Could flu drug help brain injuries?

Caused by car crashes, falls, or assaults, every year, 1.7 million Americans suffer a traumatic brain injury. Now something approved decades ago for a much different ailment is helping speed recovery for some.

Life for Kim and her husband John, changed in an instant. For unknown reasons, Kim suffered a brain hemorrhage.

When she awoke from surgery, she was in a minimally conscious state.

"She could squeeze your finger, but wasn't communicative,” said her husband. “She would say typically one word or up to three word answers for things and would tend not to speak at all unless spoken to."

There is no standard treatment for severe brain injuries, but, doctor Joseph Giacino hopes that his research helps change that.

"This is the first trial to demonstrate that we can indeed influence the course of recovery from severe traumatic brain injury," said Dr. Joseph Giacino, Director of Rehabilitation Neuropsychology at Harvard Medical School Spaulding Rehabilitation Hospital

It focuses on amantadine, a common drug for Parkinson's that was originally used to treat respiratory infections caused by the flu. In the trial, brain injury patients were either given amantadine or a placebo for four weeks. At four weeks the flu drug group improved by one points over the placebo group on the disability scale.

"Restoring you know, human interaction between family to family, between a patient and a health care team, I think that's a very significant step forward," said Dr. Giacino.

One that paves the way to testing amantadine on more patients like Kim. She's been on the drug for six weeks.

"It has kept all of our hopes for her alive," said husband John.

"I think it's going very well," said Kim/

Those in the study who received amantadine recovered the ability to answer yes and no questions and consistently follow commands within four weeks which was faster than participants taking the placebo. Two weeks after treatment stopped, the level of recovery in both groups was about the same.

BACKGROUND: Traumatic brain injuries are a form of acquired brain injury in which a sudden trauma causes damage to the brain. This can occur when an individual's head suddenly and violently hits an object, such as can happen in car accidents, or if something pierces the scull and damages the brain tissue. Not all brain injuries are caused by trauma to a person's head and some are the result of brain bleeds, known as hemorrhages. Around half of patients with a severe brain injury will need surgery to repair ruptured blood vessels known as hematomas, or bruised brain tissue called contusions. However, the severity of the brain injury can vary significantly, depending on how much damage to the brain occurred.

SYMPTOMS: There are some symptoms associated with traumatic brain injuries ranging from mild, moderate, to severe:

Mild traumatic brain injuries may cause headaches, blurred vision, ringing in the ears, a bad taste in the mouth, behavioral or mood changes, and trouble with memory, attention, concentration, and thinking. People with a mild traumatic brain injury also normally do not lose consciousness at the time of the injury, or if they do, only for a few minutes.

Moderate to severe traumatic brain injuries can cause many of the same symptoms as those caused by a mild traumatic brain injury but the person may also experience a headache that will not go away, repeated vomiting, seizures, an inability to awake from sleep, dilation of one or both pupils, slurred speech, and weakness or numbness in the extremities.

TREATMENT: Patients who have a moderate or severe traumatic brain injury are at first stabilized, in which it is made sure that their brain and the rest of their body are receiving the appropriate amount of oxygen, that blood flow is stable, and that blood pressure is controlled. Afterwards, the patients will probably need some form of rehabilitation to return to normal functioning. This therapy is tailored to the specific case and includes physical therapy, speech therapy, occupational therapy, and social support. However, sometimes all of the individual's normal functions do no return, even with rehabilitation. (Source: www.ninds.nih.gov)

FLU DRUG TO TREAT BRAIN INJURIES: Amantadine, once used to treat the flu, is now commonly prescribed to patients with prolonged consciousness disorders after suffering a brain injury. Dr. Giacino's placebo-controlled trial took 184 patients in a vegetative or minimally conscious state and gave them either a placebo or amantadine for four weeks, and then continued to study the patients for two more weeks after they stopped taking the medication. There was a marked improvement in recovery of cognitive skills amongst the amantadine group compared to the placebo, and although recovery slowed in the two weeks that the patients were not taking amantadine, it was shown to accelerate the pace of functional recovery in patients with post-traumatic disorders of consciousness. The drug must be actively used to speed recovery. (Source: www.nejm.org)

FOR MORE INFORMATION, PLEASE CONTACT:

Timothy Sullivan
Director of Communications
Spaulding Rehabilitation Network
(617) 573-2918
tsullivan11@partners.org


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