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Caffeine as a neurostimulant: Two pediatric acquired brain injury cases
Patrick J Barrett1, Ellen K Casey, Charles Sisung
1Physical Medicine and Rehabilitation Service, Jesse Brown VA Medical Center, USA Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, USA.
Insights
Caffeine administration improved attention and function in two pediatric patients with acquired brain injury (ABI). Functional gains were observed in communication and mobility, with improvements reversing upon caffeine cessation.
Area of Science:
- Neuroscience
- Pediatric Rehabilitation
- Clinical Neurology
Background:
- Acquired brain injury (ABI) in pediatric patients often leads to significant attention and arousal impairments, hindering rehabilitation progress.
- Two adolescents with ABI experienced difficulties in therapy participation due to these cognitive deficits.
Purpose of the Study:
- To investigate the potential of caffeine as a therapeutic agent for improving attention, arousal, and functional outcomes in pediatric patients with ABI.
- To assess the safety and efficacy of low-dose caffeine administration in this patient population.
Main Methods:
- Case report of two pediatric patients (16-year-old female and 16-year-old male) with ABI undergoing acute inpatient rehabilitation.
- Administration of caffeine 80 mg daily to address attention/arousal impairments.
- Monitoring of functional improvements using clinical observation and Functional Independence Measurement (FIM) scores.
Main Results:
- Both patients showed notable functional improvements after initiating caffeine, including enhanced communication and mobility.
- The second patient experienced dramatic improvements in FIM scores, transitioning from total dependence to requiring only moderate assistance or supervision.
- Functional gains and FIM scores declined upon caffeine cessation and improved with re-administration, with no adverse events reported.
Conclusions:
- Caffeine (80 mg daily) appears to be a safe, inexpensive, and effective neurostimulant for improving attention and arousal in pediatric ABI patients.
- Further research is needed to establish optimal caffeine dosing, timing, and duration for pediatric ABI rehabilitation and to explore its impact on chronic functional outcomes.
Objective:
This report describes two pediatric patients undergoing acute inpatient rehabilitation for acquired brain injury.
Design:
The first patient was a 16-year-old African American female with an acquired brain injury from multiple intracranial hemorrhages secondary to an arteriovenous malformation. The second patient was a 16 year-old African American male who sustained a traumatic brain injury due to assault. In both cases, the patients had difficulty participating in therapy due to significant attention/arousal impairments.
Results:
Both patients demonstrated functional improvements after the initiation of caffeine 80 mg daily. The first patient's function improved from being unable to communicate to being able to signal yes/no with thumb movements. The functional independence measurement (FIM) scores of the second patient improved dramatically after caffeine was initiated. His function improved from being totally dependent in ambulation, wheelchair ambulation, and communication to only requiring moderate assistance with ambulation and supervision with wheelchair ambulation and communication after 3 weeks of treatment. The second patient's attention/arousal and FIM scores declined when caffeine was stopped for 3 days and improved once administration of caffeine resumed. There were no adverse events reported for either patient.
Conclusion:
Caffeine is a safe and inexpensive neurostimulant that may be used to treat attention/arousal impairments. Additional research is warranted to determine criteria of use, optimal timing, duration, and dosing of caffeine administration and to investigate whether caffeine improves chronic functional outcomes after ABI in pediatric acquired brain injury patients.
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