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Effect of Methylphenidate in Patients with Acute Traumatic Brain Injury; a Randomized Clinical Trial

Published online by Cambridge University Press:  12 December 2007

Hossein A. Khalili  and
Kamyar Keramatian
Hossein A. Khalili
Affiliation:
Department of Neurosurgery, Amiralmomenin Hospital, Shiraz University of Medical Sciences, Grash, Iran; Email: [email protected]
Kamyar Keramatian
Affiliation:
Neuroscience Program, University of British Columbia, Vancouver, Canada; Email: [email protected]
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Extract

ABSTRACT

Background: Traumatic brain injury (TBI) is one of the major causes of death and disability among young people. Methylphenidate is a neural stimulant with possible brain protection properties and has been mainly used in clinic for childhood attention deficit/hyperactivity disorder. TBI patients with late psychosocial problems could benefit from methylphenidate because of the effect on arousal and consciousness level in the sub-acute phase. We studied this effect during the acute phase of moderate and severe TBI. Design and Methods: Forty patients with severe TBI (GCS = 5–8) and 40 moderate TBI patients (GCS = 9–12) were randomly divided into treatment and placebo groups on the day of admission. Treatment group received methylphenidate 0.3 mg/kg two times a day orally, beginning on the second day of admission and continuing until being discharged. Admission information and daily Glasgow Coma Scale (GCS) were recorded. Medical, surgical, and discharge plans for patients were decided by attending physicians, who were kept blinded during the course of treatment. Results: In the severe TBI patients, both hospital and ICU length of stay, on average, were shorter in the treatment group compared with the control group. In the moderate TBI patients, ICU stay was shorter in the treatment group, there was no significant reduction of the period of hospitalization. Interpretation: There were no significant differences between the treatment and control groups in terms of age, sex, post-resuscitation GCS, or brain scan findings, in either severely or moderately impaired TBI patients. Methylphenidate was associated with reductions in ICU and hospital length of stay by 23% in severe TBI patients (p = 0.06 for ICU and p = 0.029 for hospital stay time), in the moderately TBI patients who received methylphenidate, there was 26% fall (p = 0.05) in ICU length of stay.

Keywords

clinical trialhospitalization lengthICUmethylphenidatetraumatic brain injury.
Type
Research Article
Information
Progress in Neurotherapeutics and Neuropsychopharmacology , Volume 3 , Issue 1 , January 2008 , pp. 189 - 197
Copyright
© 2008 Cambridge University Press

