Neurostimulant Prescribing Patterns in Children Admitted to the Intensive Care Unit after Traumatic Brain Injury.

TL;DR: In this article, the authors performed a retrospective review of adult patients admitted to a level I trauma center from 2016-2019 with a severe TBI and found that dual versus monotherapy was associated with an increased likelihood of excellent neurorecovery.

TL;DR: Although large clinical trials for children with DoC are lacking, single-site and multisite programmatic data inform standards of care and treatment options for childrenwith DoC.

Abstract: Abstract Background We sought to examine the use of neurostimulants (NS) in the acute setting among patients with severe traumatic brain injury (TBI) and assess their impact on cognitive outcomes. Methods We performed a retrospective analysis of prospectively collected data from patients aged ≥ 18 years with a severe (Glasgow Coma Scale score ≤ 8), blunt TBI at eight US trauma centers from 2020 to 2023. Patients were grouped according to whether they received NS. Our primary outcome was cognitive disability at 28 days or discharge (whichever occurred first), measured by the Disability Rating Scale (DRS). A DRS score < 12 was considered a favorable outcome. Results The cohort comprised 405 patients: 29.9% ( n = 121) received NS and 70.1% ( n = 284) did not. The most common NS was amantadine (97.5%, n = 118). The median time to NS initiation was 8.0 days (5.0–13.5), and the median treatment duration was 12.0 days (5.5–17.0). NS patients had worse injury severity scores (29 vs. 26, p = 0.02), had more neurosurgical interventions (64.4% vs. 33.2%, p < 0.0001), and were less likely to have a favorable outcome (30.8% vs. 67.1%, p < 0.0001). In a subgroup analysis of only NS patients, individuals receiving NS within 7 days of admission were three times as likely to have a favorable outcome compared to those receiving NS > 7 days after admission (odds ratio 3.01, 95% confidence interval 1.11–8.18, p = 0.03). Conclusions Nearly a third of patients with severe TBI received NS. Patients receiving NS were more injured and had worse disability at discharge compared to non-NS patients. However, among patients who received NS, treatment within 7 days was associated with an increased odds of a favorable outcome.

TL;DR: It is indicated that there is variable use of MPH during acute inpatient rehabilitation for children with TBI, and children who receive MPH tend to be older with lower cognitive states, likely consistent with underdosing.

TL;DR: Amantadine accelerated the pace of functional recovery during active treatment in patients with post-traumatic disorders of consciousness, indicating a benefit with respect to the primary outcome measure.

TL;DR: The impact of early brain insults has been considered to be less significant than for later brain injuries, consistent with the notion that the young brain is more flexible and able to reorganize in the context of brain insults as mentioned in this paper.

TL;DR: Blanpied, Thomas A., Faye Boeckman, Elias Aizenman, and Jon W. Johnson as mentioned in this paper investigated the channel block of NMDA-activated responses by amantadine and memantine.

TL;DR: Female TBI patients had a better predicted outcome and it is suggested that progesterone, acting as a neuroprotective agent, may explain this difference in outcome.