D L Kaelin1, D X Cifu, B Matthies. 1. Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Richmond, USA.
Abstract
OBJECTIVES: To determine the efficacy of methylphenidate in improving attention and functional outcome in acutely brain-injured adults. DESIGN: Prospective multiple baseline design (A-A-B-A) utilized on a consecutive sample of patients. SETTING: Acute brain injury rehabilitation unit in a large academic medical center. PATIENTS: Eleven acutely brain-injured adults were included by performing below two standard deviations of the age equivalent norms on 4 of 5 neuropsychological tests for attentional capacity. One subject was withdrawn after developing tachycardia. INTERVENTION: After a 1-week baseline assessment, subjects were placed on increasing doses of methylphenidate (Ritalin) so that on Day 7 all patients received a dose of 15 mg at 8 am and 12 pm. MAIN OUTCOME MEASURES: Nine neuropsychological subtests measured attention on admission, at 1 week, while on methylphenidate, and 1 week after its discontinuation. Functional outcome was evaluated utilizing the Disability Rating Scale (DRS) at the same intervals. RESULTS: Digit Span, Mental Control, and Symbol Search scores improved significantly (p < .05) on methylphenidate (A-B) as compared with the pre-methylphenidate (A-A) period. This advantage remained when the drug was removed. The mean improvement in DRS scores on methylphenidate approached a significant difference (p < .06) from that change in the DRS scores between baseline 1 and 2. CONCLUSIONS: Use of methylphenidate in acutely brain-injured adults was well tolerated and demonstrated a significant improvement in attention compared to natural recovery in a rehabilitation setting. Methylphenidate also correlated with faster functional recovery as measured by the Disability Rating Scale although the improvement did not achieve statistical significance.
OBJECTIVES: To determine the efficacy of methylphenidate in improving attention and functional outcome in acutely brain-injured adults. DESIGN: Prospective multiple baseline design (A-A-B-A) utilized on a consecutive sample of patients. SETTING: Acute brain injury rehabilitation unit in a large academic medical center. PATIENTS: Eleven acutely brain-injured adults were included by performing below two standard deviations of the age equivalent norms on 4 of 5 neuropsychological tests for attentional capacity. One subject was withdrawn after developing tachycardia. INTERVENTION: After a 1-week baseline assessment, subjects were placed on increasing doses of methylphenidate (Ritalin) so that on Day 7 all patients received a dose of 15 mg at 8 am and 12 pm. MAIN OUTCOME MEASURES: Nine neuropsychological subtests measured attention on admission, at 1 week, while on methylphenidate, and 1 week after its discontinuation. Functional outcome was evaluated utilizing the Disability Rating Scale (DRS) at the same intervals. RESULTS: Digit Span, Mental Control, and Symbol Search scores improved significantly (p < .05) on methylphenidate (A-B) as compared with the pre-methylphenidate (A-A) period. This advantage remained when the drug was removed. The mean improvement in DRS scores on methylphenidate approached a significant difference (p < .06) from that change in the DRS scores between baseline 1 and 2. CONCLUSIONS: Use of methylphenidate in acutely brain-injured adults was well tolerated and demonstrated a significant improvement in attention compared to natural recovery in a rehabilitation setting. Methylphenidate also correlated with faster functional recovery as measured by the Disability Rating Scale although the improvement did not achieve statistical significance.
Authors: Brenna C McDonald; Laura A Flashman; David B Arciniegas; Robert J Ferguson; Li Xing; Jaroslaw Harezlak; Gwen C Sprehn; Flora M Hammond; Arthur C Maerlender; Carrie L Kruck; Karen L Gillock; Kim Frey; Rachel N Wall; Andrew J Saykin; Thomas W McAllister Journal: Neuropsychopharmacology Date: 2016-11-22 Impact factor: 7.853
Authors: Lea T Drye; Roberta W Scherer; Krista L Lanctôt; Paul B Rosenberg; Nathan Herrmann; David Bachman; Jacobo E Mintzer Journal: Am J Geriatr Psychiatry Date: 2013-01-18 Impact factor: 4.105
Authors: Antonio Verduzco-Mendoza; Paul Carrillo-Mora; Alberto Avila-Luna; Arturo Gálvez-Rosas; Adriana Olmos-Hernández; Daniel Mota-Rojas; Antonio Bueno-Nava Journal: Front Neurosci Date: 2021-06-24 Impact factor: 4.677