Psychostimulant Use in the Rehabilitation of Individuals with Traumatic Brain Injury

Whyte, John; Vaccaro, Monica; Grieb-Neff, Patricia; Hart, Tessa

doi:10.1097/00001199-200208000-00003

Cited by 83 publications

(64 citation statements)

References 34 publications

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“…Most studies have used methylphenidate at doses of 0.3 mg/kg given twice daily to patients with moderate to severe traumatic brain injury (Whyte 2002).…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Beyond ADHD and narcolepsy: psychostimulants in general psychiatry

Ng¹,

O'Brien²

2009

Adv. psychiatr. treat

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SummaryPsychostimulants (dexamphetamine, methylphenidate, modafinil) reduce fatigue, promote alertness and wakefulness, and have possible mood-enhancing properties. In modern psychiatric practice, their use has been limited to attention-deficit hyperactivity disorder and sleep disorders such as narcolepsy. Despite this, research has continued into psychostimulant use in general psychiatry, especially in the treatment of depression and fatigue. This article reviews the recent literature regarding psychostimulant use in general and consultation-liaison psychiatry. Although psychostimulants continue to attract clinical research, there is currently not enough evidence to recommend their routine use for general psychiatric conditions.

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“…Most studies have used methylphenidate at doses of 0.3 mg/kg given twice daily to patients with moderate to severe traumatic brain injury (Whyte 2002).…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Beyond ADHD and narcolepsy: psychostimulants in general psychiatry

Ng¹,

O'Brien²

2009

Adv. psychiatr. treat

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“…Clinicians use neuropharmacological interventions such as methylphenidate, cholinergic agents, and serotonin reuptake inhibitors to control agitation and to improve attention and memory. Despite widespread offlabel use, evidence regarding the effectiveness of neuropharmacology is inconclusive [7][8][9][10]. Evidence of improved functioning given behavioral interventions, such as sensory stimulation, is also inconclusive [11].…”

Section: Introductionmentioning

confidence: 99%

A measure of neurobehavioral functioning after coma. Part II: Clinical and scientific implementation

Pape¹,

Senno²,

Guernon³

et al. 2005

JRRD

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Abstract-This longitudinal validation study is Part II of a twopart series. Part I focuses on the methods used to construct the neurobehavioral measure derived from the Disorders of Consciousness Scale (DOCS) as well as the evidence of reliability and validity. Part II illustrates, through a series of selected case reports, the clinical use of repeated DOCS measures to enhance and complement medical rehabilitation management. The use of repeated DOCS measures in scientific investigations of mechanisms of injury is also described. Participants included patients at rehabilitation hospitals who were 18 years of age and older and unconscious after severe brain injury. Medical decision making regarding short-term effects of pharmacological intervention was augmented and improved through the examination of individual neurobehavioral recovery patterns. We identified medications to treat secondary medical complications and successfully determined effective dosage, presumably improving prognosis for recovery. We facilitated and enhanced development and refinement of individualized rehabilitation programs. Two investigations of treatment effectiveness during coma recovery and examination of the relationship between behavioral changes and neural adaptation are also described. By systematically tracking and mapping individual patterns of neurobehavioral recovery, we show that medical and rehabilitation management after coma can be enhanced. In addition, we also show that by examining the relationship between the DOCS neurobehavioral measure with mechanistic indicators of neurological recovery such as functional magnetic resonance imaging, scientific investigations of treatment and rehabilitation effectiveness can be enhanced.

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“…For an average 70 kg adult, this translates into about 20 mg BID. This target dose was based on studies demonstrating efficacy in improving cognitive function in TBI populations (Plenger et al, 1996;Whyte et al, 1997;Whyte et al, 2002). Participants with modest side effects who wished to continue in the protocol were allowed dose reduction at physician discretion, but needed to be able to tolerate a dose of at least 10mg/day to remain in the study.…”

Section: Attention Builders Training (Abt)mentioning

confidence: 99%

“…Evidence suggests that MPH improves performance on measures of attention, memory, verbal fluency, processing speed, motor performance, and arousal, and is also associated with improvements in subjective (self or informant) assessment of cognitive functioning (Gualtieri and Evans, 1988;Johansson et al, 2015;Kaelin et al, 1996;McAllister et al, 2015;Plenger et al, 1996;Whyte et al, 1997;Whyte et al, 2004;Whyte et al, 2002;Willmott and Ponsford, 2009). Indeed, the Defense and Veterans Brain Injury Center's Neurobehavioral Guidelines Working Group evidence-based review of pharmacotherapies for post-traumatic cognitive impairments recommended MPH at the Guideline level for attention and processing speed impairments, and at the Option level for general cognitive deficits and memory impairments (Warden et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Methylphenidate and Memory and Attention Adaptation Training for Persistent Cognitive Symptoms after Traumatic Brain Injury: A Randomized, Placebo-Controlled Trial

McDonald

Flashman

Arciniegas

et al. 2016

Neuropsychopharmacol

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The purpose of this multicenter, prospective, randomized, placebo-controlled study was to evaluate and compare the efficacy of two cognitive rehabilitation interventions (Memory and Attention Adaptation Training (MAAT) and Attention Builders Training (ABT)), with and without pharmacologic enhancement (i.e., with methylphenidate (MPH) or placebo), for treating persistent cognitive problems after traumatic brain injury (TBI). Adults with a history of TBI at least four months prior to study enrollment with either objective cognitive deficits or subjective cognitive complaints were randomized to receive MPH or placebo and MAAT or ABT, yielding

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Psychostimulant Use in the Rehabilitation of Individuals with Traumatic Brain Injury

Abstract: This article reviews the controlled research literature on the use of these drugs in TBI and presents preliminary data from the authors' laboratory that extends these findings. Some of the common research pitfalls that have limited progress in research on these drugs are discussed.

Cited by 83 publications

References 34 publications

Beyond ADHD and narcolepsy: psychostimulants in general psychiatry

Beyond ADHD and narcolepsy: psychostimulants in general psychiatry

A measure of neurobehavioral functioning after coma. Part II: Clinical and scientific implementation

Methylphenidate and Memory and Attention Adaptation Training for Persistent Cognitive Symptoms after Traumatic Brain Injury: A Randomized, Placebo-Controlled Trial

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