Methylphenidate for Patients with Traumatic Brain Injury

1. METHYLPHENIDATE FOR PATIENTS WITH
TRAUMATIC BRAIN INJURY
ADE WIJAYA MD – APRIL 2018

2. INTRODUCTION
 Traumatic brain injuries (TBI)  high mortality & socioeconomic burden
 Sequele: cognitive impairment & psychomotor retardation
 Methylphenidate, has been shown to be a potential therapeutic option against TBI-associated
neurological sequelae
Warden D.L., Gordon B., McAllister T.W., Silver J.M., Barth J.T., Bruns J., Drake A., Gentry T., Jagoda A., Katz D.I., Kraus J., Labbate L.A., Ryan L.M., Sparling M.B., Walters B., Whyte J., Zapata A., Zitnay G. Neurobehavioral Guidelines
Working Group. Guidelines for the pharmacologic treatment of neurobehavioral sequelae of traumatic brain injury. J. Neurotrauma. 2006;23(10):1468–1501.
Phillips J.P., Devier D.J., Feeney D.M. Rehabilitation pharmacology: bridging laboratory work to clinical application. J. Head Trauma Rehabil. 2003;18(4):342–356.
Sivan M., Neumann V., Kent R., Stroud A., Bhakta B.B. Pharmacotherapy for treatment of attention deficits after non-progressive acquired brain injury. A systematic review. Clin. Rehabil. 2010;24(2):110–121.

3. COGNITIVE COMPLAINTS AFTER TBI
 Immediate vs late
 40-60 % at 1-3 months after injury
 Deficits in information processing, attention, memory, cognitive flexibility, and problem solving
McAllister T.W. Neuropsychiatric sequelae of head injuries. Psychiatr. Clin. North Am. 1992;15(2):395–413.
Sivan M., Neumann V., Kent R., Stroud A., Bhakta B.B. Pharmacotherapy for treatment of attention deficits after non-progressive acquired brain injury. A systematic review. Clin. Rehabil. 2010;24(2):110–121.

4. METHYLPHENIDATE
 First synthesized in 1944
 A psychostimulant and a dopamine reuptake inhibitor
 Short half life
 Minimal side effects (e.g., abdominal pain and nausea) that often dissipate with continued use
 The current major therapeutic use of methylphenidate is for the treatment of narcolepsy and ADHD in
children
Leonard B.E., McCartan D., White J., King D.J. Methylphenidate: a review of its neuropharmacological, neuropsychological and adverse clinical effects. Hum. Psychopharmacol. 2004;19(3):151–180.
Zametkin A.J., Rapoport J.L. Neurobiology of attention deficit disorder with hyperactivity: where have we come in 50 years? J. Am. Acad. Child Adolesc. Psychiatry. 1987;26(5):676–686.

5. METHYLPHENIDATE
 Methylphenidate elevates the synaptic concentration of dopamine and noradrenalin by blocking their
reuptake, resulting in an increase in the extracellular levels of these neurotransmitters in various brain
regions
 Mostly benefit for selective attention.
Sivan M., Neumann V., Kent R., Stroud A., Bhakta B.B. Pharmacotherapy for treatment of attention deficits after non-progressive acquired brain injury. A systematic review. Clin. Rehabil. 2010;24(2):110–121.
Birmaher B., Greenhill L.L., Cooper T.B., Fried J., Maminski B. Sustained release methylphenidate: pharmacokinetic studies in ADDH males. J. Am. Acad. Child Adolesc. Psychiatry. 1989;28(5):768–772.

7. ADMINISTRATION
 Dose: 0,25 – 0,3 mg / KgBB ( < 0,6 mg / KgBB) bid
 10 – 20 mg / day (bid or qd)
 Duration: 28 days
Huang CH, Huang CC, Sun CK, Lin GH, Hou WH. Methylphenidate on cognitive improvement in patients with traumatic brain injury: a meta-analysis. Current neuropharmacology. 2016 Apr 1;14(3):272-81.

8. SUMMARY
 Methylphenidate might useful for enhancing the attention in patients with TBIs, whereas no notable
benefit was observed in the facilitation of memory or processing speed.