(1760) Evaluating Amantadine for Cognitive Recovery in Severe Pediatric TBI: A Multidisciplinary Approach

Introduction: The most meaningful outcome in severe pediatric traumatic brain injury (TBI) is long-term cognitive recovery, highlighting the need for dedicated post-acute care guidelines amid a national shortage of rehabilitation specialists. Amantadine has been shown to accelerate recovery in adults, but its use in pediatric TBI is not well understood. Our institution implemented multidisciplinary guidelines for a stepwise approach to TBI patients, incorporating selective amantadine administration. We hypothesized that this multidisciplinary approach enhances cognitive recovery.

Methods: A retrospective study was conducted on surviving TBI patients aged 1-18 years with a Glasgow Coma Score of 8 or less, presenting to our level 1 pediatric trauma center from 2020 to 2024. Patients with a hospital length of stay of less than one week were excluded. Patient characteristics, outcomes, and physical therapy (PT) assessments were compared between those who did and did not receive amantadine. Serial Rancho Los Amigos Scale (RLAS) scores were analyzed for all patients. Amantadine prescribing patterns, adverse effects, and hospital disposition were evaluated.

Results: 51 patients were included, 24 (47%) received amantadine. Across cohorts, males (59%) and Black patients (55%) predominated. The non-amantadine cohort had more penetrating injuries (0% vs 22%, p = .02) and were younger (10 vs 5). While not statistically significant, patients treated with amantadine trended towards being more severely injured, demonstrated by longer ICU days (15 vs 10), mechanical ventilation days (10 vs 7), and more discharges to rehabilitation (71% vs 33% p=.01). The amantadine cohort scored lower on the RLAS (2 vs 3) during the initial PT assessment, which occurred around one week for both groups. Amantadine was started at a median of 10.5 days after admission and showed improvement, with 79% performing motor activities within 14 days. No adverse events were identified.

Conclusions: The implementation of amantadine administration through a multidisciplinary approach in post-acute pediatric severe TBI care is feasible and may enhance recovery. Future prospective studies are needed to better identify amantadine's targeted use and optimize cognitive and functional outcomes in pediatric trauma.