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The effect of pharmacological agents on recovery in chronic disorders of consciousness remains unsatisfactory.1 Amantadine, a dopaminergic agonist, has been suggested to behaviourally improve recovery from both a vegetative state (VS) and a minimally conscious state (MCS).2 3 Here, we report the effect of amantadine in a chronic anoxic MCS patient using standardized behavioural evaluations, actigraphy and serial positron emission tomography.
A 23-year-old man was found comatose after ventricular fibrillation. A brain computed tomography scan was normal and electroencephalography showed an alpha-coma pattern. Somatosensory-evoked potentials detected no cortical (N20) responses. After 3 weeks, the patient evolved to a vegetative state (VS) and was transferred to a rehabilitation centre (where no cognitive-enhancing interventions were given). He returned home after 6 months, having been diagnosed as being in a VS. After 2 years, the family contacted us for re-evaluation. Using the Coma Recovery Scale-Revised (CRS-R),4 the patient was recognised as being in a minimally conscious state (MCS; that is, presence of visual pursuit). After written informed consent from the patient’s legal representative, amantadine treatment (200 mg per day) in an ABAB design was proposed in conjunction with weekly CRS-R assessment, actimetry monitoring and serial FDG-PET (fluorodeoxyglucose-positron emission tomography) (3 weeks baseline period, amantadine …