Practice Guideline for Methylphenidate Use in Persons with Traumatic Brain Injury: Report of the American Congress of Rehabilitation Medicine.

Abstract

This clinical practice guideline (CPG) provides evidence-informed recommendations on the use of methylphenidate hydrochloride (MPH) in adults with cognitive and non-cognitive neuropsychiatric symptoms in the subacute or chronic periods after traumatic brain injury (TBI). The CPG was developed by an ACRM multidisciplinary author panel with expertise in brain injury rehabilitation and included professionals in physical medicine & rehabilitation, basic/translational science, neurology, behavioral neurology & neuropsychiatry, nursing, and neuropsychology. Rationales and recommendations were written based on evidence from an accompanying systematic review. The generation and finalization of CPG recommendations followed procedures in the 2017 AAN Guideline Development and Process Manual. Clinicians should establish a therapeutic alliance and apply principles of pharmacotherapy in persons with TBI to identify indications for and contraindications to MPH use, facilitate treatment adherence, and optimize outcomes. MPH should be offered to improve sustained attention and processing speed performance and may be offered to improve selective attention performance among adults with TBI. MPH should be offered to improve depressive symptoms among adult patients with TBI in whom rapid resolution of depressive symptoms and/or treatment of co-occurring cognitive impairments are clinical priorities. MPH should not be offered to improve performance in executive functioning or working memory among adults with TBI. While MPH is usually well tolerated among adults with TBI, clinicians should follow standard assessment, education, dosing, and monitoring recommendations when prescribing MPH to optimize its safety and tolerability. A summary of all recommendations on the use of MPH in TBI is available at the end of the CPG.