New England Journal of Medicine published an article today showing a significant breakthrough in treating patients with a vegetative and minimally conscious state. The drug, known as Amantadine was previously used to treat flu, but when given to severely injured patients, recovery results were markedly improved.

Neuropsychologist Joseph Giacino of Boston’s Spaulding Rehabilitation Hospital, co-leader of the study said :

“This drug moved the needle in terms of speeding patient recovery, and that’s not been shown before … It really does provide hope for a population that is viewed in many places as hopeless.”

Doctors have been using Amantadine for some years to treat brain injuries, but there has never been a comprehensive study to analyze the results. The new findings are an important step in the right direction, but many questions remain, including whether the drug will help patients that have less severe injuries, and also whether Amantadine will speed the recovery in the long term.

Doctors have been forced to use a variety of medicines normally approved for other ailments in the hopes that they would help brain injury patients. With nearly two million patients suffering traumatic debilitating injuries, the need for a comprehensive treatment is evident and while three quarters are mild concussions that heal over time, more than 50,000 die each year from brain injuries and another 275,000 are hospitalized.

Study co-leader, John Whyte, M.D., Ph.D, Director of Moss Rehabilitation Research Institute

“Now that we know that amantadine can accelerate neurologic recovery, we need to explore the dose and treatment schedule that provides the greatest and most durable treatment impact … Importantly, this study adds to the growing evidence that patients with disorders of consciousness have rehabilitation potential that we are just beginning to tap.”

The problem to date is that doctors have been treating patients based on hunches and common sense, rather than actual physical data. Amantadine is one such weapon of choice, a flu drug that was approved in the mid-1960s, appeared to improve those with Parkinson’s disease, who were treated with it whilst in nursing homes. The drug seems to have an effect on the brain’s dopamine system, and the Parkinson’s patients showed improved movement and alertness. What started as an intuitive finding, is now approved for Parkinson’s.

Whyte continued that:

“(It’s now commonly used for brain injuries, and the researchers felt it was important to find out) whether we’re treating patients with a useful drug, a harmful drug or a useless drug,”

The recent study was carried out in Germany and looked at 184 disabled patients with an average age of 36. A third of them were in what is termed a vegetative state, where they are mainly unconscious with only short periods showing signs of awareness.

Amandatine was randomly assigned to patients, the rest were given a dummy drug for four weeks. Both groups seemed to show some signs of improvement, but those on amantadine had better, faster results. When researchers stopped the drug, recovery in patients who had received it slowed, and two weeks after stopping treatment, both groups appeared about the same again.

One possible use for the drug is in treating US troops with brain injuries. Since 2000, nearly a quarter of a million US soldiers have suffered traumatic brain injuries, including more than 6,000 serious cases, mostly from bomb blasts or shrapnel. Another area that clearly needs more research is in treating other kinds of trauma, such as that from a stroke.

Giacino said the drug still has value even if it only hastens recovery :

“What condition would we not jump for joy if we could have it
over with faster?”

Written by Rupert Shepherd