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Height, weight, and cardiovascular effects of stimulants on children with brain tumors
Raja B Khan1, Maha Bano2, Fang Wang3
1Division of Neurology, St Jude Children's Research Hospital, Memphis, Tennessee.
Insights
Stimulant medications can help children with brain tumors manage inattention and hypersomnia. While generally well-tolerated, these treatments may slow height growth, necessitating careful monitoring.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Pharmacology
Background:
- Children with brain tumors often experience cognitive and sleep disturbances like inattention and hypersomnia.
- Stimulant medications are used to manage these symptoms, but their impact on physical development and cardiovascular parameters requires thorough investigation.
Purpose of the Study:
- To evaluate the effects of stimulant medications on growth, heart rate, and blood pressure in children with brain tumors.
- To compare the outcomes between different stimulant drugs (Modafinil and Methylphenidate) and assess the influence of hormone therapy and radiation treatment.
Main Methods:
- A retrospective study of 65 children with brain tumors who received stimulant treatment.
- Data collected included tumor characteristics, radiation treatment details, medication type, hormone therapy, and measurements of body mass index, heart rate, and blood pressure before and after stimulant initiation.
Main Results:
- Stimulant treatment did not significantly alter body mass index, heart rate, or blood pressure. However, the rate of height acquisition was found to slow down during stimulant therapy (P = .0096).
- Thyroxine treatment correlated with an increase in body mass index. Younger age and higher pre-stimulant body mass index were associated with increased heart rate on stimulants, while older age at radiation treatment correlated with elevated systolic blood pressure.
Conclusions:
- Stimulant medications are generally well-tolerated in children with brain tumors, especially when endocrine deficiencies are managed.
- A potential side effect of stimulant use in this population is a reduced trajectory of height attainment, warranting careful consideration and monitoring.
Introduction:
Children with brain tumors may develop inattention, slow processing, and hypersomnia. Stimulant medications improve these problems, but their effect on growth, heart rate, and blood pressure (BP) are inadequately explored.
Procedure:
We retrospectively studied children with brain tumors treated at our institution that had data available for 1 year pre and 2 years on stimulant treatment. Tumor location, gender, radiation treatment (RT), age at RT, drug type, and hormone therapy were variables of interest.
Results:
We identified 65 children (35 males) that fulfilled eligibility criteria. Focal RT was utilized in 58; 11 additionally had whole brain RT; and seven received no RT. Thirty were treated for hypersomnia and inattention, eight for hypersomnia alone, and rest for inattention. Modafinil was the first drug in 18 (27.7%), and methylphenidate in the others. Forty-seven (72.3%), 45 (69.2%), and 49 (75.4%) were on thyroxine, cortisone, and growth hormones, respectively. There was no difference in pre- and post-stimulant body mass index (BMI), heart rate, and BP. There was also no difference between modafinil and methylphenidate groups. Rate of height acquisition slowed on stimulants (P = .0096). Thyroxine treatment correlated with increase in BMI after stimulants (P = .04). Younger age (P = .0003) and higher prestimulant BMI (P = .0063) correlated with increased heart rate on stimulants, while higher age at RT (P =.016) correlated with elevated systolic BP on stimulants. No associations were found with height acquisition and diastolic BP.
Conclusion:
Stimulants are well tolerated by children with brain tumors that are appropriately managed for endocrine deficiencies, but may reduce the trajectory of height attainment.
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