Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2025-01-05T12:45:59.912Z Has data issue: false hasContentIssue false
  • English
  • Français

Methylphenidate Treatment of Attention-Defit/Hyperactivity Disorder Secondary to Traumatic Brain Injury: A Critical Appraisal of Treatment Studies

Published online by Cambridge University Press:  07 November 2014

Charles Jin  and
Russell Schachar
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Are stimulants effective in treating attention-deficit/hyperactivity disorder secondary to traumatic brain injury (ADHD/TBI)? The authors reviewed and examined the current knowledge on efficacy of stimulant treatment ADHD/TBI.

Method:

A systematic review of the literature using a quality assessment scale to assess the quality of randomized clinical trials was undertaken. We identified all studies in which stimulants had been administered to individuals with ADHD/TBI. Information was extracted on study characteristics, interventions, and outcomes. A meta-analysis was not performed because of the limited number of studies with strict research design and the heterogeneity of outcome measures. Seven studies involving 118 subjects, 41 of whom were children and adolescents, were identified.

Results:

Of the seven identified studies, one was a chart review, one used a single-blind, placebo-controlled crossover design, and five were double-blind, placebo-controlled crossovers. These studies used >50 subjective and objective tests to measure behavioral and cognitive outcomes. Methylphenidate (MPH) effects on behavior (hyperactivity, impulsivity) were evident but were not as robust as those typically observed with MPH in primary ADHD. The effect of MPH on cognition was less apparent. More favorable outcome was associated with initiation of treatment soon after head injury, although this factor was not systematically studied, and trials with relativly long durations. Studies with negative MPH response reported neither improvement in behavioral nor cognitive symptoms.

Conclusion:

There is only modest evidence to support the efficacy of MPH in the treatment of ADHD/TBI. While MPH might still be a promising treatment for ADHD/TBI, there is need for rigorous treatment outcome research among representative samples of ADHD/TBI individuals.

