Short-term efficacy and tolerability of methylphenidate in children with traumatic brain injury and attention
Ozalp Ekinci1, Meltem Çobanoğulları Direk2, Serkan Gunes1
1Mersin University Medical Faculty, Department of Child and Adolescent Psychiatry, Mersin, Turkey.
Insights
Immediate-release methylphenidate (IR-MPH) effectively reduced attention deficit and hyperactivity symptoms in children with traumatic brain injury (TBI). The treatment was well-tolerated, showing promise for managing ADHD symptoms post-TBI.
Area of Science:
- Pediatric Neurology
- Neurorehabilitation
- Child Psychiatry
Background:
- Traumatic brain injury (TBI) in children can lead to persistent attention deficit and hyperactivity-impulsivity symptoms, mimicking Attention Deficit Hyperactivity Disorder (ADHD).
- Effective management strategies for these symptoms following TBI are crucial for improving functional outcomes.
- Immediate-release methylphenidate (IR-MPH) is a common pharmacotherapy for ADHD, but its efficacy in pediatric TBI populations requires further investigation.
Purpose of the Study:
- To evaluate the short-term efficacy and tolerability of IR-MPH in children with a history of TBI.
- To assess the impact of IR-MPH on ADHD-related symptoms in this specific pediatric population.
Main Methods:
- An open-label study involving twenty children with TBI and twenty children with primary ADHD, all exhibiting significant attention and/or hyperactivity-impulsivity symptoms.
- Standardized rating scales (T-DSM-IV-S, CPRS, CTRS-R, CGI-I) were administered at baseline and after 8 weeks of IR-MPH treatment (10mg t.i.d.) in the TBI group.
- Adverse effects were monitored using a specifically developed scale.
Main Results:
- No significant baseline differences in symptom severity were observed between the TBI and ADHD groups.
- IR-MPH treatment led to significant improvements in T-DSM-IV-S, CPRS, and CTRS-R scores among children with TBI (p<0.05).
- Seventy percent (14/20) of children with TBI showed marked improvement, and 95% experienced no or mild adverse effects, indicating good tolerability.
Conclusions:
- IR-MPH appears to be a safe and effective short-term treatment option for managing ADHD symptoms in children with a history of TBI.
- These preliminary findings suggest IR-MPH may be beneficial for addressing neurobehavioral sequelae of pediatric TBI.
- Further controlled studies are warranted to confirm these promising results and establish long-term efficacy and safety.
Purpose:
This study aims to investigate the short-term efficacy and tolerability of immediate-release methylphenidate (IR-MPH) in children with a history of traumatic brain injury (TBI).
Methods:
Twenty children with TBI (mean age: 12.7±3.1years) who had clinically significant attention deficit and/or hyperactivity-impulsivity symptoms and twenty children with primary Attention Deficit Hyperactivity Disorder (ADHD) (mean age: 12.3±3.05years) were included. Study measures, which included the Turgay DSM-IV based ADHD rating Scale (T-DSM-IV-S), Conners' Parent Rating Scale (CPRS), Conners' Teacher Rating Scale (CTRS-R) and Clinical Global Impression-Improvement Scale (CGI-I), were completed at the baseline for both of the groups. For the TBI group, study measures and an adverse effect scale developed by the authors were completed 8weeks after IR-MPH treatment (10mg dose t.i.d).
Results:
No significant difference was found regarding the baseline scale scores between the study groups. Among children with TBI, most of the scores on T-DSM-IV-S, CPRS and CTRS-R were found to improve significantly after MPH treatment, (p<0.05). 70% (N=14) of the sample were much improved at the endpoint. MPH was generally well-tolerated (95% had either no adverse effect or mild adverse effects).
Conclusion:
In this preliminary open-label study, IR-MPH was found as a safe and effective treatment option for ADHD symptoms after TBI. However, future controlled studies are needed to confirm our findings.
