2026 Southeastern Residency Conference

Introduction: Traumatic brain injury (TBI) is a major cause of long-term disability, with persistent cognitive and functional deficits affecting millions of survivors. Neurostimulants such as amantadine are recommended for disorders of consciousness after TBI; however, limited evidence exists evaluating the impact of combination neurostimulant therapy with methylphenidate on functional recovery. This study evaluated the effect of single versus dual neurostimulant therapy on functional-cognitive outcomes in patients with moderate to severe TBI.
Methods: A single-center retrospective observational study was conducted at a Level I trauma center from January 1 to December 31, 2024. Adult patients (age >16 years) with moderate to severe TBI, defined as a Glasgow Coma Score (GCS) < 12 within 72 hours of arrival, who received amantadine alone or amantadine plus methylphenidate for ≥3 days during intensive care unit (ICU) admission were included. The primary outcome was discharge functional-cognitive capacity measured by the Rancho Los Amigos Scale-Revised (RLAS-R). Secondary outcomes included change in GCS, ICU and hospital length of stay (LOS), and discharge disposition. Propensity matching (1:4) and multivariable analyses were performed.
Results: Seventy-six patients were included (amantadine n=57; dual therapy n=19). Baseline demographics and injury characteristics were similar between groups. Median discharge RLAS-R scores did not significantly differ between dual therapy and monotherapy groups (4 vs 5, p=0.12). ICU and hospital LOS were comparable between groups, and discharge disposition distributions were similar. Multivariable regression adjusting for initial GCS demonstrated no significant association between treatment strategy and discharge functional-cognitive outcomes (OR 0.73, 95% CI 0.30–1.81). ICU (21 vs 19 days, p = 0.20) and hospital LOS (29 vs 33 days, p = 0.10) were comparable between groups, and discharge disposition distributions were similar, with more than 50% of patients being discharged to an acute rehab facility.
Conclusions: Early initiation of dual neurostimulant therapy (amantadine plus methylphenidate) produced functional-cognitive outcomes comparable to amantadine monotherapy without decreasing resource utilization. These findings suggest no clear additive benefit of combination therapy in moderate to severe TBI and highlight the need for