Type
Original Research
Information
CNS Spectrums , Volume 9 , Issue 3 , March 2004 , pp. 217 - 226
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Guerrero, JL, Thurman, DJ, Sniezek, JE. Emergency department visits associated with traumatic brain injury: United States, 1995-1996. Brain Inj. 2000;2:181–186.CrossRefGoogle Scholar
2.Thurman, DJ, Alverson, C, Dunn, KA, Guerrero, J, Sniezek, JE. Traumatic brain injury in the United States: A public health perspective. J Head Trauma Rehabil. 1999;6:602–615.CrossRefGoogle Scholar
3.Mahalick, DM, Koller, CJ, Pleim, EP. Pediatric trauma and head injury. Trauma. 1996;38:39–56.Google Scholar
4.Gerring, JP, Brady, KD, Chen, A, et al.Premorbid prevalence of ADHD and development of secondary ADHD after closed head injury. J Am Acad Child Adolesc Psychiatry. 1998;6:647–654.CrossRefGoogle Scholar
5.Max, JE, Lindgren, SD, Knutson, C, Pearson, CS, Ihrig, D, Welborn, A. Child and adolescent traumatic brain injury: correlates of injury severity. Brain Inj. 1998;1:31–40.Google Scholar
6.Biederman, J, Faraone, S, Milberger, S, et al.A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Arch Gen Psychiatry 1996;5:437–446.CrossRefGoogle Scholar
7.Max, JE, Roberts, MA, Koele, SL, et al.Cognitive outcome in children and adolescents following severe traumatic brain injury: influence of psychosocial, psychiatric, and injury-related variables. J Int Neuropsychol Soc. 1999;1:58–68.CrossRefGoogle Scholar
8.Salazar, AM, Warden, DL, Schwab, K, et al.Cognitive rehabilitation for traumatic brain injury: A randomized trial. Defense and Veterans Head Injury Program (DVHIP) Study Group. JAMA. 2000;23:3075–3081.CrossRefGoogle Scholar
9.Consensus Conference. Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury. JAMA. 1999;10:974–983.Google Scholar
10.Challman, TD, Lipsky, JJ. Methylphenidate: its pharmacology and uses. Mayo Clin Proc. 2000;7:711–721.CrossRefGoogle Scholar
11.Lipper, S, Tuchman, MM. Treatment of chronic post-traumatic organic brain syndrome with dextroamphetamine: first reported case. J Nerv Ment Dis. 1976;5:366–371.CrossRefGoogle Scholar
12.Justice, AC, Cho, MK, Winker, MA, Berlin, JA, Rennie, D. Does masking author identity improve peer review quality? A randomized controlled trial. PEER Investigators. JAMA. 1998;3:240–242.CrossRefGoogle Scholar
13.Jadad, AR, Moore, RA, Carroll, D, et al.Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;1:1–12.CrossRefGoogle Scholar
14.Moher, D, Pham, B, Jones, A, et al.Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 1998;9128:609–613.CrossRefGoogle Scholar
15.Schulz, KF, Chalmers, I, Hayes, RJ, Altman, DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995;5:408–412.CrossRefGoogle Scholar
16.Kay, T, Harrington, DT. Definition of mild traumatic brain injury. J Head Trauma Rehabilitation. 1993;8:86–87.CrossRefGoogle Scholar
17.Levin, HS, Aldrich, EF, Saydjari, C, et al.Severe head injury in children: experience of the Traumatic Coma Data Bank. Neurosurgery. 1992;3:435–443;discussion 43–44.CrossRefGoogle Scholar
18.Teasdale, G, Jennett, B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien). 1976;1–4:45–55.CrossRefGoogle Scholar
19.Gualtieri, CT, Evans, RW. Stimulant treatment for the neurobehavioural sequelae of traumatic brain injury. Brain Inj. 1988;4:273–290.CrossRefGoogle Scholar
20.Mooney, GF, Haas, LJ. Effect of methylphenidate on brain injury-related anger. Arch Phys Med Rehabil. 1993;2:153–160.Google Scholar
21.Speech, TJ, Rao, SM, Osmon, DC, Sperry, LT. A double-blind controlled study of methylphenidate treatment in closed head injury. Brain Inj. 1993;4:333–338.CrossRefGoogle Scholar
22.Whyte, J, Hart, TSchuster, K, Fleming, M, Polansky, M, Coslett, HB. Effects of methylphenidate on attentional function after traumatic brain injury. A randomized, placebo-controlled trial. Am J Phys Med Rehabil. 1997;6:440–450.CrossRefGoogle Scholar
23.Hornyak, JE, Nelson, VS, Hurvitz, EA. The use of methylphenidate in paediatric traumatic brain injury. Pediatr Rehabil. 1997;1:15–17.CrossRefGoogle ScholarPubMed
24.Williams, SE, Ris, MD, Ayyangar, R, Schefft, BK, Berch, D. Recovery in pediatric brain injury: is psychostimulant medication beneficial? J Head Trauma Rehabil. 1998;3:73–81.CrossRefGoogle Scholar
25.Mahalick, DM, Carmel, PW, Greenberg, JP, et al.Psychopharmacologic treatment of acquired attention disorders in children with brain injury. Pediatr Neurosurg. 1998;3:121–126.CrossRefGoogle Scholar
26.Stern, JM. Cranio-cerebral injured patients: A psychiatric clinical description. Scand J Rehabil Med 1978;1:7–10.Google Scholar
27.Haas, JECope, DN. Neuropharmacologic management of behavior sequelae in head injury: a case report. Arch Phys Med Rehabil. 1985;7:472–474.Google Scholar
