The use of stimulant medication to improve neurocognitive and learning outcomes in children diagnosed with brain tumours: a systematic review.

PURPOSE: Impaired attention is reported in children following treatment for brain tumours (BT). Attention problems impact on information processing and encoding, ultimately leading to academic under-performance. Having been successfully used to manage attention-deficit/hyperactivity disorder (ADHD), stimulants such as methylphenidate (MPH) have been investigated as a beneficial treatment for survivors of childhood BT. In order to develop appropriate strategies to manage late neurocognitive effects, the results of such trials should be evaluated to identify those children most likely to benefit from stimulants.
DESIGN: An advanced search was performed across twelve electronic databases for the selection of relevant randomised controlled trials with at least one active stimulant-treated arm. Abstracts were screened for eligibility and data on study design and results were extracted.
RESULTS: Of the 5446 records identified, 11 full text articles were assessed for eligibility and seven included in qualitative synthesis. Of the seven papers there were four original trials. Short term outcomes for MPH on objective direct measures of attention and parent/teacher ratings of behaviour were favourable. Observations of side effects indicate that MPH is generally well tolerated. Heterogeneity of study design and outcome measures precluded meta-analysis.
CONCLUSION: Despite yielding only a small number of trials with limited sample size, studies investigating the use of stimulant medication in survivors of childhood BT have provided promising outcomes. Current evidence indicates males, older age when treated, and higher baseline intelligence quotient (IQ) were predictive of greater responsiveness to MPH. While encouraging, additional research using a standardised protocol of outcome measures would be beneficial in identifying those likely to benefit from stimulant use. Further, the available data have yet to establish clear evidence for the effectiveness of MPH being translated into improvements on standardised measures of academic achievement.