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References

Al-Adawi, S., Burke, D.T., & Dorvlo, A.S. (2006). The effect of methylphenidate on the sleep–wake cycle of brain-injured patients undergoing rehabilitation. Sleep Medicine, 7 (3), 287–291. Epub 2006 March 27.Google Scholar
Alban, J.P., Hopson, M.M., Ly, V., & Whyte, J. (2004). Effect of methylphenidate on vital signs and adverse effects in adults with traumatic brain injury. American Journal of Physical Medicine and Rehabilitation, 83 (2), 131–137; quiz 138–141, 167.Google Scholar
Burke, D.T., Glenn, M.B., Vesali, F., Schneider, J.C., Burke, J., Ahangar, B., & Goldstein, R. (2003). Effects of methylphenidate on heart rate and blood pressure among inpatients with acquired brain injury. American Journal of Physical Medicine and Rehabilitation, 82 (7), 493–497.Google Scholar
Challman, T.D., & Lipsky, J.J. (2000). Methylphenidate: its pharmacology and uses. Mayo Clinic Proceedings, 75 (7), 711–721.Google Scholar
Forsyth, R., & Jayamoni, B. (2003). Noradrenergic agonists for acute traumatic brain injury. Cochrane Database of Systematic Reviews, Issue 1:CD003984 (review).Google Scholar
Hornyak, J.E., Nelson, V.S., & Hurvitz, E.A. (1997). The use of methylphenidate in paediatric traumatic brain injury. Pediatric Rehabilitation, 1 (1), 15–17.Google Scholar
Husson, I., Mesples, B., Medja, F., Leroux, P., Kosofsky, B., & Gressens, P. (2004). Methylphenidate and MK-801, an N-methyl-d-aspartate receptor antagonist: shared biological properties. Neuroscience, 125 (1), 163–170.Google Scholar
Jin, C., & Schachar, R. (2004). Methylphenidate treatment of attention-deficit/hyperactivity disorder secondary to traumatic brain injury: a critical appraisal of treatment studies. CNS Spectrums, 9 (3), 217–226 (review).Google Scholar
Kajs-Wyllie, M. (2002). Ritalin revisited: does it really help in neurological injury? Journal of Neuroscience Nursing, 34 (6), 303–313 (review).Google Scholar
Kim, Y.H., Ko, M.H., Na, S.Y., Park, S.H., & Kim, K.W. (2006). Effects of single-dose methylphenidate on cognitive performance in patients with traumatic brain injury: a double-blind placebo-controlled study. Clinical Rehabilitation, 20 (1), 24–30.Google Scholar
Kline, A.E., Yan, H.Q., Bao, J., Marion, D.W., & Dixon, C.E. (2000). Chronic methylphenidate treatment enhances water maze performance following traumatic brain injury in rats. Neuroscience Letters, 280 (3), 163–166.Google Scholar
Mahalick, D.M., Carmel, P.W., Greenberg, J.P., Molofsky, W., Brown, J.A., Heary, R.F., Marks, D., Zampella, E., Hodosh, R., & von der Schmidt III E., (1998). Psychopharmacologic treatment of acquired attention disorders in children with brain injury. Pediatric Neurosurgery, 29 (3), 121–126.Google Scholar
Moein, H., Khalili, H.A., Keramatian, K. (2006). Effect of methylphenidate on ICU and hospital length of stay in patients with severe and moderate traumatic brain injury. Clinical Neurology and Neurosurgery, 108 (6), 539–542.Google Scholar
Plenger, P.M., Dixon, C.E., Castillo, R.M., Frankowski, R.F., Yablon, S.A., & Levin, H.S. (1996). Subacute methylphenidate treatment for moderate to moderately severe traumatic brain injury: a preliminary double-blind placebo-controlled study. Archives of Physical Medicine and Rehabilitation, 77 (6), 536–540.Google Scholar
Rosati, D.L. (2002). Early polyneuropharmacologic intervention in brain injury agitation. American Journal of Physical Medicine and Rehabilitation, 81 (2), 90–93.Google Scholar
Siddall, O.M. (2005). Use of methylphenidate in traumatic brain injury. Annals of Pharmacotherapy, 39 (7–8), 1309–1313. Epub 2005 May 24 (review).Google Scholar
Speech, T.J., Rao, S.M., Osmon, D.C., & Sperry, L.T. (1993). A double-blind controlled study of methylphenidate treatment in closed head injury. Brain Injury, 7 (4), 333–338.Google Scholar
Whyte, J., Hart, T., Schuster, K., Fleming, M., Polansky, M., & Coslett, H.B. (1997). Effects of methylphenidate on attentional function after traumatic brain injury. A randomized, placebo-controlled trial. American Journal of Physical Medicine and Rehabilitation, 76 (6), 440–450.Google Scholar
Whyte, J., Hart, T., Vaccaro, M., Grieb-Neff, P., Risser, A., Polansky, M., & Coslett, H.B. (2004). Effects of methylphenidate on attention deficits after traumatic brain injury: a multidimensional, randomized, controlled trial. American Journal of Physical Medicine and Rehabilitation, 83 (6), 401–420.Google Scholar
Williams, S.E., Ris, M.D., Ayyangar, R., Schefft, B.K., & Berch, D. (1998). Recovery in pediatric brain injury: is psychostimulant medication beneficial? Journal of Head Trauma Rehabilitation, 13 (3), 73–81.Google Scholar
Worzniak, M., Fetters, M.D., & Comfort, M. (1997). Methylphenidate in the treatment of coma. Jouranl of Family Practice, 44 (5), 495–498.Google Scholar
Wroblewski, B.A., Leary, J.M., Phelan, A.M., Whyte, J., & Manning, K. (1992). Methylphenidate and seizure frequency in brain injured patients with seizure disorders. Journal of Clinical Psychiatry, 53 (3), 86–89.Google Scholar