PHARMACOTHERAPY FOR POST-TRAUMATIC CONFUSION

Project Principal Investigator; Stuart A. Yablon, M.D.

Background : Patients with TBI who require inpatient rehabilitation are frequently confused at the time of admission for rehabilitation. Our investigations of confusion conducted as part of the TBIMSM have clarified the nature of confusion in early recovery after TBI. Early post-traumatic confusional state (PTCS) has been found a complex syndrome characterized by disorientation, cognitive impairment, restlessness, decreased level of daytime arousal, sleep disturbance, fluctuation of symptoms, and psychotic-type symptoms. PTCS complicates early management of patients with TBI and may contribute to increased risk of injury to patients and hospital staff, increased stress among family members and staff, decreased participation in therapies, increased cost of care, and an increased likelihood of being discharged to psychiatric or long-term care settings. These facts indicate the need for effective management of PTCS.

Consensus regarding optimal treatment of the cognitive and behavioral symptoms encountered among patients with PTCS does not exist currently. While many agents have been tried to address such symptoms in TBI, few have been investigated systematically. These circumstances indicate the need for appropriate clinical trials to provide guidance to clinicians for medical treatment of PTCS. In response, the TBIMSM is conducting a randomized, double-blinded, placebo-controlled, parallel group trial for the pharmacological treatment of PTCS. The agent selected for this trial is amantadine, an indirect dopamine agonist. Amantadine will be compared on response measures of efficacy and safety against placebo treatment.

Research Questions or Hypotheses:

Hypothesis 1: Amantadine (an indirect dopamine agonist) will be more effective than placebo in reducing the severity and number of symptoms of PTCS in patients with TBI

Hypothesis 2: Amantadine will be more effective than placebo in reducing disruption of nursing and therapy activities due to symptoms of PTCS during inpatient rehabilitation of patients with TBI.
Hypothesis 3: When compared with placebo, amantadine will not be associated with an increased number of patients withdrawn from study for any reason, including incidence of adverse effects among patients with PTCS.