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Poster 299 Amantadine in the Treatment of Irritability and Aggression in Chronic Traumatic Brain Injury: A Randomized, Controlled Trial
S172
Conclusions: The cost of comprehensive outpatient rehabilitation in patients with malignant brain tumors is less expensive than that in patients with traumatic brain injuries or strokes, which are neurological diagnoses commonly seen in day rehabilitation. This study shows that cost should not be a barrier to providing outpatient therapies to this patient population. Poster 299 Amantadine in the Treatment of Irritability and Aggression in Chronic Traumatic Brain Injury: A Randomized, Controlled Trial. Flora Hammond, MD (Indiana University, Indianapolis, IN, United States). Disclosures: F. Hammond, Avanir Prism II Steering Committee, Other Objective: This study tested the hypothesis that amantadine reduces irritability (primary hypothesis) and aggression (secondary hypothesis) among individuals with chronic traumatic brain injury (TBI) (> 6 months post-TBI) through two recent randomized controlled trials. Design: Two parallel-group, randomized, double-blind, controlled trials. Setting: Community. Participants: 76 individuals with chronic TBI were enrolled in a single site study and 168 in a multisite trial. Interventions: Amantadine 100 mg twice daily or placebo. Main Outcome Measures: Irritability was measured before and after treatment using the Neuropsychiatric Inventory (NPI) Irritability and Aggression Domains which measures the frequency and severity of these problems. NPI-Caregiver Distress was also measured. Results or Clinical Course: Mean change in NPI-I was -4.3 in the amantadine group and -2.6 in the placebo group (p¼.0085). In the amantadine group 80.56% improved at least 3 points on the NPI-I, compared to 44.44% who improved at least 3 points in the placebo group. Excluding individuals with minimal to no baseline aggression, mean change in NPI-A was -4.56 in the amantadine group and -2.46 in the placebo group (p¼.046). Mean change in NPI-I Caregiver Distress was not significantly different in the two groups. Adverse event occurrence did not differ between the two groups. The results of the multisite trial will also be presented. Conclusions: Amantadine appears to be a beneficial treatment for reducing the frequency and severity of irritability that accompanies chronic TBI.
Poster 300 The Tibial Somatosensory Evoked Potential Can Prognosticate for Ambulation in Hemiplegic Stroke. Sungju Jee (Chungnam National University Hospital, Daejeonchungcheong Regional Medical Rehabilitation Center, Regional Cardiocerebrovascular Center, Daejeon, Korea, Republic of). Disclosures: S. Jee, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: To examine the association between tibial nerve somatosensory evoked potentials (SEP) and ambulatory outcomes in hemiplegic stroke patients.
PRESENTATIONS
Design: Medical record review. Setting: University medical rehabilitation center setting. Participants: Hemiplegic patients with the first ever stroke who participated in inpatient rehabilitation from January 2009 to May 2013. Main Outcome Measures: Tibial SEP at admission for rehabilitation, Berg balance scale (BBS) and functional ambulation category (FAC) at discharge. Results or Clinical Course: Thirty one hemiplegic patients were included. BBS and FAC were significantly different according to the SEP findings (ANOVA, P<.001). Post-hoc analysis showed significant difference between normal and absent response in BBS (P<.001) and FAC (P<.001), and between abnormal and absent response in BBS (P¼.012) and FAC (P¼.019). Functional outcomes of normal response group were better than abnormal group, but there was no statistical significance. Conclusions: These findings suggest that initial tibial nerve SEP can be a useful biomarker for prognosticating functional outcomes in hemiplegic patients. Poster 384 An Investigation of the Relationship Between Autonomic Dysreflexia and Intrathecal Baclofen in Spinal Cord Patients. Anna Sophia Tritle (MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH, United States); Melvin S. Mejia, MD; Greg A. Nemunaitis, MD. Disclosures: A. Tritle, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: To study the relationship between autonomic dysreflexia (AD) and intrathecal baclofen (ITB) in patients with spinal cord injury. Design: Retrospective Chart Review. Setting: Inpatient and Outpatient Acute Rehabilitation Facility. Participants: 34 subjects. Interventions: We reviewed patients’ medical records to ascertain the presence of symptomatic AD prior to and after implantation of an ITB pump for debilitating spasticity in susceptible spinal cord injury patients. We also recorded risk factors for AD including kidney and bladder stones, heterotopic ossification (HO), and ischial / sacral pressure ulcers. Main Outcome Measures: Presence of AD pre and post-ITB pump placement, presence of risk factors associated with the development of AD including (1) kidney or bladder stones, (2) HO, and (3) pressure ulcers. Results or Clinical Course: Of the 34 subjects, 25 (73.5%) experienced symptomatic AD prior to ITB pump placement and only 2 (5.9%) experienced AD after placement. Four subjects (11.8%) had kidney or bladder stones, of which, all had AD prior to placement and none had AD afterwards. Twenty six subjects (76.5%) had pressure ulcers, of which, all experienced AD prior to placement and only one (0.02%) had AD afterwards. Six patients (17.6%) had HO, of which 5 (83%) had AD prior to placement and none had AD afterwards. Additionally, three patients (8.8%) had at least 2 of the above risk factors, of which, all had AD prior to ITB placement and none had AD afterwards. Conclusions: This study showed a significant reduction in symptomatic episodes of AD in individuals with spinal cord injury, even in those who had additional risk factors for the development of AD.
