Efficacy of methylphenidate in the rehabilitation of attention following traumatic brain injury: a randomised, crossover, double blind, placebo controlled inpatient trial.

Abstract

OBJECTIVES:

Most previous studies evaluating the use of methylphenidate following traumatic brain injury (TBI) have been conducted many years post-injury. This study evaluated the efficacy of methylphenidate in facilitating cognitive function in the inpatient rehabilitation phase.

METHODS:

40 participants with moderate-severe TBI (mean 68 days post-injury) were recruited into a randomised, crossover, double blind, placebo controlled trial. Methylphenidate was administered at a dose of 0.3 mg/kg twice daily and lactose in identical capsules served as placebo. Methylphenidate and placebo administration was randomised in a crossover design across six sessions over a 2 week period. Primary efficacy outcomes were neuropsychological tests of attention.

RESULTS:

No participants were withdrawn because of side effects or adverse events. Methylphenidate significantly increased speed of information processing on the Symbol Digit Modalities Test (95% CI 0.30 to 2.95, Cohen's d = 0.39, p = 0.02), Ruff 2 and 7 Test-Automatic Condition (95% CI 1.38 to 6.12, Cohen's d = 0.51, p = 0.003), Simple Selective Attention Task (95% CI -58.35 to -17.43, Cohen's d = 0.59, p = 0.001) and Dissimilar Compatible (95% CI -70.13 to -15.38, Cohen's d = 0.51, p = 0.003) and Similar Compatible (95% CI -74.82 to -19.06, Cohen's d = 0.55, p = 0.002) conditions of the Four Choice Reaction Time Task. Those with more severe injuries and slower baseline information processing speed demonstrated a greater drug response.

CONCLUSIONS:

Methylphenidate enhances information processing speed in the inpatient rehabilitation phase following TBI. This trial is registered with the Australian New Zealand Clinical Trials Registry (12607000503426).

• Authors: C Willmott, J Ponsford
• Journal: Journal of neurology, neurosurgery, and psychiatry (J Neurol Neurosurg Psychiatry) Vol. 80 Issue 5 Pg. 552-7 (May 2009) ISSN: 1468-330X [Electronic] England
• PMID: 19060022 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Central Nervous System Stimulants
• Methylphenidate

Topics

• Adolescent
• Adult
• Attention (drug effects)
• Brain Injuries (psychology, rehabilitation)
• Central Nervous System Stimulants (adverse effects, therapeutic use)
• Cross-Over Studies
• Double-Blind Method
• Female
• Hemodynamics (drug effects)
• Humans
• Male
• Memory, Short-Term
• Methylphenidate (adverse effects, therapeutic use)
• Middle Aged
• Neurologic Examination
• Neuropsychological Tests
• Predictive Value of Tests
• Psychomotor Performance (physiology)
• Reaction Time (physiology)
• Treatment Outcome
• Wechsler Scales
• Young Adult