28.Evans, RW, Gualtieri, CT, Patterson, D. Treatment of chronic closed head injury with psychostimulant drugs: a controlled case study and an appropriate evaluation procedure. J Nerv Ment Dis. 1987;2:106–110.CrossRefGoogle Scholar
29.Frances, A, Jensen, PS. Separating psychological factors from brain trauma in treating a hyperactive child. Hosp Community Psychiatry. 1985;7:711–713.Google Scholar
30.Weinberg, RM, Auerbach, SH, Moore, S. Pharmacologic treatment of cognitive deficits: a case study. Brain Inj. 1987;1:57–59.CrossRefGoogle ScholarPubMed
31.Parmelee, DX, O'Shanick, GJ. Neuropsychiatrie interventions with head injured children and adolescents. Brain Inj. 1987;1:41–47.CrossRefGoogle Scholar
32.Wroblewski, B, Glenn, MB, Cornblait, R, Joseph, AB, Suduikis, S. Protriptyline as an alternative stimulant medication in patients with brain injury: a series of case reports. Brain Inj. 1993;4:353–362.CrossRefGoogle Scholar
33.Bleiberg, J, Garmoe, WS, Cedarquist, J, Reeves, DL, Lux, W. Effects of dexedrine on performance consistency following brain injury. Neuropsychiatry Neuropsychol Behav Neurol. 1993;6:245–248.Google Scholar
34.Jadad, AR, Booker, L, Gauld M, K, et al.The treatment of attention-deficit hyperactivity disorder: an annotated bibliography and critical appraisal of published systematic reviews and metaanalyses. Can J Psychiatry. 1999;10:1025–1035.CrossRefGoogle Scholar
35.Mehta, MA, Owen, AM, Sahakian, BJ, Mavaddat, N, Pickard, JD, Robbins, TW. Methylphenidate enhances working memory by modulating discrete frontal and parietal lobe regions in the human brain. J Neurosci. 2000;6:RC65.CrossRefGoogle Scholar
36.Tannock, R, Ickowicz, A, Schachar, R. Differential effects of methylphenidate on working memory in ADHD children with and without comorbid anxiety. J Am Acad Child Adolesc Psychiatry. 1995;7:886–896.CrossRefGoogle Scholar
37.Kube, DA, Petersen, MC, Palmer, FB. Attention deficit hyperactivity disorder: comorbidity and medication use. Clin Pediatr (Phila). 2002;7:461–469.CrossRefGoogle Scholar
38.Handen, BL, Feldman, HM, Lurier, A, Murray, PJ. Efficacy of methylphenidate among preschool children with developmental disabilities and ADHD. J Am Acad Child Adolesc Psychiatry. 1999;7:805–812.CrossRefGoogle Scholar
39.Pary, R, Lewis, S, Matuschka, PR, Rudzinskiy, P, Safi, M, Lippmann, S. Attention deficit disorder in adults. Ann Clin Psychiatry. 2002;2:105–111.CrossRefGoogle Scholar
40.Vaidya, CJ, Austin, G, Kirkorian, G, et al.Selective effects of methylphenidate in attention deficit hyperactivity disorder: a functional magnetic resonance study. Proc Natl Acad Sci USA. 1998;24:14494–14499.CrossRefGoogle Scholar
41.Wroblewski, BA, Leary, JM, Phelan, AM, Whyte, J, Manning, K. Methylphenidate and seizure frequency in brain injured patients with seizure disorders. J Clin Psychiatry. 1992;3:86–89.Google Scholar
42.Albensi, BC. Models of brain injury and alterations in synaptic plasticity. J Neurosci Res. 2001;4:279–283.CrossRefGoogle Scholar
43.Gerring, J, Brady, K, Chen, A, et al.Neuroimaging variables related to development of secondary attention deficit hyperactivity disorder after closed head injury in children and adolescents. Brain Inj. 2000;3:205–218.Google Scholar
44.Seeman, P, Madras, BK. Anti-hyperactivity medication: methylphenidate and amphetamine. Mol Psychiatry. 1998;5:386–396.CrossRefGoogle Scholar
45.Coull, JT. Neural correlates of attention and arousal: insights from electrophysiology, functional neuroimaging and psychopharmacology. Prog Neurobiol. 1998;4:343–361.CrossRefGoogle Scholar
46.Bloom, DR, Levin, HS, Ewing-Cobbs, L, et al.Lifetime and novel psychiatric disorders after pediatric traumatic brain injury. J Am Acad Child Adolesc Psychiatry. 2001;5:572–579.CrossRefGoogle Scholar
47.Dixon, CE, Hamm, RJ, Taft, WC, Hayes, RL. Increased anticholinergic sensitivity following closed skull impact and controlled cortical impact traumatic brain injury in the rat. J Neurotrauma. 1994;3:275–287.CrossRefGoogle Scholar
48.Plenger, PM, Dixon, CE, Castillo, RM, Frankowski, RF, Yablon, SA, Levin, HS. Subacute methylphenidate treatment for moderate to moderately severe traumatic brain injury: a preliminary double-blind placebo-conttolled study. Arch Phys Med Rehabil. 1996;6:536–540.CrossRefGoogle Scholar
49.Kaelin, DL, Cifu, DX, Matthies, B. Methylphenidate effect on attention deficit in the acutely brain-injured adult. Arch Phys Med Rehabil. 1996;1:6–9.CrossRefGoogle Scholar
50.Worzniak, M, Fetters, MD, Comfort, M. Methylphenidate in the treatment of coma. J Fam Pract. 1997;5:495–498.Google Scholar
51.Kline, AE, Yan, HQ, Bao, J, Marion, DW, Dixon, CE. Chronic methylphenidate treatment enhances water maze performance following traumatic brain injury in rats. Neurosci Lett. 2000;3:163–166.CrossRefGoogle Scholar
52.Graham, DI, McIntosh, TK, Maxwell, WL, Nicoll, JA. Recent advances in neurotrauma. J Neuropathol Exp Neurol. 2000;8:641–651.CrossRefGoogle Scholar