2026 American Academy of Neurology Abstract Website

Pavan Raju Kola¹, Arkansh Sharma², Rishu Raj³, Aditi Agarwal⁴, Allimuthu Nithyanandam⁵, Vinay Suresh⁶, Muaz Ali⁷
¹All India Institute Of Medical Sciences, New Delhi, India, ²Government Medical College, Omandurar, Chennai, Tamil Nadu, India, ³Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India, ⁴Osmania Medical College, Hyderabad, India, ⁵Department of Neurology, Tamil Nadu Government Multi-Super Speciality Hospital, Omandurar Government Estate, Chennai, India, ⁶University of Oxford, United Kingdom, ⁷Cleveland Clinic Florida, USA

Objective:

To identify the optimal amantadine dosing strategy for neurological and functional recovery in traumatic brain injury (TBI).

Background:

TBI is a major cause of long-term neurological disability, and treatment options for cognitive and functional recovery are limited. Amantadine, a dopaminergic neurostimulant, shows promise, but optimal dosing remains unclear. Prior meta-analyses have not fully leveraged indirect comparisons.

Design/Methods:

We searched PubMed, EMBASE, SCOPUS, and Web of Science through September 2025 for RCTs of amantadine in TBI. Two reviewers screened studies, extracted data, and assessed quality. A frequentist network meta-analysis was conducted in R (netmeta) using a random-effects model with DerSimonian–Laird estimator. Studies compared different amantadine doses versus placebo. Primary outcomes were GCS at 7 days, DRS at 6 weeks, and MMSE at final follow-up. Language and reporting clarity were refined using ChatGPT (OpenAI, GPT-5).

Results:

Six studies (426 patients; 205 receiving amantadine) were analyzed. For GCS at 7 days (3 studies, 4 arms), 200 mg daily improved outcomes versus placebo (MD 2.50, 95% CI 1.24–3.76, p < 0.0001); 100 mg BID showed a nonsignificant trend (MD 1.83, 95% CI –0.21 to 3.87, p = 0.078), and dose escalation (200 mg × 3 days then 400 mg) was ineffective (MD 0.33, 95% CI –0.83 to 1.49, p = 0.578). For DRS at 6 weeks (2 studies), 200 mg daily was beneficial (MD 2.84, 95% CI 0.41–5.27, p = 0.022); 100 mg BID was nonsignificant (MD 1.68, 95% CI –0.98 to 4.34, p = 0.215). For MMSE, 100 mg BID improved cognition (MD 3.23, 95% CI 0.53–5.94, p = 0.019; I² = 0%).

Conclusions:

Amantadine, especially 200 mg daily, improves early neurological and functional outcomes in TBI, while 100 mg BID may enhance cognition. Moderate dosing appears most effective, supporting further trials to optimize regimens.