Therapeutic Role of Amantadine in Prolonged Postictal Encephalopathy: A Case Report in an Elderly Patient

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Abstract
Introduction: Prolonged postictal encephalopathy in elderly patients can be difficult to manage, especially when standard treatments fail. Amantadine, a dopaminergic agent with NMDA antagonist properties, is approved for use in Parkinson’s disease and has demonstrated efficacy in enhancing recovery in TBI. However, its role in nontraumatic etiologies such as postictal states is not well established. Case Presentation: We describe a 95-year-old man with multiple comorbidities who remained somnolent and minimally responsive for 14 days after convulsive status epilepticus, despite seizure control and metabolic correction. EEGs showed no epileptiform activity, and imaging revealed no acute pathology. A trial of amantadine 100 mg daily was initiated for suspected postictal encephalopathy. Within 48 h, the patient showed significant improvement in alertness, orientation, and interaction, returning near baseline by day 10. Conclusion: This case suggests a potential role for amantadine in treating prolonged postictal encephalopathy in elderly patients. Further research is needed to assess its efficacy in nontraumatic disorders of consciousness.

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