Benefits of Methylphenidate for Long-Term Attention Problems After Traumatic Brain Injury in Childhood: A Randomized, Double-Masked, Placebo-Controlled, Dose-Titration, Crossover Trial.
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ABSTRACT: OBJECTIVE:To characterize the benefits and optimal dose of long-acting methylphenidate for management of long-term attention problems after childhood traumatic brain injury (TBI). DESIGN:Phase 2, randomized, double-masked, placebo-controlled, dose-titration, crossover clinical trial. SETTING:Outpatient, clinical research. PARTICIPANTS:Twenty-six children aged 6 to 17 years who were at least 6 months post-TBI and met criteria for attention-deficit hyperactivity disorder (ADHD) at the time of enrollment. OUTCOME MEASURES:Vanderbilt Rating Scale of attention problems, Pittsburgh Side Effects Rating Scale, and vital signs. RESULTS:Among the 26 participants randomized, 20 completed the trial. The mean ages at injury and enrollment were 6.3 and 11.5 years, respectively. Eight participants had a severe TBI. On an optimal dose of medication, greater reductions were found on the Vanderbilt Parent Rating Scale for the medicated condition than for placebo (P = .022, effect size = 0.59). The mean optimal dose of methylphenidate was 40.5 mg (1.00 mg/kg/day). Preinjury ADHD diagnosis status was not associated with a differential medication response. Methylphenidate was associated with weight loss (?1 kg), increased systolic blood pressure (?3- to 6-point increase), and mild reported changes in appetite. CONCLUSION:Findings support use of long-acting methylphenidate for management of long-term attention problems after pediatric TBI. Larger trials are warranted of stimulant medications, including comparative effectiveness and combination medication and nonmedication interventions.
SUBMITTER: Kurowski BG
PROVIDER: S-EPMC6395577 | biostudies-literature | 2019 Mar/Apr
REPOSITORIES: biostudies-literature
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