The Effects of Methylphenidate on Command Following and Yes/No Communication in Persons with Severe Disorders of Consciousness

Abstract

This study did not identify a clinically meaningful effect of MPH in the doses used on responsiveness or accuracy in standardized command-following protocols in the overall study group of patients with severe DOC, or in any subgroup that was assessed. Because MPH has been shown to have some positive effects in higher-level patients with TBI, more research is needed to define the types of individuals with TBI who do and do not benefit from this drug, and/or the dose that provides optimal benefit.

Beyond ADHD and narcolepsy: psychostimulants in general psychiatry

“…A meta-analysis of controlled single-subject trials involving individuals included at a mean of 7.5 days after traumatic brain injury showed no effect of methylphenidate on command-following or yes/ no communication abilities (Martin 2007). Kaelin and colleagues (1996) reported an improvement in a number of attentional domains in a prospective study of 11 adults who received 10 days of methylphenidate, at a mean duration of 20 days after traumatic brain injury.…”

Responsiveness, Minimal Detectable Change, and Minimally Clinically Important Differences for the Disorders of Consciousness Scale

“…To our knowledge, ours is the first study to report evidence of ES, SRM, MDC, and MCID for an assessment tool developed specifically for patients in states of SIC due to traumatic and non-traumatic brain injuries. There have been attempts to compute ES for specific NBF test items such as command following 49 and studies characterizing clinically meaningful NBF change according to the proportion of patients emerging from VS or MCS, 50 but this study is unique in that it is the first to report ES, SRM, MDC, and 2 indices of MCID for a measure of global NBF in patients with SIC.…”

Treatment of Disorders of Consciousness in the Veterans Health Administration Polytrauma Centers

“…Methylphenidate has been used for reversal of barbiturate-induced coma 31 and has demonstrated improvement of arousal in some case series 32 but no conclusive evidence supports use of neurostimulants to increase level of consciousness 26 and meta analysis of N-of-1 studies demonstrated no significant effect of methylphenidate. 33 Serotonergic and adrenergic receptors are at risk in TBI, so antidepressants that block reuptake are also used in treatment of TBI. 34 Amantadine, bromocriptine, and carbidopa/levedopa which are medications commonly used to treat Parkinson's syndromes work in various ways to increase levels of dopamine and thus have been used also in brain injury cases as well.…”