blinded rehabilitation therapy staff documented daily objective performance scores including JFK Coma Recovery Scale (CRS), Boston Diagnostic Aphasia Examination, and Orientation Log. Setting: The Rehabilitation Institute of Michigan, an acute inpa- tient rehabilitation hospital affiliated with Wayne State University and part of the Detroit Medical Center. Results or Clinical Course: For the JFK CRS there was signif- icant improvement from no zolpidem to any dose and no difference between doses. For the Boston Naming Test, there was a significant improvement between no zolpidem and 10 mg as well as between 10 mg and 20 mg. There was no significant difference between 20 mg, 30 mg, or 40 mg. For the Orientation Log, only the 30 mg dose provided a score greater than 24. Conclusions: Zolpidem has been used effectively in the past in arousing severely brain injured patients from a minimally conscious state. In this case, higher doses of zolpidem from 20 to 40 mg daily showed additional gains in cognitive measures as compared to a standard dose of 10 mg daily. However, the patient did display greater distractibility and agitation at 30 and 40 mg doses which led to poorer overall functioning as compared to 20 mg dosing. Poster 49 Serotonin Syndrome in Patients with Acquired Brain Injury: A Case Series. Tara Chilakamarri, MD (University of Cincinnati, Cincin- nati, OH, United States); Sheital Bavishi, DO. Disclosures: T. Chilakamarri, No Disclosures. Case Description: Each patient was started on either selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) for increasing emotional lability during inpatient rehabilitation. All patients had a premorbid diagnosis of depression for which they were taking either SSRI or SNRI. In two patients, medications were resumed at half the premorbid dosage. The third case involved a medication increase to double the patient’s premorbid SSRI dose. Medication regimens were otherwise un- changed. Within 24 hours, each patient developed nausea, vomiting and altered mental status, including increased somnolence, confu- sion, confabulation, agitation, and visual or auditory hallucinations. Electrolyte panels were normal and urine cultures were negative for infection. Each patient was started on intravenous fluids and within one week SSRI or SNRI was decreased to one-fourth premorbid medication dosage. After 24 to 48 hours, each patient’s symptoms resolved and mental status returned to baseline. Program Description: Three patients with acquired brain inju- ries (ABI); two with traumatic brain injuries and one with embolic strokes who developed serotonin syndrome. Setting: Rehabilitation hospital. Results or Clinical Course: Three patients continued on lower than premorbid dose of SSRI or SNRI with improvement in emo- tional lability and no symptoms of serotonin syndrome. Discussion: In patients with a premorbid history of depression and new ABI, initiation or titration of SSRI or SNRI should be done with caution. To our knowledge, this is a unique finding of dose- related serotonin syndrome in patients with ABI. There are no guidelines for use of SSRIs or SNRIs in patients with ABI. Recent studies regarding benefit of SSRI use after ABI have been reported but little data exists on resumption of premorbid depression treat- ment. Conclusions: Serious iatrogenic reactions to SSRI or SNRI are possible in non-naive patients after acquired brain injury. Poster 50 Significant Improvement in Neurobehavioral Function with Amantadine in Anoxic Brain Injury: A Case Report. Todd Beery, DO (Univ of Penn, Philadelphia, PA, United States); Michael Rhee, MD; Kelli Williams, PhD. Disclosures: T. Beery, No Disclosures. Setting: A 47-year-old man with sickle cell anemia was hospital- ized for acute pain crisis. His course was complicated by acute respiratory distress syndrome and respiratory failure. Magnetic res- onance imaging showed bilateral symmetric acute infarcts of the corpus callosum, midbrain, and brachium pontis, consistent with anoxic brain injury (ABI). The patient was admitted to an acute rehabilitation facility nearly 9 weeks after the anoxic event and found to be in a minimally conscious state (MCS). Results or Clinical Course: His initial neurologic examination was notable for only visual pursuit but essentially no other demon- strable neurologic function. He scored a 9/23 on the Coma Recovery Scale-Revised (CRS-R) and failed to make any progress. On day 11 of rehab, amantadine 100 mg twice daily was started. Over one week, the patient had significant improvement as he began follow- ing simple commands, moving all four limbs purposefully and vocalizing. These changes were confirmed with a score of 19/23 on the CRS-R 7 days after starting amantadine, denoting emergence from MCS. The improvements were maintained over the subse- quent weeks. Discussion: Amantadine is a dopaminergic agent that has been implicated in many traumatic brain injury (TBI) studies as promot- ing neurobehavioral recovery. Amantadine increases pre-synaptic dopamine release and number of post-synaptic receptors. There is a relative dearth of studies examining the use of amantadine in ABI. This case report demonstrates significant benefits in an ABI patient in MCS, similar to what has been observed in the TBI population. Although spontaneous recovery cannot be excluded, the timing of improvement directly correlates with amantadine initiation. The magnitude of change was remarkable, with an increase of 10 points on the CRS-R in one week. It should be noted that the patient’s progress had essentially made no gains when amantadine was started, and he was on no other psychoactive medications. This case report suggests amantadine should be considered in ABI patients with MCS for improving neurobehavioral function. Conclusions: This case demonstrated rapid and significant im- provement in neurobehavioral function as exhibited on neurologic examination and by CRS-R score after starting amantadine in an ABI patient. Larger scale studies are needed to substantiate these findings. **Poster 53 Longitudinal Course of Interhemispheric Dynamics in Neglect Patients: Important Implications for rTMS/tDCS Neuromodulation Efforts. Yaron Sacher, MD (Loewenstein Rehabilitation Hospi- tal, Raanana, Israel); Corinne Serfaty, MD; Nachum Soroker, MD. Disclosures: Y. Sacher, No Disclosures. Objective: To assess the longitudinal course of interhemispheric dynamics in stroke patients with unilateral spatial neglect (USN). S206 PRESENTATIONS