Conclusions: The cost of comprehensive outpatient rehabilitation in patients with malignant brain tumors is less expensive than that in patients with traumatic brain injuries or strokes, which are neurological diagnoses commonly seen in day rehabilitation. This study shows that cost should not be a barrier to providing outpatient therapies to this patient population. Poster 299 Amantadine in the Treatment of Irritability and Aggression in Chronic Traumatic Brain Injury: A Randomized, Controlled Trial. Flora Hammond, MD (Indiana University, Indianapolis, IN, United States). Disclosures: F. Hammond, Avanir Prism II Steering Committee, Other Objective: This study tested the hypothesis that amantadine reduces irritability (primary hypothesis) and aggression (secondary hypothesis) among individuals with chronic traumatic brain injury (TBI) (> 6 months post-TBI) through two recent randomized controlled trials. Design: Two parallel-group, randomized, double-blind, controlled trials. Setting: Community. Participants: 76 individuals with chronic TBI were enrolled in a single site study and 168 in a multisite trial. Interventions: Amantadine 100 mg twice daily or placebo. Main Outcome Measures: Irritability was measured before and after treatment using the Neuropsychiatric Inventory (NPI) Irritability and Aggression Domains which measures the frequency and severity of these problems. NPI-Caregiver Distress was also measured. Results or Clinical Course: Mean change in NPI-I was -4.3 in the amantadine group and -2.6 in the placebo group (p¼.0085). In the amantadine group 80.56% improved at least 3 points on the NPI-I, compared to 44.44% who improved at least 3 points in the placebo group. Excluding individuals with minimal to no baseline aggression, mean change in NPI-A was -4.56 in the amantadine group and -2.46 in the placebo group (p¼.046). Mean change in NPI-I Caregiver Distress was not significantly different in the two groups. Adverse event occurrence did not differ between the two groups. The results of the multisite trial will also be presented. Conclusions: Amantadine appears to be a beneficial treatment for reducing the frequency and severity of irritability that accompanies chronic TBI.
Poster 300 The Tibial Somatosensory Evoked Potential Can Prognosticate for Ambulation in Hemiplegic Stroke. Sungju Jee (Chungnam National University Hospital, Daejeonchungcheong Regional Medical Rehabilitation Center, Regional Cardiocerebrovascular Center, Daejeon, Korea, Republic of). Disclosures: S. Jee, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: To examine the association between tibial nerve somatosensory evoked potentials (SEP) and ambulatory outcomes in hemiplegic stroke patients.
PRESENTATIONS
Design: Medical record review. Setting: University medical rehabilitation center setting. Participants: Hemiplegic patients with the first ever stroke who participated in inpatient rehabilitation from January 2009 to May 2013. Main Outcome Measures: Tibial SEP at admission for rehabilitation, Berg balance scale (BBS) and functional ambulation category (FAC) at discharge. Results or Clinical Course: Thirty one hemiplegic patients were included. BBS and FAC were significantly different according to the SEP findings (ANOVA, P<.001). Post-hoc analysis showed significant difference between normal and absent response in BBS (P<.001) and FAC (P<.001), and between abnormal and absent response in BBS (P¼.012) and FAC (P¼.019). Functional outcomes of normal response group were better than abnormal group, but there was no statistical significance. Conclusions: These findings suggest that initial tibial nerve SEP can be a useful biomarker for prognosticating functional outcomes in hemiplegic patients. Poster 384 An Investigation of the Relationship Between Autonomic Dysreflexia and Intrathecal Baclofen in Spinal Cord Patients. Anna Sophia Tritle (MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH, United States); Melvin S. Mejia, MD; Greg A. Nemunaitis, MD. Disclosures: A. Tritle, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: To study the relationship between autonomic dysreflexia (AD) and intrathecal baclofen (ITB) in patients with spinal cord injury. Design: Retrospective Chart Review. Setting: Inpatient and Outpatient Acute Rehabilitation Facility. Participants: 34 subjects. Interventions: We reviewed patients’ medical records to ascertain the presence of symptomatic AD prior to and after implantation of an ITB pump for debilitating spasticity in susceptible spinal cord injury patients. We also recorded risk factors for AD including kidney and bladder stones, heterotopic ossification (HO), and ischial / sacral pressure ulcers. Main Outcome Measures: Presence of AD pre and post-ITB pump placement, presence of risk factors associated with the development of AD including (1) kidney or bladder stones, (2) HO, and (3) pressure ulcers. Results or Clinical Course: Of the 34 subjects, 25 (73.5%) experienced symptomatic AD prior to ITB pump placement and only 2 (5.9%) experienced AD after placement. Four subjects (11.8%) had kidney or bladder stones, of which, all had AD prior to placement and none had AD afterwards. Twenty six subjects (76.5%) had pressure ulcers, of which, all experienced AD prior to placement and only one (0.02%) had AD afterwards. Six patients (17.6%) had HO, of which 5 (83%) had AD prior to placement and none had AD afterwards. Additionally, three patients (8.8%) had at least 2 of the above risk factors, of which, all had AD prior to ITB placement and none had AD afterwards. Conclusions: This study showed a significant reduction in symptomatic episodes of AD in individuals with spinal cord injury, even in those who had additional risk factors for the development of AD.