The combined use of amantadine and l-dopa/carbidopa in the treatment of chronic brain injury.
The frontal lobes are particularly vulnerable to injury during trauma. The syndrome commonly attributed to frontal lobe dysfunction includes problems with impulsivity, perseveration, disinhibition, amotivation, attention, planning, and problem solving. These symptoms can respond to certain pharmacologic interventions, such as the dopaminergic agents. The case of a 50-year-old woman who showed persistent frontal dysfunction 5 years post-injury is described. After treatment with amantadine alone, she showed decreased impulsivity and perseveration and improved executive function. Further positive response was obtained with the addition of l-dopa/carbidopa, with additional improvements in constructional praxis, divided auditory attention, and cognitive flexibility. Her improved functioning following treatment demonstrates the potential for increasing effectiveness through a combination of dopaminergic agents. No side effects were observed, and the patient maintained gains at follow-up. The rationale for using dopaminergic agents alone and in combination is discussed.
Kraus
M F
MF
Division of Geriatrics and Neuropsychiatry, Western Psychiatric Hospital and Clinic, Pittsburgh, PA 15213, USA.
Maki
P
P
D000547:Amantadine / Q000627:therapeutic use*; D001519:Behavior / Q000187:drug effects; D001930:Brain Injuries / Q000188:drug therapy* / Q000523:psychology; D002230:Carbidopa / Q000627:therapeutic use*; D002908:Chronic Disease; D003071:Cognition / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests
D007980:Levodopa; D000547:Amantadine; D002230:Carbidopa