and RLA grades at the sixth weekends were significantly different(P<0.05).Compared with the second weekends,the DRS scores,CRS-R scores and RLA grades at the tenth weekends were also significantly improved(P<0.05).Compared with the sixth weekends,all the scores at the tenth weekends were siginificantly improved(P<0.05).Comparison in the control group:There was no significant difference in DRS scores,CRS-R scores,and RLA grades between the two groups on the first day and the second weekends(P>0.00).Compared with the second weekends,the DRS scores,CRS-R scores and RLA grades at the sixth weekends were no significantly different(P>0.05).Compared with the second weekends,the DRS scores,CRS-R scores and RLA grades at the tenth weekends were significantly improved(P<0.05).Compared with the sixth weekends,the DRS scores,CRS-R scores and RLA grades at the tenth weekends were siginificently improved(P<0.05).Comparison between the two groups: compared with control group,the DRS scores,CRS-R scores and RLA grades at the sixth weekends were siginificantly better than those in the control group(P<0.05),and all the scores at the tenth weekends were also siginificantly improved(P<0.05).Conclusions:Amantadine combined with comprehensive rehabilitation can promote the recovery of the consciousness in the vegetative state with post-traumatic brain injury patients.Early application of amantadine intervention improves physiological arousal and cognitive function in traumatic brain injury.And it may have a sustained therapeutic effect on the recovery of the vegetative state in traumatic brain injury patients.